NCM 116a – Perception &

Coordination

Herniated Nucleus
Pulposus (HNP)
 Alternative Names
• Lumbar radiculopathy;
• Cervical radiculopathy;
• Herniated intervertebral disk;
• Prolapsed intervertebral disk;
• Slipped disk;
• Ruptured disk
 Herniated Nucleus Pulposus:
• A slipped disc along the spinal cord.

• Occurs when all or part of the soft center of a

spinal disc is forced through a weakened part
of the disc.

• Displacement of the central area of the disc

(nucleus) resulting in impingement on a nerve
root.
Herniated Nucleus Pulposus:
 Stages of HNP
1. Disc
Degeneration
- Chemical
changes
associated with
aging causes discs
to weaken, but
without a
herniation.
 Stages of HNP
2. Prolapse
- The form or
position of the disc
changes with some
slight impingement
into the spinal
canal.
- Also called a bulge
or protrusion.
 Stages of HNP
3. Extrusion
- The gel-like
nucleus pulposus
breaks through
the tire-like wall
(annulus fibrosus)
but remains
within the disc.
 Stages of HNP
4. Sequestration or
Sequestered Disc
- Nucleus pulposus
breaks through
the annulus
fibrosus and lies
outside the disc in
the spinal canal
(HNP).
 Predisposing FACTORS

• Advanced age
• History of back trauma
• Male
• Congenital conditions
 Precipitating FACTORS

• Sedentary lifestyle
• Sitting without lumbar support
• Cigarette smoking
• Chronic coughing
• Strenuous activities
 CLINICAL MANIFESTATIONS
• Arm muscle weakness
• Deep pain near or over the shoulder blades
on the affected side
• Neck pain, especially in the back and sides
• Increased pain when bending the neck or
turning head to the side
• Pain radiating to the shoulder, upper arm,
forearm, and rarely the hand, fingers or chest
• Pain made worse with coughing, straining, or
laughing
• Spasm of the neck muscles
 MEDICAL MANAGEMENT
• Herniations of the cervical and the lumbar
disks occur most commonly and are usually
managed conservatively with bed rest and
medication (Hickey, 2009).
 MEDICAL MANAGEMENT
• Nonsteroidal anti-inflammatory
(NSAIDs) & narcotic pain killers
− Given to clients with a sudden
herniated disk caused by some sort
of injury (such as a car accident or
lifting a very heavy object) that is
immediately followed by severe pain
in the back and leg.
 MEDICAL MANAGEMENT
• NSAIDs (Ibuprofen, Naproxen Na)
are used to relieve pain and
swelling
• Narcotics (Opioids) may be given
if the pain does not respond to
anti-inflammatory drugs.
• Muscle Relaxants
−For back spasms

• On rare occasions, steroids may

be given either by pill or directly
into the blood through an IV.
• Steroid injections
- Helps control pain for
several months.
- Reduces swelling around
the disk and relieve many
symptoms
- Spinal injections are usually
done on an outpatient
basis, using x-ray or
fluoroscopy to identify the
area where the injection is
needed.
 Surgical Management
 Discectomy
- Removal of a
protruding disc
- This procedure
requires general
anesthesia
(asleep and no
pain) and 2 - 3
day hospital stay.
 Microdiscectomy -a
procedure removing
fragments of
nucleated disk
through a very small
opening.

 Useof electron
microscope through
a small incision to
remove a portion of
the HNP that is
displaced
 Chemonucleolysis
- involves the injection
of an enzyme (called
chymopapain) into
the herniated disk to
dissolve the
protruding gelatinous
substance.

- This procedure may

be an alternative to
discectomy in certain
situations.
 Foraminotomy
- A decompression
surgery that is
performed to
enlarge the
passageway where
a spinal nerve root
exits the spinal canal
 POSSIBLE NURSING DIAGNOSIS
• Pain acute/chronic related to injuring
agents, nerve compression, muscle
spasm
• Impaired physical mobility related to
pain and discomfort
• Fatigue related to inability to
maintain usual routines,
compromised concentration
 POSSIBLE NURSING DIAGNOSIS

• Ineffective coping related to

situational crisis
• Knowledge deficit regarding
condition, prognosis, and treatment
related to lack of knowledge
 NURSING RESPONSIBILITIES
• Bed rest with firm mattress; log roll; side lying
position with knees bent and pillow between
legs to support legs

• Avoid flexion of the spine- brace/corset,

cervical collar to provide support

• Heat/cold therapy to decrease muscle

spasms
 NURSING RESPONSIBILITIES
• Massage, relaxation techniques
• Progressive mobilization with
approved exercise program –
includes abdominal/thigh
strengthening
• Teaching good body mechanics
• Weight loss