ORTHOPEDIC NURSING

MANAGEMENT OF PATIENTS WITH MUSCULOSKELETAL DISORDERS

LOW BACK PAIN HERNIATED INTERVERTEBRAL DISK
CAUSES - Herniated disc (slipped or ruptured disc) -
• Acute lumbosacral strain intervertebral disc protrudes into the spinal canal.
• Herniated disc Aging process- L4-L5 & L5-SI subject to greatest
• Curvature (Scoliosis, Lordosis, Kyphosis) mechanical stress
• Unequal leg length
• Obesity, stress, depression
• Osteoporotic vertebral fractures
• Osteoarthritis of the spine

Assessment:
• History taking- nature of work, hobbies, past medical
history.
• Bend forward and then laterally- observe discomfort.
• Check deep tendon reflexes, sensations, and muscle
strength.
• Straight leg raising (supine- leg is lifted upward with STRAIGHT-LEG-RAISING TEST
the knee extended)- pain suggests nerve root
involvement.

TREATMENT
• Limit bed rest: keep your knees flexed to decrease
strain on your back.
• Nonpharmacological pain management – superficial
heat, yoga
• Pharmacological approaches – NSAIDs,
acetaminophen, muscle relaxants
• Weight reduction. Achieve ideal body weight.

PREVENTION LASEGUE’S TEST – RESISTANCE AND PAIN (SPINAL ROOT

• Stretch to enhance flexibility. COMPRESSION)
• Back exercises
• Exercise 30 minutes daily- speed walking, swimming,
stationary biking.

Proper and Improper Proper and Improper

Standing Postures Lifting Techniques 90 DEGREES
Proper and Improper Standing INCREASE PAIN
Postures • BOWEL MOVEMENT
• COUGHS EXCESSIVELY

Even coughing, sneezing, and

sitting can worsen symptoms because it puts pressure on
nerves near the disk, resulting in pain.

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 ORTHOPEDIC NURSING
MANAGEMENT OF PATIENTS WITH MUSCULOSKELETAL DISORDERS
HERNIATED INTERVERTEBRAL DISK
OTHER TESTS:
• X-rays - Note any structural defects.
• Myelogram, MRI, CT scan -localizes site of
herniation.
• Electromyogram (EMG) - determine severity of
nerve irritation caused by herniation.

HNP o Spinal Fusion – (if laminectomy doesn’t

• Nursing interventions eliminate pain and instability) – to stabilize the
o Analgesics, muscle relaxants, and/or spine.
brace - bed rest with firm mattress or Operation includes the use of bone graft
bed board to strengthen the weakened vertebral
o APPLY THE BACK BRACE BEFORE GETTING column.
OUT OF BED
o Don’t drive with a brace.
o Nerve block may be given.
o Intermittent traction - Buck’s or Pelvic

• Implementation - Promoting Comfort

o Maintain bed rest - Low Fowler’s with knees
slightly flexed
o Chemonucleolysis – injection of the enzyme
chymopapain into the herniated disk to
dissolve the nucleus pulposus.

o Chymopapain - has an anti-inflammatory role

o Log roll if needed to turn side to side. in the nerve root.
o May have BRP - or roll onto fracture bedpan.
o Analgesics, muscle relaxants
o Moist heat and back rubs

• Implementation - Preventing Injury

o Teach log rolling.
o Prevent constipation - Stool softeners -
Increase fluids and roughage in the diet.
o ROM exercises and back-strengthening
exercises
o Teach principles of good body mechanics
• Implementation - Home Care
o Log rolling
o Avoid prolonged sitting - do not cross legs -
may use lumbar roll or pillow for sitting.
o Do not lift or carry weight more than 5 lbs.
o Avoid driving cars.
o Avoid stairs.
o No exercise including walking, running, or
exercise program without consulting MD or PT
• SURGERY
o Laminectomy – the most common procedure,
involves the excision of a portion of the lamina
and removal of the protruding disk.
o Diskectomy – to remove fragments of nucleus
pulposus.
• Pre-op Teaching
o Maintain proper alignment of the spine
o Teach the patient to log roll.
o May have PCA pump.
o Deep breathing and sighing - but no coughing
• Post-op Care
o Focus -positioning, mobility, wound care,
comfort.
o Getting out of bed (first time)- watch for
orthostatic hypotension- faint – have client sit
on the edge of the bed and hold him upright.
o Neuro assessment to extremities q2h
- circulation, sensation and motor ability
(Feel and Move)
o Deep breath and sigh - Don’t cough.
o Monitor I&O
o Monitor bowel sounds and for abdominal
distension.
o BACK BRACE