Laminectomy is a surgery that involves the excision of a vertebral posterior arch and is commonly performed for injury to the spinal column or to relieve pressure/pain in the presence of a herniated disc. Also known as decompression surgery, surgery, the procedure may be done with or without fusion of vertebrae. Nursing are !lans "elow are # laminectomy nursing care plans. Nursing !riorities $.%aintain tissue perfusion/neurological function. &.!romote comfort and healing. '.!revent/minimi(e complications. ).Assist with return to normal mobility. *.!rovide information about condition/prognosis, treatment needs, and limitations. +ischarge oals $.Neurological function maintained/improved. &.omplications prevented. '.Limited mobility achieved with potential for increasing mobility. ).ondition/prognosis, therapeutic regimen, and behavior/lifestyle changes are understood. *.!lan in place to meet mee t needs after discharge. $. -mpaired !hysical %obility
Nursing +iagnosis %obility, impaired physical %ay be related to Neuromuscular impairment Limitations imposed by condition pain !ossibly evidenced by -mpaired coordination, limited 01% 0eluctance to attempt movement +ecreased muscle strength/control +esired 1utcomes +emonstrate techni2ues/behaviors that enable resumption of activities. %aintain or increase strength and function of affected bod y part.
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0ationale
3ncourage the patient to move his legs, as allowed. !atient participation promotes independence and sense of control. 4ork closely with the physical therapy department. 5o ensure a consistent regimen of leg6and6back6strengthening exercises. 7chedule activity and procedures with rest periods. 3ncourage participation in A+Ls within individual limitations. 3nhances healing and builds muscle strength and endurance. !atient participation promotes independence and sense of control. !rovide and assist with passive and active 01% exercises depending on surgical procedure. 7trengthens abdominal muscles and flexors of spine promotes good body mechanics. Assist with activity and progressive ambulation. 8ntil healing occurs, activity is limited and advanced slowly according to individual tolerance. 0eview proper body mechanics and techni2ues for participation in activities. 0educes risk of muscle strain, injury, pain and increases likelihood of patient involvement in progressive activity. &. -neffective 5issue !erfusion
Nursing +iagnosis 5issue !erfusion, ineffective 9specify: %ay be related to +iminished/interrupted blood flow 9e.g., edema of operative site, hematoma formation: ;ypovolemia !ossibly evidenced by !aresthesia numbness +ecreased 01%, muscle strength +esired 1utcomes 0eport/demonstrate normal sensations and movement as appropriate.
Nursing -nterventions 0ationale
4atch for any deterioration in neurologic status. heck neurological signs periodically and compare with baseline. Assess movement and sensation of lower extremities and feet 9lumbar: and hands or arms 9cervical:. Although some degree of sensory impairment is usually present, deterioration and changes ma y reflect development or resolution of
spinal cord edema and inflammation of the tissues secondary to damage to motor nerve roots from surgical manipulation or tissue hemorrhage compressing the spinal cord, re2uiring prompt medical evaluation intervention. 9will test glucose6 positive:, re2uiring prompt intervention. Administer -? fluids or blood as indicated. >luid replacement depends o n the degree of hypovolemia and duration of oo(ing, bleeding, 7> leaking. %onitor blood counts like hemoglobin 9;b:, he matocrit 9;ct:, and red blood cells 90"s:. Aids in establishing replacement needs, and monitors effectiveness of therapy. '. 0isk for 5rauma
Nursing +iagnosis 5rauma, risk for 9spinal: 0isk factors may include 5emporary weakness of vertebral column "alancing difficulties, changes in muscle coordination !ossibly evidenced by Not applicable. 3xistence of signs and symptoms establishes an actual nursing diagnosis. +esired 1utcomes %aintain proper alignment of spine. 0ecogni(e need for/seek assistance with activity as appropriate.
Nursing -nterventions 0ationale
!ost sign at bedside regarding prescribed position. 0educes risk of inadvertent strain and flexion of operative area. !rovide bedboard or firm mattress. Aids in stabili(ing back. %aintain cervical collar postoperatively with cervical laminectomy procedure. +ecreases muscle spasm and supports the surrounding structures, allowing normal sensory stimulation to occur. Limit activities when patient has had a spinal fusion. >ollowing surgery, spinal movement is restricted to promote healing of fusion, re2uiring a longer recuperation time. Logroll patient from side to side. ;ave patient fold arms across chest, tighten long back muscles, keeping shoulders and pelvis straight. 8se pillows between kn ees during position change and when on side. 8se turning sheet and sufficient personnel when turning, especially on the first postoperative day. %aintains body alignment while turning, preventing twisting motion, which may interfere with healing process. Assist out of bed@ logroll to side of bed, splint back, and raise to sitting position. Avoid prolonged sitting. %ove to standing position in single smooth motion. Avoids twisting and flexing of back while arising from bed or chair, protecting surgical area. Avoid sudden stretching, twisting, flexing, or jarring or spine. %ay cause vertebral collapse, shifting of bone graft, delayed hematoma formation, or subcutaneous wound dehiscence. heck "! note reports of di((iness or weakness. 0ecommend patient change position slowly. !resence of postural hypotension may result in fainting, falling and possible injury to surgical site. ;ave patient wear firm and flat walking shoes when ambulating. 0educes risk of falls. Apply lumbar brace or cervical collar as appropriate. "race or corset may be used in and out of bed during immediate postoperative phase to support spine and surrounding structures until muscle strength improves. "race is applied while patient is supine in bed. 7pinal fusion generally re2uires a lengthy recuperation period in a corset or collar. 0efer to physical therapy. -mplement program as outlined. 7trengthening exercises may be indicated during the rehabilitative phase to decrease muscle spasm and strain on the vertebral disc area. ). -neffective "reathing !attern
Nursing +iagnosis "reathing !attern/Airway learance, risk for ineffective 0isk factors may include 5racheal/bronchial obstruction/edema +ecreased lung expansion, pain !ossibly evidenced by Not applicable. 3xistence of signs and symptoms establishes an actual nursing diagnosis. +esired 1utcomes
%aintain a normal/effective respiratory pattern free of cyanosis and other signs of hypoxia, with A"s within acceptable range.
Nursing -nterventions 0ationale
1bserve for edema of face and neck 9cervical laminectomy:, especially first &))# hr after surgery. 5racheal edema and compression or nerve injury can compromise respiratory function. Listen for hoarseness. 3ncourage voice rest. %ay indicate laryngeal nerve injury, which can negatively affect cough 9ability to clear airway:. Auscultate breath sounds, note presence of whee(es or rhonchi. 7uggests accumulation of secretions and need to engage in more aggressive therapeutic actions to clear airway. 0emind the patient to cough, deep breathe, and use blow bottles or an incentive spirometer. >acilitates movement of secretions and clearing of lungs reduces risk of respiratory complications 9pneumonia:. Administer supplemental oxygen, if indicated. %ay be necessary for periods of respiratory distress or evidence of hypoxia. %onitor and graph A"s or pulse oximetry. %onitors effectiveness of breathing pattern or therapy. *. Acute !ain
Nursing +iagnosis !ain, acute %ay be related to !hysical agent@ surgical manipulation, edema, inflammation, harvesting of bone g raft !ossibly evidenced by 0eports of pain Autonomic responses@ diaphoresis, changes in vital signs, pallor Alteration in muscle tone uarding, distraction behaviors/restlessness +esired 1utcomes 0eport pain is relieved/controlled. ?erbali(e methods that provide relief. +emonstrate use of relaxation skills and diversional activities.
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0ationale
Assess intensity, description, location, radiation of pain, changes in sensation. -nstruct in use of rating scale9B$B:. %ay be mild to severe with radiation to shoulders and occipital area 9cervical: or hips and buttocks 9lumbar:. -f bone graft has been taken from the iliac crest, pain may be more severe at the donor site. Numbness and tingling discomfort may reflect return of sensation after nerve root decompression or result from developing edema causing nerve compression. 0eview expected manifestations and changes in intensity of pain. +evelopment and resolution of edema and inflammation in the immediate postoperative phase can affect pressure on various nerves and cause changes in degree of pain 9especially ' days after procedure, when muscle spasms and improved nerve root sensation intensify pain:. 3ncourage patient to assume position of comfort if indicated. 8se logroll for position change. !ositioning is dictated by physical preference, type of operation 9head of bed may be slightly elevated after cervical laminectomy:. 0eadjustment of position aids in relieving muscle fatigue and discomfort. Logrolling avoids tension in the operative areas, maintains straight spinal alignment, and reduces risk of displacing epidural patient6 controlled analgesia 9!A: when used. !rovide backrub massage, avoiding operative site. 0elieves and reduces pain by alteration of sensory neurons, muscle relaxation. +emonstrate and encourage use of relaxation skills like deep breathing, visuali(ation. 0efocuses attention, reduces muscle tension, promotes sense of well6being, an d decreases discomfort. !rovide soft diet, room humidifier encourage voice rest following anterior cervical laminectomy. 0educes discomfort associated with sore throat and difficulty swallowing. -nvestigate patient reports of return of radicular pain. 7uggests complications 9collapsing of disc space, shifting of bone graft: re2uiring further medical evaluation and intervention. Note@ 7ciatica and muscle spasms often recur after laminectomy bu t should resolve within several days or weeks. Administer analgesics, as indicated@ Narcotics@ morphine, codeine, meperidine 9+emerol:, oxycodone 95ylox:, hydrocodone 9?icodin:, acetaminophen 95ylenol: with codeine Narcotics are used during the first few postoperative days, then nonnarcotic agents are incorporated as intensity of pain diminishes. Note@ Narcotics may be administered via epidural catheter. %uscle relaxants@ cycloben(aprine 9>lexeril:, dia(epam 9?alium:. %ay be used to relieve muscle spasms resulting from intraoperative nerve irritation. -nstruct patient and assist with !A. ives patient control of medication administration 9usually narcotics: to achieve a more constant level of comfort, which may enhance healing and sense of well6being. !rovide throat sprays or lo(enges, viscous Cylocaine. 7ore throat may be a major complaint following cervical laminectomy. Apply 53N7 unit as needed. %ay be used for incisional pain or when nerve involvement continues after discharge. +ecreases level of pain by blocking nerve transmission of pain.
D. onstipation
Nursing +iagnosis onstipation %ay be related to !ain and swelling in surgical area -mmobili(ation, decreased physical activity Altered nerve stimulation, ileus 3motional stress, lack of privacy hanges/restriction of dietary intake !ossibly evidenced by +ecreased bowel sounds -ncreased abdominal girth Abdominal pain/rectal fullness, nausea hange in fre2uency, consistency, and amount of stool +esired 1utcomes 0eestablish normal patterns of bowel functioning. !ass stool of soft/semiformed consistency without straining.
Nursing -nterventions 0ationale
1bserve and document abdominal distension and auscultate bowel sounds. +istension and absence of bowel sounds indicate that bowel is not functioning, possibly bec ause of sudden loss of parasympathetic enervation of the bowel. 8se fraction or child6si(e bedpan until allowed out of bed. !romotes comfort, reduces muscle tension. !rovide privacy. !romotes psychological comfort. 3ncourage early ambulation. 7timulates peristalsis, facilitating passage of flatus. "egin progressive diet as tolerated. 7olid foods are not started until bowel sounds have returned or flatus has been passed and danger of ileus formation has abated. !rovide rectal tube, suppositories, and enemas as needed. %ay be necessary to relieve abdominal distension, promote resumption of normal bowel habits. Administer laxatives, stool softeners as indicated. 7oftens stools, promotes normal bowel habits, decreases straining. E. 8rinary 0etention
Nursing +iagnosis 8rinary 0etention, risk for 0isk factors may include !ain and swelling in operative area Need for remaining flat in bed !ossibly evidenced by Not applicable. 3xistence of signs and symptoms establishes an actual nursing diagnosis. +esired 1utcomes 3mpty bladder in sufficient amounts. "e free of bladder distension, with postvoid residuals within normal limits 94NL:.
Nursing -nterventions 0ationale
Assess for bowel and bladder functions. 5o know if bowel and bladder is not functioning. 1bserve and record amount and time of voiding. +etermines whether bladder is being emptied and when interventions may be necessary. !alpate for bladder distension. %ay indicate urine retention. ive plenty of fluids. %aintains kidney function and prevents renal stasis. 8se a fracture bedpan for the patient on complete bedrest. !romotes comfort, reduces muscle tension. 7timulate bladder emptying by running water, pouring warm water over p eritoneal area, or having patient put hand in warm water as needed. !romotes urination by relaxing urinary sphincter. atheteri(e for bladder residual after voiding, when indicated. -nsert and maintain indwelling catheter as needed. -ntermittent or continuous catheteri(ation may be necessary for several days postoperatively until swelling is decreased. #. +eficient
Nursing +iagnosis
!ossibly evidenced by 0e2uest for information statement of misconception -naccurate follow6through of instruction +esired 1utcomes ?erbali(e understanding of condition, prognosis, and potential complications. List signs/symptoms re2uiring medical follow6up. ?erbali(e understanding of therapeutic regimen. -nitiate necessary lifestyle changes.
Nursing -nterventions 0ationale
0ecall particular condition and prognosis -ndividual needs dictate tolerance levels and limitations of activity. -f the patient re2uires myelography@ Huestion him carefully about allergies to iodine, iodine6containing substances, or seafood. 7uch allergies may indicate sensitivity to the testIs radiopa2ue dye. 5ell the patient to expect some pain. 0eassure that heIll receive a sedative before the test. 5o keep patient calm and comfortable as possible. After the test, urge the patient to remain in bed with his head elevated, especially if metri(amide was used. 5o relieve the patient from discomfort and frustration of low back pain. +rink plenty of fluids and monitor -=1. !rovides information about circulatory status and replacement needs. 4atch for sei(ures and allergic reactions. 3xpeditious diagnostic evaluation of unrecogni(ed dural tear during surgery must be instituted immediately to avoid untoward se2uelae. +iscuss possibility of unrelieved and renewed pain. 7ome pain may continue for several months as activity level increases and scar tissue stretches. !ain relief from surgical procedure could be temporary if other discs have similar amount of degeneration. +iscuss use of heat 9warm packs, heating pad, or showers:. -ncreased circulation to the back and surgical area transports nutrients for healing to the area and aids in resolution of pathogens and exudates out of the area. +ecreases muscle spasms that may result from nerve root irritation during healing process. +iscuss judicious use of cold packs before an d after stretching activity, if indicated. %ay decrease muscle spasm in some instances more effectively than hea t. Avoid tub baths for ') wk, depending on physician recommendation. 5ub baths increase risk of falls and flexing and twisting of spine. 0eview dietary and fluid needs. 7hould be tailored to reduce risk of constipation and avoid excess weight gain while meeting nutrient needs to facilitate healing.
0eview and reinforce incisional care. orrect care promotes healing, reduces risk of wound infection. Note@ 5his information is especially critical for the patientIs 71 and caregiver in this era of early discharge 9sometimes &) hr after surgery:. -dentify signs and symptoms re2uiring notification of healthcare provider 9fever, increased incisional pain, inflammation, wound drainage, decreased sensation and motor activity in extremities:. !rompt evaluation and intervention may prevent complications and permanent injury. +iscuss necessity of follow6up care. Long6term medical supervision may be need ed to manage problems and complications and to reincorporate individual into desired and altered lifestyle and activities. 0eview the need of immobili(ation device, as indicated. orrect application and wearing time is important to gaining the most benefit from the brac e. Assess current lifestyle, job, finances, activities at home and leisure. lexing and twisting of the spine aggravates the healing process and increases risk of injury to spinal cord.
3ncourage lying6down rest periods, balanced with activity 0educes general and spinal fatigue and assists in the healing or recuperative p rocess. 3xplore limitations and abilities. !lacing limitations into perspective with abilities allows patient to understand own situation and exercise choice. 1ther Nursing +iagnoses $.%obility, impaired physicalKdecreased strength/endurance, pain, immobili(ing device. &.7elf6are deficitKdecreased strength/endurance, pain, immobili(ing device. '.5rauma, risk forKweakness, balancing difficulties, decreased muscle c oordination, reduced temperature/tactile sensation. ).>amily oping, ineffective@ compromisedKtemporary family disorgani(ation and role changes. 7ee Also
