HERNIATED NUCLEUS PULPOSUS

DEFINITION A herniated nucleus pulposus is a slipped disk along the spinal c o r d . Th e condition occurs when all or part of the soft center of a spinal disk is forced through aweakened part of the disk

Etiology Intervertebral disc herniation is also known as herniated nucleus pulposus (HNP). HNP may be asymptomatic despite radiographic evidence of bulging, protrusion, or extruded disc. Theetiology may be either nonspecific or attributable to a precipitating event. Even when the patient is symptomatic, surgical intervention often is not required. An HNP may be symptomatic due toa combination of direct nerve root compression, the release of inflammatory chemicals (e.g., matrix metalloproteinases, prostaglandin E2, interleukin- 6, nitric oxide), and hypoxia of the nerve root and basal ganglion (Ireland, 2009). Radicular pain can be accompanied by paresthesias or paresis (i.e., weakness) in the anatomic distribution of the affected nerve root.

pathophysiology Mechanical stress ( compression, fusion, HPN, rotational forces.) Aggravated by age due to degenerative changes thus resulted in weak muscles. Decreased in protein contents (oncotic agents) Men gender are mostly predisposed to -Decreased fluid in the annulus. -Dehydration of the annulus. -weakening of the annulus, thus less elastic, thus prone to tearing. Erosion of vertebral body by bulging disk teared annulus. -Increased uptake of fluid in the nucleus pulposus. -Increase pressure in the nucleus pulposus. Irritated pain fibris Stimulation of new bone growth accompanied by vertebral spasm. Local tenderness PAIN Increased tension Ligament thicken Calcification Accompanied by: Autonomic responses: -inc. v/s -papillary dilatation -diaphoresis Replacement of nucleus Results in neutral obstruction Decrease flow of blood in the affective area Compression of spinal nerve Numbness occurs Impaired mobility

MANAGEMENT The main treatment for a herniated disk is a short period of rest with pain and antiinflammatory medications, followed by physical therapy. Most people who follow these treatments will recover and return to their normal activities. A small number of people need to have further treatment, which may include steroid injections or surgery. MEDICATIONS Nonsteroidal anti-inflammatory medications (NSAIDs) and narcotic pain killers will be given to people 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. NSAIDs are used for long-term pain control, but narcotics may be given if the pain does not respond to anti-inflammatory drugs. Muscle relaxants are usually given if the patient has back spasms. On rare occasions, steroids may be given either by pill or directly into the blood through an IV. Steroid injections into the back in the area of the herniated disk can help control pain for several months. Such injections reduce 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.

SURGERY Diskectomy - removes a protruding disk. This procedure requires general anesthesia (asleep and no pain) and 2 - 3 day hospital stay. Microdiskectomy - a procedure removing fragments of nucleated disk through a very small opening. 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 diskectomy in certain situations.

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 Ineffective coping related to situational crisis Knowledge deficit regarding condition, prognosis, and treatment related to lack of knowledge

NURSING RESPONSIBILITIES

1. Reduce back stress, muscle spasm, and pain. 2. Promote optimal functioning. 3. Support patient/SO in rehabilitation process. 4. Provide information concerning condition/prognosis and treatment needs. 5. Discharge plan DRG projected mean length of inpatient stay: 4.96.5 days considerations: May require assistance with transportation, self-care, and homemaker/maintenance tasks Refer to section at end of plan for postdischarge considerations.