英文护理查房

Lumbar disc herniation in nursing rounds

Patient data：Patients with Zheng Baorong, female, 54 years old, a chief complaint of low back pain 8 years, increase with double lower limbs pain numbness and weakness in 2 months

The patient is now history：The patient said in 8 years ago five apparent inducement appear gradually lower back pain, lower limb swelling and discomfort, fatigue after the increase of rest after remission, and occasional pain, line of symptomatic treatment, symptoms can be relieved, then still recurring symptoms. 2 months ago the exacerbation of symptoms and gradually appeared in both the lateral lower leg and foot pain, posterolateral, lower extremity weakness, pain like stabbing, burning, was continuing, especially with the double foot is heavy, night is obvious, the intense pain affect sleep, oral pain because of poor efficacy, and double the dorsum of the foot, foot numbness, consciously plantar " on the cotton ". The patients for further treatment to the hospital, outpatient investigation to " lumbar disc herniation " for the diagnosis of wards. In the course of the disease in patients without obvious fever, night sweats, fatigue symptoms, right foot fracture after long time bed double lower limb muscle atrophy, and decreased body weight of about 10kg, poor sleep, diet, two times can be.

Characteristics of disease：Lumbar disc herniation is refers to the degeneration of intervertebral disc, fibrous ring rupture, the nuclear organization salient stimuli and compression of the nerve root and cause a syndrome. Traditional Chinese medicine books without lumbar intervertebral disc protrusion in the name of. Lumbar disc corresponds to an amphiarthrosis, is covered by hyaline cartilage plates, annulus fibrosus and nucleus pulposus composition, distribution in the lumbar spine bone room. Lumbar intervertebral disc degenerative changes or trauma induced by fibrous ring rupture, nucleus pulposus prolapse from rupture, compression lumbar nerve, and leg radioactivity pain, so the medical profession that lumbar disc herniation is a " low back and leg pain, rheumatism " category. Here's Bian Tingting to introduce the symptoms of lumbar, lumbar disc herniation patients the most common symptoms are pain, low back pain, sciatica performance, typical sciatica is at the back of the thigh, hip, leg lateral to the heel or foot back pain radiation. According to clinical statistics, about 95% of the lumbar disc herniation patients have varying degrees of pain, 80% patients with lower extremity pain. Especially low back pain, lumbar disc herniation not only is the most common symptom, is also one of the earliest symptoms. The pain occurs mainly due to the prominent, degeneration of nucleus pulposus on adjacent tissues ( mainly for sinus vertebral nerve and spinal nerve root stimulation and oppression, and at the same time ) in the nucleus pulposus in glycoprotein and other biological material overflows, the release of histamine and other local chemical inflammation, induced by chemical and mechanical nerve root

caused by inflammation, cause or light or heavy chronic pain of waist and leg. And the lumbar degeneration also often occurring simultaneously in the waist of the other organizations, such as the lumbar facet joints, ligaments, muscles of waist, causing the local tissue of chronic inflammation, cause pain. Two factor interaction, mutual aggravation, the back and leg pain for sexual development. Protrusion of the lumbar intervertebral disc herniated nucleus pulposus in front of posterior longitudinal ligament called " outstanding ", through the posterior longitudinal ligament into the spinal canal, known as the " prolapse ". According to the nucleus pulposus rearward protrusion part is divided into 3 type:

1 after the outer lateral protrusion: fibrous ring of the weakest part of the rear in the intervertebral disc in the midline, this itself is weak, and lack of the posterior longitudinal ligament of the powerful central fiber support, therefore, is the waist intervertebral disc prominent the most common site of. Clinically most common, accounting for about 80%.

2 central protrusion: refers to the nucleus pulposus through the annulus posterior central projection, reach the posterior longitudinal ligament under. In addition to cause sciatic nerve symptoms, but also can stimulate or compression of the cauda equina, manifested as perineal paralysis and the size of obstacles.

3 prominent within the intervertebral foramen and far lateral: refers to the nucleus pulposus through the rear of the fiber ring back and posterior longitudinal ligament into the spinal canal, into the intervertebral foramen, easily missed, but fortunately, its incidence is low, only about 1%. The following from Wu Junhua to tell you about the etiology.

Nursing diagnosis and measure of

Pain from a herniated nucleus pulposus pressure edema of nerve root compression and spasm.

( 1) the rest: patients in the acute phase of absolute horizontal rigid bed rest, three weeks after illness allows ambulation.

( 2): the patient supine posture, head elevation of 30 degrees, knees, the popliteal fossa on a soft pillow.

( 3) and pelvic traction

( 4): according to the prescribed application drug analgesia analgesics or

non-steroidal drugs.

( 5 ): psychological nursing can relieve distractions such as listen to music and chat.

Constipation with cauda equina compression and prolonged bed rest on

( 1) bowel training: training the patient bed defecation, guide patients to use the potty.

( 2) diet and drinking water: to give the patient is rich in fiber digestible diet, encourage patients

More water to reduce fecal dry.

( 3) drugs: severe constipation, according to medicine

Will give enema or laxatives.

( 4) to create a suitable environment: defecation as mentioned

For the secret of environment and enough time to wait.

Somatic dyskinesia and intervertebral disc herniation, traction and operation about

( 1) relieve muscle spasm: for pain caused by restricted activities give the pain measures, while the local hot compress to relieve muscle spasm.

( 2) position: pelvic traction supine position, postoperative patients for pillow lying on a hard bed, turning over once every 2 hours.

( 3) low back muscle exercise

1) five point support method

2) three point support method

3) four point support method

4) head of upper limbs and the back back

5) lower limbs and waist back

6) the whole body backward

The potential complications of cerebrospinal fluid leakage, urinary retention or infection

( 1) for monitoring vital signs: in addition to detection of basic life signs observed sensory and motor.

( 2) position: according to the condition and operation of different types of anthropometric, generally slightly raised bed.

( 3) strengthen the incision and drainage nursing: Observation of incision and drainage tube is smooth, colour and quantity of liquid, such as abnormal timely report to a doctor.

( 4): urinary tract nursing recording intake and output volume, assist the urination and so.

( 5 ): strengthening the prevention of infection

Vital signs monitoring; cut

The observation and nursing.