Nursing care plan herniated nucleus pulposus


I. Pathophysiology—Occurs when all or part of the gelatinous
center of the intervertebral disc (nucleus pulposus) is forced
through a weakened part or tear in the disc
a. Also known as herniated disc (most common term), ruptured
disc, slipped disk, or prolapsed intervertebral disc
b. Symptoms can arise if a disc fragment exerts pressure on a
spinal nerve root or the structures collapse because of loss of
the cushion normally provided by a healthy nucleus pulposa.

II. Etiology
a. Herniation (either complete or partial) most often occurs in
discs of the lumbosacral vertebral areas of L4 to L5 and L5
to S1, as well as the cervical (neck) vertebral areas of C5 to
C6 and C6 to C7. Lumbar disc herniation occurs 15 times
more often than cervical herniation (Medline plus, 2006).
b. Disc degeneration is due in part to the aging process but
also as a result of sedentary lifestyles with too little
(sometimes punctuated by too much) exercise.
c. Other risk factors include congenital conditions affecting
the size of the spinal canal, occupations requiring lifting of
heavy objects or repetitive lifting, and accidents or trauma.
d. Condition affects men and women equally and usually
occurs between ages 30 and 50; in older adults, disc herniation
occurs more frequently in men—especially those
involved in strenuous physical activity (MedlinePlus, 2006).

III. Statistics
a. Morbidity: In 2001, back pain was listed as the leading cause
of disability in Americans under age 45 (Edwards et al,
2001); in 2006, low back pain was reported as the most common
(27%) source of pain. (National Center for Health
Statistics, 2006).
b. Cost: In 2005, Americans spent $85.9 billion attempting
to relieve back and neck pain, which was up from
$52.1 billion in 1997 (Brook et al, 2008).

Care Setting
Most disc problems are treated conservatively at the community
level, although diagnostics and therapy services may
be provided through outpatient facilities. Brief hospitalization
is restricted to episodes of severe debilitating pain or
neurological deficit.

Related Concerns
Disc surgery
Psychosocial aspects of care

Nursing Priorities
1. Reduce back stress, muscle spasm, and pain.
2. Promote optimal functioning.
3. Support client and SO in rehabilitation process.
4. Provide information concerning condition, prognosis, and
treatment needs.

Discharge Goals
1. Pain relieved or manageable.
2. Proper lifting, posture, and exercises demonstrated.
3. Motor function and sensation restored to optimal level.
4. Disease and injury process, prognosis, and therapeutic
regimen understood.
5. Plan in place to meet needs after discharge.

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