Low back pain

Background Info

100

lack of muscle tone, excess weight, poor posture, smoking, stress, jobs

What is risk factors for low back pain?

200

has the most flexibility and holds the majority of the body's weight; contains nerve roots; at the bottom it "fans" where the problem is located

What is lumbar spine?

300

metabolic (osteoporosis), gynecological problems, neurological and psychological problems.

What is possible causes of low back pain?

400

lumbar strain is the most common reason for the pain, next to osteoarthritis, maybe intervertebral buldge, herniated disc, instability of the lumbar-sacral junction (especially see this in young weight lifters).

What is acute low back pain?

500

degenerative disc disease, ruptured disc, bone spurs, caused from structural problems like spinal stenosis (not enough room for the nerve impulses to go through).

What is chronic low back pain?

Assessment

100

back pain, radiculopathy (if a disc involved), decreased reflexes (deep tendon), paresthesias, muscle weakness, bowel or bladder incontinence.

What is clinical manifestations of low back pain?

200

past surgeries, injuries, systemic diseases such as DM, RA, MS, lupus; recent infection can go to the disc through the bloodstream and cause dis-spaced infection; malignancies? car wrecks?

What is history for low back pain?

300

on a scale of 0-10 where is the pain? does it radiate? and what alleviates it?

What is evaluate pain?

400

spine (kyphosis, lordosis, scoliosis), ROM (side-bend, rotation, if it hurts in the hamstring not back pain), asymmetrical gait, strength, sensory, relfexes, pulses, pain (over one vertebral body is unusual (compression fracture, tumor, or infection).

What is physical exam findings for low back pain?

500

x-ray, myelogram dye (into the spinal cord via lumbar puncture tilt the table and the dye will run down the spinal cord, must lay flat 6-8 hours. drink plenty of fluids); MRI or CT scan, EMG (determines severity of nerve irritation); diagnostic injections (facet joint).

What is diagnostic testing for low back pain?

Treatment

100

keep working, analgesics (NSAID, muscle relaxors), physical therapy, chiropractor, heat and stretching, avoid bed rest and extremes of motion.

What is conservative treatment?

200

accupuncture, back brace (usually preventative) but do not wear it all the time to avoid dependence.

What is alternative therapy?

300

percutaneous lateral diskectomy (a stab wound made to remove the disc), laminectomy (remove bone), spinal fusion (bone graft), rods, Kyphoplasty (cement injection to stop compression pain).

What is surgical treatment?

400

radiculopathy (sometimes not back pain, only leg pain); try conservative treatment then surgery referral if unsuccessful.

What is most common degenerative disc disease?

500

one of the most common ailments of the lumbar spine secondary to natural degeneration of the disc due to repeated stress or trauma on the spine; the most common site L5-6, C6-7 (low on the lumbar and cervical spine).

What is HNP or slip disc

Nursing Care

100

sensation (compare to pre-operative status), toes to nose, capillary refill, pulses, check for 5 P's (pain, pulselessness, pallor, paresthesias, and paralysis). Check LOC.

What is neuro & neurovascular checks?

200

know if the patient is supposed to lay flat and for how long. log roll the patient to prevent twisting of the spine; need to have back brace on before they get out of bed.

What is position and activity post-op?

300

monitor BP for hypovolemia (blood loss).

What is vital signs?

400

assess bowel sounds before the patient can eat anything (b/c ileus is common after back surgery); give a stool softner; monitor I & O (urinary retention is common after back surgery because they are manipulating nerves).

What is GI/GU assessment post-op?

500

ask if they have to climb stairs at home; do not drive due to a decreased reaction time, do not lift over 5 pounds.

What is teach post-op back surgery?

Diagnostic Studies

100

dye is injected into the spinal cord via lumbar puncture, then the table is tilted so that they dye will run down the spinal cord; after the procedure the patient needs to lay flat for 6-8 hours to prevent a spinal headache and seepage of CSF; can not do this is the patient has an allergy to dye.

What is myelogram?

200

determines the severity of nerve irritation; done on the nerve and muscle (nerve conduction study).

What is EMG?

300

used when the patient has back pain that is idiopathic; if pain is relieved by this procedure then indicative of pain caused by arthritis).

What is diagnostic injections (Facet joint injection)?