BSN4A - GRP 4

HERNIATED NUCLEUS
PULPOSUS
REPORTED BY: KIANAH AYEN M. REYES
WHAT IS IT?

HNP or Herniated Nucleus Pulposus is a term for herniated disc. It is a

gel-like material that is found in the spinal discs. When that disc
tears, nucleus pulposus may push through the disc waall and it can
compressed a nerve or the spinal cord and may experience pain,
numbness, weakness, and tingling sensation.
STAGES
 STAGE 1: BULGING
Bulging, occurs when the disc inside of the spinal disc moves around that causes the disc to
extend abnormally to one side. This can lead to spinal nerve irritation, in which the nucleus
pulposus is slightly pushed against the outer shell. However, it is still not a serious for most
people as the disc may return to its normal state.
 STAGE 2: PROTRUSION
Disc protrusion is when the disc reaches the annulus fibrosus and the disc bulge is more
noticeable, which increases discomfort to an individual. This is when the person will notice
the numbness and tingling sensations.
 STAGE 3: EXTRUSION
Inner disc goes outside the shell or breaks
through the disc, in which the individual
may experience severe discomfort such as
lower back pain, that extends downward if
the affected disc is in the lumbar area,
which are very common. Related symptoms
may be manageable or subsided with
treatments such as physical therapy with
its posture exercises, however, it may come
back within some times, in which in this
case, surgery will be recommended by the
attending physician.
 STAGE 4: SEQUESTRATION
This occurs when inner disc breaks entirely in the shell, detaches fully from the spinal disc. It
is serious and often requires surgery called discectomy. It can be contributed to some critical
issues, especially when it get lodges within spinal canal, then the patient will experience
severe nerve irritation and discomfort.
WHAT ARE THE AFFECTED AREAS?
4 CERVICAL
1. C5 nerve root
2. C6 nerve root
3. C7 nerve root
4. C8 nerve root
WHAT ARE THE AFFECTED AREAS?
5 lumbar & 1 sacral
L1 to L5 nerve root
S1 nerve root
 SIGN & SYMPTOMS
It is asymptomatic, however, a protruding nucleus can compress near the nerves or by the spinal cord which may
lead to serious nerve damage and must be treated immediately. Therefore, it is important to have a
comprehensive diagnosis as soon as possible.

Chronic pain and discomfort Pin and needle-like sensations

Pain that travels from the nerve and Abnormal muscle reflex reactions
radiates through the extremities Loss of coordination
Numbness When nerves compressed, the person
Muscle weakness may have fever and incontinence in
Tiingling sensations their bowels or bladder.
PATHOPHYSIOLOGY
 DIAGNOSTIC TESTS

X-RAY
Getting x-rays to rule out other
causes of back or neck pain.
 DIAGNOSTIC TESTS

MRI
Most common and accurate imaging
test for a suspected herniated disk.
 DIAGNOSTIC TESTS

MYELOGRAM
Injection of a dye in the spine using X-ray or CT scan
guide.
The dye can reveal the narrowing of the spinal canal or
spinal stenosis and the location of the herniated disc.
 DIAGNOSTIC TESTS

EMG
IPlacing small needles in the muscle and evaluate the
function of the nerves. It can help to determine which
nerve of a herniated disk is affected.
 TREATMENT & MANAGEMENT

Epidural
Cortisone
Injections
 TREATMENT & MANAGEMENT

Stretching
and Exercise
 TREATMENT & MANAGEMENT

Heat and
Cold
Compression
Therapy
 TREATMENT & MANAGEMENT

Microdiskectomy
NURSING CARE
Assess the patient if there is any experience of pain, note the
location of pain, duration, and its precipitating or aggravating
factors occur to the patient. Ask them to rate their pain on the
scale of 1-10.
Bed rest on a firm mattress
Limit activity, watch out for heavy lifting
Ask for assistance with the family or personal healthcare
provider
Place the patient in semi-fowler’s position
Encourage correct body posture
REFERENCES
https://www.scribd.com/doc/17471588/Nursing-Care-Plan-for-Herniated-Nucleus-
Pulposus-Ruptured-Inter-Vertebral-Disc
https://www.spineorthocenter.com/common-treatment-for-herniated-nucleus-
pulposus/
https://www.ncbi.nlm.nih.gov/books/NBK542307/
https://www.physio-pedia.com/Disc_Herniation
https://blog.barricaid.com/blog/herniated-disc-stages
https://musculoskeletalkey.com/surgical-decompression-for-herniated-nucleus-
pulposus/
https://synergyorthopedics.com/sports-disorders-hnp.html
https://www.researchgate.net/figure/A-B-Subarticular-SA-and-paracentral-PC-
herniated-nucleus-pulposus-HNP-C_fig4_272516635