Analysis Of Nursing Care In Post-operating Lumbar

Stenosis Patients With Implementation Of Early

Mobilization In Ulin Hospital, Banjarmasin

Prasmita Damayanti1, Jenny Saherna2, Novia Heriani3

University of Muhammadiyah Banjarmasin

Faculty Of Nursing And Health Sciences
Study Program of Nurse Profession

Prasmita.dmy@gmail.com
Introduction
Lumbar Spinal Stenosis (LSS) is a condition in which the spinal canal or disc opening is so
narrow that the opening compresses nerves and blood vessels. Narrowing of the spinal canal
or disc foramen can be affected by herniated disc hypertrophy of the yellow ligament. With
the compression of nerves and blood vessels will cause back pain, leg pain, reduced ability
to walk (Wu, et al., 2017).

Management of lumbar stenosis is usually carried out by surgery. After surgery, many
neurological symptoms get worse. Postoperative lumbar stenosis patients will experience an
inability to carry out daily activities and cause a decrease in quality of life (Apsari, et al.,
2013).

Early mobilization can accelerate the wound healing process or post-surgical wound
recovery, improve lung function, reduce the risk of blood clot formation, and also allow the
client to return to full physiological function (Susilo, 2016).
Methods
This final scientific work is made using a design in the form of a case
study with a single case. The case study method is to collect data, analyze
data and draw data conclusions. A case study is research that intensively
or in-depth studies one member of the target group of an object of
research (Azizah, et al., 2022).

Focus Study: Data Collection Technique:

- Nursing care of patients with lumbar stenosis - Interview

- Early mobilization - Observation
- There is an increase in muscle tone - Documentation
 Assessment
On November 14, 2022, a study was carried out
on Ms. S is 57 years old with a diagnosis of
lumbar stenosis. The patient has undergone
spinal lumbar surgery with decompression.
Subjective Data
• The patient said that her body felt numb.
• The patient said that it was still very painful
P: Postoperative pain
Q: The pain is like being stabbed
R: Pain in the back and lower extremities
S: 4/10
T: Pain when moved
• The patient said that she was still very
afraid to move her body and legs.
• The patient said that she wanted to be able
to move quickly, but was afraid that
something would happen if she moved.
Objective Data
The patient appears to have a drainage tube
The patient groans and points to the painful area
The patient appears to have a 3lpm nasal cannula installed
The patient appeared to have had a blood transfusion because
the results of the postoperative laboratory obtained an HB
value of 9 g/dl.
The patient looked weak and dry lip mucosa.
The patient appeared limp and just lay in bed
The patient appears confused and restless.
The patient seems to always ask when she can move.
Results of postoperative vital signs
BP: 130/88 mmHg, T: 36.8oC, P: 78x/minute, RR:
20x/minute.
Pharmacological therapy was obtained by injection of
ceftriaxone 3x1gr, ketorolac 3x30mg, ranitidine 2x25mg.
upper limb muscle scale 5 and lower limb muscle scale 2
 Diagnosis

Acute Pain Impaired Physical Mobility Knowledge Deficit

Related to Related to Related to
Physical Injury Agents Decreased Muscle Strength Less Exposure to Information
(D.0077) (D.0054) (D.0111)
Main Interventions
Main intervention carried out for 4 consecutive days from 14 November – 17
November 2022 by implementing early mobilization on Ms. S postoperative lumbar
stenosis. The aim is to see the development of muscle scale and other postoperative
effects, such as pain.
Interventions
Day-1 Day-2
train the body tilt to the right
passive ROM
and tilt to the left with help

Day-3 Day-4

The patient sits with the patient is able to sit up

help of the patient bed unassisted (only 30 seconds)
(leaning)
Results
Pain Scale Lower Extremity Muscle Scales

Day-1: 4/10 Day-1: 2/5

Day-2: 3/10 Day-2: 2/5

Day-3: 2/10 Day-3: 3/5

Day-4: 2/10 Day-4: 4/5

Discussion and Conclusions
● Discussion

The results of the implementation of early mobilization measures on 14 November -

17 November 2022 showed that Ms. S felt more comfortable by saying that the pain
had decreased and the body was starting to move comfortably, even though it was
not fully able to move the limbs due to obstructions by the drainage tube attached to
the postoperative wound. This is in line with research (Debono & Wainwraight,
2021) which states that patients should be encouraged to mobilize to recover as soon
as they are able, to counter the adverse physiological effects associated with long bed
rest. In many cohort studies, early mobilization after lumbar stenosis surgery and
other major procedures has been associated with reduced morbidity and LOS.

● Conclusions

Based on these cases, it can be concluded that the importance of early mobilization
in postoperative patients with lumbar stenosis for accelerated recovery.
 References
● Wu, A. et al., 2017. Lumbar Spinal Stenosis: an Update on the Epidimiology, Diagnosis and Treatment. AME
Medical Journal, p. 63
● Susilo, R., 2016. Panduan Asuhan Nifas Evidance Based Practice. Ke1 penyunt. Yogyakarta: Deepublish.
● PPNI. Tim Pokja SDKI DPP. 2017. Standar Diagnosis Keperawatan Indonesia (SDKI) Definisi dan Indikator
Diagnostik (edisi 1). Jakarta: DPP PPNI
● PPNI. Tim Pokja SIKI DPP. 2018. Standar Intervensi Keperawatan Indonesia (SIKI) Definisi dan Tindakan
Keperawatan (edisi 1). Jakarta: DPP PPNI
● PPNI. Tim Pokja SLKI DPP. 2019. Standar Luaran Keperawatan Indonesia (SLKI) Definisi dan Kriteria Hasil
Keperawatan (edisi 1). Jakarta: DPP PPNI
● Apsari, P., Suyasa, I., Maliawan, S. & Kawiyana, S., 2013. Lumbar Spinal Canal Stenosis. E-Jurnal Medika
Udayana, p. Volume 2 Nomor 9.
● Debono, B. & Wainwraight, T. W., 2021. Consensus Statement for Perioperative Care in Lumbar Spinal Fusion:
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752.
● Azizah, S. et al., 2022. Metodologi Penelitian dan Karya Ilmiah Ilmu Peternakan. Ke1 penyunt. Malang:
Universitas Brawijaya Press.
Thank You