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HERNIATED NUCLEUS PULPOSUS (RUPTURED INTERVERTEBRAL DISC) A herniated disc (herniated nucleus pulposus) [HNP] is a major cause of severe, chronic, and recurrent back pain. Herniation, either complete or partial, of the nuclear material in the vertebral areas of L-4 to L-5, L-5 to S-1, or C-5 to C-6, C-6 to C-7 is most common and may be the result of trauma or degenerative changes associated with the aging process. CARE SETTING Most disc problems are treated conservatively at the community level, although diagnostics and therapy services may be provided through outpatient facilities. Brief hospitalization is restricted to episodes of severe debilitating pain/neurological deficit. RELATED CONCERNS Disc surgery Psychosocial aspects of care Patient Assessment Database Data depend on site, severity, whether acute/chronic, effects on surrounding structures, and degree of nerve root compression. ACTIVITY/REST May report: History of occupation requiring heavy lifting, sitting, driving for long periods Need to sleep on bedboard/firm mattress, difficulty falling asleep/staying asleep Decreased range of motion of affected extremity/extremities Inability to perform usual/desired activities May exhibit: Atrophy of muscles on the affected side Gait disturbances ELIMINATION May report: Constipation, difficulty in defecation Urinary incontinence/retention EGO INTEGRITY May report: Fear of paralysis Financial, employment concerns May exhibit: Anxiety, depression, withdrawal from family/SO NEUROSENSORY May report: Tingling, numbness, weakness of affected extremity/extremities May exhibit: Decreased deep tendon reflexes; muscle weakness, hypotonia Tenderness/spasm of paravertebral muscles Decreased pain perception (sensory) PAIN/DISCOMFORT May report: Pain knifelike, aggravated by coughing, sneezing, bending, lifting, defecation, straight leg raising; unremitting pain or intermittent episodes of more severe pain; radiation to leg/feet, buttocks area (lumbar), or shoulder or head/face, neck (cervical) Heard “snapping” sound at time of initial pain/trauma or felt “back giving way” Limited mobility/forward bending May exhibit: Stance: Leans away from affected area Altered gait, walking with a limp, elevated hip on affected side Pain on palpation
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SAFETY May report: History of previous back problems TEACHING/LEARNING May report: Lifestyle sedentary or overactive Discharge plan DRG projected mean length of inpatient stay: 4.9–6.5 days considerations: May require assistance with transportation, self-care, and homemaker/maintenance tasks Refer to section at end of plan for postdischarge considerations. DIAGNOSTIC STUDIES Spinal x-rays: May show degenerative changes in spine/intervertebral space or rule out other suspected pathology, e.g., tumors, osteomyelitis.
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