1 / 47

Module 8 Neurosensory : Herniated Disc and Spinal Cord tumors

Module 8 Neurosensory : Herniated Disc and Spinal Cord tumors. Spinal Cord Anatomy. spinal cord anatomy. Spinal Cord Anatomy. Pathophysiology /Etiology. Function of disc is to allow for mobility of the spine and act as shock absorber. Pathophysiology /Etiology.

yuli-morris
Download Presentation

Module 8 Neurosensory : Herniated Disc and Spinal Cord tumors

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Module 8 Neurosensory: Herniated Disc and Spinal Cord tumors

  2. Spinal Cord Anatomy • spinal cord anatomy

  3. Spinal Cord Anatomy

  4. Pathophysiology/Etiology • Function of disc is to allow for mobility of the spine and act as shock absorber

  5. Pathophysiology/Etiology • Located between vertebral bodies • Composed of nucleus pulposus a gelatinous material surrounded by annulus fibrosis- a fibrous coil

  6. Pathophysiology/Etiology • Spinal nerves come out between vertebra

  7. Herniated Disc • Herniated nucleus pulposus, slipped disc, ruptured disc • HNP- annulus becomes weakened/torn and the nucleus pulpsusherniates through it. Risk Factors- • Standing erect- cumulative effect and daily stress • Aging changes in disc and ligaments, osteoarthritis • Poor body mechanics • Overweight • Trauma

  8. Common Manifestations/Complications • HNP compresses • Spinal nerve (sensory or motor component) as it leaves the spinal cord • Or the cord itself- the white tracts within the cord- rare

  9. Common Manifestations/Complications • Sensory root or nerve of the spinal nerve is usually affected resulting in sensory symptoms- pain, parenthesis, or loss of sensation • Motor root or nerve may be affected which results in motor symptoms- paresis or paralysis • Manifestations depend on what nerve root, spinal nerve is being compressed– which dermatomes • Radiculopathy- pathology of the nerve root

  10. Common Manifestations/Complications Lumbar HNP • Most common site for HNP is L4-5 disc- the 5th lumbar nerve root • Most common is the posterior sensory nerve or root compressed • Classic symptoms- low back sciatica pain. The pain increases with increase in intrathorasic pressure • herniated disc L4-L5

  11. Other Symptoms Lumbar HNP: • Postural changes • Urinary/male sexual function changes • Paresis or paralysis • Foot drop • Paresthesias • Numbness • Muscle spasms • Absent cord reflexes

  12. Common Manifestations/Complications Cervical HNP C5-C6 disc- affects the 6th cervical nerve root • Pain- neck, shoulder, anterior upper arm to thumb • Absent/diminished reflexes to the arm • Motor changes- paresis or paralysis • Sensory- paresthesias or pain • Muscle spasms

  13. Therapeutic Interventions- Diagnostic Tests • X-ray identify deformities and narrowing of disk space • CT/MRI • Mylogram p1336 • Nerve conduction studies (EMG) to detect electrical activity of skeletal muscles

  14. Treatment- Conservative • 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 • Medications- nonnarcotic analgesics, anti-inflammatory, muscle relaxants, antispasmodics and tranquilizers

  15. Treatment- Conservative • Heat/cold therapy to decrease muscle spasms • Break the pain-spasm-pain cycle • Ultrasound, massage, relaxation techniques • Progressive mobilization with approved exercise program –includes abdominal/thigh strengthening • Teaching good body mechanics • Weight loss • TENS unit

  16. Treatment- Surgery • Laminectomy- removal of a portion of the lamina to relieve pressure and to get to the herniated nucleus pulposus that is protruding out • herniated disc repair

  17. Treatment- Surgery • Spinal fusion removes most of the disc and replaces it with bone usually from the patient iliac crest • Flexibility is lost at the site- requires longer hospital stay • spinal fusion

  18. Treatment- Surgery • Foraminotomy • Enlargement of the bony overgrowth at the opening which is compressing the nerve • Microdiskectomy • Use of electron microscope through a small incision to remove a portion of the HNP that is displaced • If cervical HNP, usually use the anterior approach in the neck

  19. Prevention of HNP • Back school approach- • Causes of HNP • Learn how to prevent • Good body mechanics • Exercises to strengthen leg and abdominal muscles • Change in life-style or occupation

  20. Nursing Assessment Specific to HNP Health History • Assess for risk factors- • The cumulative effect of standing erect and daily stress • Aging changes in disc/ligaments • Poor body mechanics • Overweight • Trauma • Employment • History of pain and other neuro changes

  21. Nursing Assessment Specific to HNP Physical Exam • Use similar methods to assess as utilized SCI • Muscle strength and coordination • Sensation- sharp/dull of paperclip using dermatome as reference • Pain evaluation- pain scale • Pre/Post-op assessment

  22. Post-Op Assessment for HNP • Sensory/motor assessment- care not to injure op site • Assess for CSF drainage or bleeding from op site • Encourage turn (log roll, cough, deep breath) • Assess for postural hypotension, especially if client was on bed rest for several days/weeks prior to surgery

  23. Post-op Assessment for HNP • If Anterior Cervical- • Assess injury to the carotid, esophagus, trachea, laryngeal nerve (speech- hoarseness) • Assess respiration, neck size, swallowing and speech • If Post-Op Lumbar- • Assess bowels sounds, voiding. • Minimize stress of post-op site- flat with pillow between knees, log roll, etc

  24. Nursing Problems/Interventions 1. Acute Pain • Post surgery the individual may have similar pain as pre-op due to lack of resiliency of the spinal nerves to ‘bounce’ back quickly • Donor site (illiac crest) may cause more pain than laminectomy • Individual may be in a pain-spasm-pain cycle, therefore may need both antispasmodic as well as analgesic

  25. 2. Chronic Pain • Surgery may not relieve pain • Nonpharmalogical methods to control pain • Pain clinic

  26. 3. Constipation • As a result of bed rest and decreased mobility and fear of pain with straining of stool • Constipation prevention methods– fluids, diet, etc

  27. 4. Home Care • When riding in a car, take frequent stops to move and stretch • Prevention– Back school approach • May have to deal with pain as a chronic condition • May need to make life/job changes

  28. Spinal Cord Tumors Patho- Normal Cord & Cord Tumors • CNS is made up of neural tissue (neurons) and support tissue (glial) • These tissues undergo changes and result in spinal cord tumors • Blood vessels and bone (vertebra) also can be part of the tumor

  29. Classification of Spinal Cord Tumors by Anatomical Area • Intramedullary- arise from neural tissues of the spinal cord • Extramedullary- arise from tissues outside the spinal cord may be benign or malignant • Intradural-from the nerve roots or meninges in subarachnoid space • Extradural- from the epidural tissue or vertebra

  30. Classification of Spinal Cord Tumors by Origin • Primary- originating in the spinal cord or meninges that is not relieved by bed rest • Secondary- metastases from other parts of the body

  31. Spinal Cord Tumors • Most spinal cord tumors are found in the thoracic region • Spinal cord tumors can compress (benign), invade the neural tissue, or cause ischemia to the area because of vascular obstruction

  32. Common Manifestations/Complications • Symptoms depend on the anatomical level of the spinal column, the anatomical location, the type of tumor and the spinal nerves affected • Pain that is not relieved by bed rest is the most common presenting symptom • Other symptoms are similar to those found with HNP or spinal cord injury- sensory or motor

  33. Common Manifestations/Complications • Manifestations of thoracic cord tumor • Paresis & spasticity of one leg then the other • Pain back & chest, not relieved by bedrest • Sensory changes • Babinski reflex • Bowel (ileus); bladder dysfunction (UMN in type)

  34. Therapeutic Interventions • Diagnostic tests include: • X-ray of the spinal column • Myelogram • Lumbar puncture with CSF analysis

  35. Therapeutic Interventions • Medications spinal tumors • Control pain- narcotic analgesics, may be given epidural catheter, PCA, NSAID’s • Reduce cord edema and tumor size- steroids dexamethasome (Decadron) high dose for a few days, then taper off with a Medrol dose pack

  36. Therapeutic Interventions • Surgery for spinal cord tumors • Laminectomy to remove or to decrease the size (decompression laminectomy) of the spinal cord tumor • Spinal fusion or the insertion of rods if several vertebra involved and the column is unstable • Radiation to reduce size and control pain

  37. Nursing Assessment • Health history • Pain, motor and sensory changes, bowel and bladder changes, Babinski reflex. • Physical exam • Similar to physical assessment for HNP

  38. Nursing Problems/Interventions • 1. Anxiety • Metatastic tumor vs benign spinal cord tumor • Education and support system • 2. Risk for constipation • From spinal cord compression, narcotics, bed rest • Adjust fluid and diet

  39. Nursing Problems/Interventions • 3. Impaired physical mobility • From bed rest and motor involvement • Basic nursing- ROM, etc • 4. Acute pain • From compression or invasion of tumor • Assess and treat • 5. Sexual dysfunction • Male sacral reflex ark (S 2,3,4) interference • Similar care as discussed with SCI

  40. Nursing Problems/Interventions • 6. Urinary retention • Reflex arc (S2,3,4) interference can cause neurogenic bladder as discussed with SCI • 7. Home care • Rehabilitation • Home evaluation • Support groups

  41. Nursing Care Plan: A Client with a Ruptured Intravertebral Disc http://wps.prenhall.com/wps/media/objects/737/755395/intervertebral_disk.pdf

  42. Added Critical thinking questions Nursing Care Plan: A Client with Ruptured Intervertebral Disc • 1. If Marees’ C6-C7 disk is herniated, where does the dermatome for C7 spinal nerve supply? • 2. Is Marees’ anterior or posterior nerve root being compressed by the herniation? • 3. Why is Maree Ivans prescribed both analgesics and muscle relaxants around the clock when awake? • 4. How does a cervical collar help? What else may help relieve the pain? • 5. If the conservative methods did not work, what else might the physician have done? • 6. Why are conservative methods tried for a period of time rather than immediate surgery?

  43. 7. Where is the posterior/anterior nerve root?8. Where is the lamina? 9. Would the Dr use the anterior or posterior surgical route to get to her disc?

  44. LeMone Blackboard: Media Links http://wps.prenhall.com/chet_lemone_medicalsurg_3/0,7859,757263-,00.html http://www.spine-health.com/

More Related