lumbar radiculopathy ru
TRANSCRIPT
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 1/29
UNIVERSITY OF CEBU LAPU-LAPU AND MANDAUE
COLLEGE OF NURSING
TOPIC: Lumbar Radiculopathy
GENERAL OBJECTIVE: Within 2 hours of lecture-discussion, the BSN IV-B students will be able to enhance knowledge, improve skills and develop positive attitude towa
the topic- Lumbar Radiculopathy.
SPECIFICOBJECTIVES
CONTENTS METHODOLOGY
TIMEALLOTMENT
RESOURCES EVALUATI
Specifically, the
Level IV-Bstudents will be
able to:
1. discuss the
overview of lumbar
radiculopathy.
Prayer
Preconditioning Activity
Lecture-
discussion
15 minutes
A. HumanResources:
- Students
- CIs
B.Books:
Black andHawks. (2008).
MedicalSurgicalNursing:
Clinical
Managementfor Positive
Outcomes.
Post test
2. define related
terms
Lecture-
discussion
10 minutes Mosby’s
medicalDictionary
Post test
3. state the petient’s
demographic
data
II. DEMOGRAPHIC DATA:
Name : Mrs. T.A.B
Age : 74 years oldGender : female
Civil Status : marriedReligion : Roman Catholic
Occupation : housewife
Lecture-
discussion
10 minutes Post test
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 2/29
Height : 5’1” Weight : 50 kg
Date of Admission : February 12, 2012Time of Admission : 05:09 PM
Hospital : Chong Hua HospitalPatient # : 0000289413
Room # : C-317Residence : 233 M.D. Jakosalem St. Cebu City
Physician : Dr. Virginia Español
Chief Complaints : loss of appetite, weakness, gluteal painFinal Diagnosis : Lumbar radiculopathy
4. delineate on
patient’sGordon’s
FunctionalPattern;
GORDON’S FUNCTIONAL PATTERN
1. Health Perception Health Management Pattern
2. Nutritional Metabolic Pattern
3. Elimination Pattern
4. Activity Exercise Pattern
5. Sleep Rest Pattern
6. Cognitive Perceptual Pattern
7. Sexuality Reproductive Pattern.
8. Self Perception Self Concept Pattern
9. Role Relationship Pattern
10. Coping Stress Tolerance Pattern
11. Value Belief Pattern
Lecture-
discussion
20 minutes Post test
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 3/29
Physical Appearance
General Measurement:
Height: 5’1”
Weight: 50 kg
General Appearance:
Date of Assessment: February 15,2012
Time: 11:00 pm
Seen patient lying on bed, conscious, awake, coherent and responsive with an IVF of
#5 PNSS 1L regulated at 15 gtts/min with a remaining level of 800, well infused on the
left arm. Limited range of motion and slowed movement noted. Vital signs are as
follows:
T: 36.5 °C PR: 80 bpm RR: 20cpm BP: 130/80 mmHg
Physical Assessment
SKIN: brown complexion, old wrinkled skin, good skin turgor, no masses, tenderness,
warm to touch
HEAD AND HAIR: normocephalic, equally distributed grey and black hair, no lice
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 4/29
infestations, no flaking, no swelling or tenderness, no masses palpated.
EARS: symmetrical, pinna is in line wi th outer canthus of the eye, minimal cerumen
seen in the ear canal, no discharges, and no tenderness upon palpation
NOSE AND SINUSES: nasal septum in midline, no deformities, no discharges, noswelling, no masses and tenderness upon palpation.
MOUTH AND THROAT: moist lips, moist buccal mucousa, pinkish and moist gums,
tongue at midline and rest at the floor of the mouth, uvula at midline, (+) gag reflex, no
halitosis, no pain upon swallowing, tonsils are not inflamed.
NECK: centrally located, supple, no lesions, no lymphadenopathy, undistended jugular
vein, trachea at midline, smooth and firm, no tenderness, non-palpable lymph nodes,
no masses.
THORAX AND LUNGS: equal chest expansion, (-) adventitious sounds, RR= 20 cpm
CARDIOVASCULAR: distinct S1 and S2, no chest pain, no palpitations, no murmurs,
heart rate= 80 bpm
ABDOMEN: no lesions, umbilicus at midline, round fatty abdomen, symmetrical, bowel
sounds of 5 clicks/minute, no masses, (-) kidney punch left flank.
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 5/29
GENITALIA AND ANUS: grossly female, no discharges.
EXTREMITIES: short clean fingernails and toenails, pinkish nail beds, ( -) nail clubbing,
CRT= <2 secs, full active range of motion for upper extremities, weak lower extremities
CRANIAL NERVES
CN 1: identified smell of perfume and alcohol
CN 2: identified color of student nurse’s uniform (stripe white and red), unable to read
at
2 feet distance
CN 3: (+) PERRLA, (+) extra ocular movements
CN 4 and 6: (+) cardinal gaze
CN 5: felt wisp of tissue on her cheeks, able to chew upon eating food
CN 7: active and symmetrical facial muscles movement upon smiling and frowning
CN 8: able to repeat “hello” as whispered by the student nurse at 2 feet distance
CN 9 and 10: able to swallow, identified sweet taste of banana, (+) gag reflex
CN 11: good strength of sternocleidomastoid and trapezius muscles as indicated
through
instructing the patient to rotate head and elevate shoulders while student nurse
applies resistance on the shoulder
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 6/29
CN 12: able to protrude, elevate and depress the tongue
(See Appendix A for the genogram.)
5. review theanatomy and
physiology of the nervous
system.
Anatomy and Physiology of Pancreas, Cerebral Cortex and Hippocampus Lecture-discussion
20 minutes Seeley.Anatomy &
Physiology.pp.145-148
Post test
6. trace thepathophysiolog
y of lumbarradiculopathy.
See Appendix B for the conceptual framework.
Lecture-Discussion
15 minutes Black &Hawks.
Medical-Surgical
Nursing.pp.1067-1070
Post test
7. identify theideal and actual
management;
MEDICAL AND SURGICAL MANAGEMENT
A. LABORATORY EXAMINATIONS
IDEAL ACTUAL
Lecture-discussion
10 minutes patient’s data
Post test
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 7/29
B. DIAGNOSTIC EXAMS
IDEAL ACTUAL
Chest X-ray-this is done to find out any
abnormalities on the patient's chest
ECG-a recorded of electrical activity of
the heart, shows certain wavescalled P,Q,R,S,T and U waves
Magnetic resonance imaging
(MRI)-is a test that uses a magnetic field
and pulses of radio wave energy tomake pictures of organs and
structures inside the body.
Computerized axial tomographyscan (CT Scan)
- is an x-ray procedure thatcombines many x-ray images with
the aid of a computer to generatecross-sectional views and, if needed,
three-dimensional images of theinternal organs and structures of the
- chest x-ray
- ECG
- MRI
- CT scan
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 8/29
body. A CT scan is used to definenormal and abnormal structures in
the body and/or assist in proceduresby helping to accurately guide the
placement of instruments ortreatments.
See Appendix C for the laboratory results.
C. MEDICATIONS AND TREATMENT
IDEAL ACTUAL
.
D. SURGICAL MANAGEMENT
IDEAL ACTUAL
E. DIET
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 9/29
IDEAL ACTUAL
8. discuss theideal and actual
nursingmanagement;
IDEAL ACTUAL
Actual Nursing Management
1. Assessed patient’s condition.
2. Regulated IVF to 15 gtts/min.3. Bedside care done.
4. Vital signs taken and monitoredevery hour.
5. Neuro vital signs taken andmonitored every hour.
6. Intake and output taken andrecorded.
7. Assisted patient on repositioningself.
8. Provided safety measures by
raising side rails up.9. Assisted with activities of
toileting.10. Changed diaper.
11. Gave health teachings.12. Encouraged deep breathing
exercises.
13. Placed patient on seizure
precaution.14. Attended patient’s needs.
15. Provided adequate rest.
Lecturediscussion
5 minutes Smeltzer,Suzanne C. et
al.(2008).
Brunner and Suddharth’s
Textbook of Medical-
Surgical Nursing. 11
th
edition.
LippincottWilliams and
Wilkins
Post test
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 10/29
9. enumeratethe different
drugs andintravenous
fluidsadministered to
the patient;
(See Appendix D for Drug & IVF Study)
Lecture-discussion
10 minutes Spratto,George R. et
al.(2007). PDR
Nurse’s Drug
Handbook. 2007th edition
Post test
10. appreciate
the nursing careplans;
(See Appendix E)
Lecture-
discussion
10 minutes Doenges,
Marilynn E.et.al.(2008). Nurse’s
Pocket guide: Diagnosis,
Prioritized Interventions, Rationales.
11th edition.
Philadelphia
Post test
11. formulate a
discharge plan;
(See Appendix F) Lecture-
discussion
5 minutes Doenges,
Marilynn E.et.al.(2008). Nurse’s
Pocket guide:
Diagnosis, Prioritized
Interventions, Rationales.11th edition.
Philadelphia
Post test
12. identify theprognosis;
Lecture-discussion
3 minutes Post test
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 11/29
APPENDIX A
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 12/29
(Genogram)
APPENDIX B
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 13/29
(Pathophysiology)
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 14/29
APPENDIX C
(LABORATORY RESULTS)
LABORATORY AND DIAGNOSTIC TEST RESULTS
02/14/12
Sodium test
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 15/29
TEST RESULT REFERENCE UNIT IMPLICATION
Sodium (serum) 1110.0 134.0-148.0 Mmol/l hyponatremia
02/12/12
Electrocardiographic report
-sinus rhythm with non-specific ST-T wave changes
02/12/12
Complete blood count
TEST RESULT REFERENCE UNIT IMPLICATION
WBC 13.50 ↑ 4.8-10.8 10^3/uL infection
Platelet 522 ↑ 130-400 10^3/uL thromboembolism
PDW 8.3 ↑ 9.0-14.0 % Myeloproliferative
neoplasms
Neutrophil 81.4 ↑ 40-74 % Bacterial infection
Lymphocyte 15.3 ↑ 19-48 % Viral infection
Monocyte 2.0 ↓ 2.4-9.0 % Bone marrow injury
02/12/12
Lumbosacral Spine X-ray- APL, Cone down
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 16/29
Conclusions:
1. straightening of the lumbar lordosis due to muscular spasm
2. mild hypertrophic degenerative changes of the lumbar spine and lateral aspect of both iliac bones
3. generalized osteopenia/osteoporosis
4. atherosclerosis of the abdominal aorta
5. fecal stasis in some of the colonic segments
02/12/12
Chest X-ray- PA or AP
Conclusions:
1. clear lung fields
2. magnified cardiac silhouette with slightly accentuated upper pulmonary vascular markings due to positioning
3. tortuous and atheromatous aorta
4. hypertrophic degenerative changes of the thoracic spine
5. generalized osteopenia/ osteoporosis
02/15/12
Ultrasound report
Whole abdomen
Conclusions:
1. unremarkable GB, CBD and biliary radicles
2. normal sized liver with mild fatty infiltration and structural changes compatible with aging liver, and/or non specific, hepatic, parenchymal disease
3. essentially normal pancreas and spleen
4. bilateral fullness of the pelvo-calyceal structures, which may relate to any of the following:a. distal, partially obstructing processes, proximal to UVS at present
b. decreased ureteral peristalsis as seen in recent passage of a stone and/or UTI
5. normal sized uterus with physiologic endometrium.
6. Ovaries not seen, most likely atrophic
7. structurally unremarkable urinary bladder
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 17/29
8. atherosclerotic abdominal aorta
02/12/12
Clinical Neurophysiology Laboratory
Interpretation:
The nerve conduction study of both upper and both lower limbs is abnormal due to the:
1. absent of the action potential of both median sensory senses
2. absence of the action potential of both median motor nerves
3. severely decreased amplitude of the action potentials of the right peroneal motor nerve
4. decreased conduction velocities of both peroneal and both tibial motor nerves
5. absence of the F waves of the right peroneal motor nerve
6. prolonged F wave latencies of the left peroneal and both tibial nerves
7. absence of the H reflexes of both tibial nerves.
The needle (muscle) study is abnormal due to the:
1. presence of spontaneous potentials on certain limb muscles and certain paracervical muscles tested
2. difficulty in attaining relaxation of the paralumbosacral muscles
3. presence of the serrated muaps on certain limb muscles tested
4. decreased insertional activities on certain limb muscles tested.
The EMG-IVCV studies suggest the following conditions:
1. Pathology proximal to the dorsal root ganglia of both L4-S1 nerve roots. This is most likely bilateral L4-S1 radiculopathy with signs of acute and chronic denervation changes.
2. Pathology proximal to the dorsal root ganglia of right C5-C6 nerve roots. This is most likely right C5-C6 radiculopathy with signs of chronic denervation changes and signs of muscle
reinnervation.
3. Bilateral distal median neuropathy, sensory and motor, demyelinating and axonopathic at the level between the mid-palms and the distal creases of the wrists. This is most likely
bilateral carpal tunnel syndrome, severe.
02/14/12
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 18/29
CT-Scan report
Brain Plain-CT16
Conclusion:
Brain atrophy with suspicious areas of i schemia in the subcortical white matter of the left
posterior frontal lobe.
02/14/12
Magnetic Resonance Imaging Report
Conclusion:
1. Mild bilateral neural foramen stenosis of L2/L3, L3/L4 & L5/S1.
2. Severe central canal and moderate bilateral neural foramen stenosis at L4/L5.
3. Mild cervical kyphosis. This may be due to muscle spasm.
4. Markedly dilated urinary bladder.
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 19/29
APPENDIX E(NURSING CARE PLAN)
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 20/29
EVALUAT
1. Goal metPatient maint
free from signimpaired skin
breakdown asevidenced by
redness over bony promine
and capillary of less than 6
seconds over areas
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 21/29
APPENDIX D
(DRUG &IVF STUDY)
Drug Name Dosage and
Frequency
Mechanism of
Action
Indication Contraindication Side Effects Nursing Responsibilities
Generic Name:
Lactulose
Brand Name:
Lilac
Classification:
laxative
A. Patient’s dose
and Frequency:
-20 ml OD
B. Minimum
Dose and
Frequency:
- 2.5 ml OD
Produces osmoticeffect in colon.
Resulting
distention
promotes
peristalsis.
Decreases blood
ammonia build-up
that causes hepatic
encephalopathy,
probably as aresult of bacterial
degredation which
lowers pH of colon
Constipation Containdicated inpatients on low
galactose diet. Use
cautiously in
patients with
diabetes mellitus
because drug
contains lactose,
galactose and other
sugars.
GI:
Abdominal cramps
and distention,
belching, diarrhea,
flatulence, nausea
& vomiting
Important patient teachings:
- Replace fluid loss.
- Diarrhea may indicate overdose.- To minimize sweet taste, dilute with
water or fruit juice or give with food.- Advice patient to dilute drug with
food to improve taste.- Inform patient of adverse reactions
and tell him to notify prescriber.
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 22/29
How supplied:
A. Patient’s
supply:
- syrup
B. Other forms:- crystals for
reinsitution
C. Maximum
dose andFrequency:
- 300 ml OD
contents.
Spratto, George R.et al.(2007). PDR
Nurse’s Drug
Handbook. 2007th
edition
Drug Name Dosage and
Frequency
Mechanism of
Action
Indication Contraindication Side Effects Nursing Responsibilities
Generic Name:
Azithromycin
Brand Name:
Zithromax
A. Patient’s dose
andFrequency:
-
- 500 mg tablet
Birds to 50S
Subunit of
bacterial ribosome,
blocking protein
synthesis;bacteriostatic or
bactericidal,
depending on
Acute bacterial
exacerbation,
community
acquired
pneumonia,bacterial sinusitis,
nongonococcal
urethritis,
prevention of
Contraindicated in
patient
hypersensitive to
erythromycin or
other macrolides.
CNS: anxiety,
dizziness,
headache
CV: Torsades de
pointes,
prolonged QT
interval
Important nursing responsibilities:
- Don’t give drug I.M or by I.V bolusinjection.
- If patient vomits within 5 minutes of
drinking extended-release solution,consider additional antibiotic treatment.
- Don’t give with antacids.
- Tell patient that tablets or oralsuspension may be taken with or
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 23/29
Classification:
Antibiotic
How supplied:
A. Patient’ssupply:
- Tablet
B. Other forms:- Injection
- Powder for oral
suspension
B. Minimum
Dose andFrequency:
- 10 mg/ P.O daily
C. Maximumdose and
Frequency:
- 600 mg P.O
daily
concentration.
Spratto, George R.et al.(2007). PDR
Nurse’s Drug
Handbook. 2007th
edition
disseminated
mycobacterium
avium complex,
pelvic
inflammatory
disease, genital
ulcer disease, acute
otitis media,
chlamydialophthalmia
neonatorum.
EENT: Hearing
loss, tinnitus,
dyspepsia
GI: Abdominal
pain, diarrhea
nausea
GU: candiasis,
nephritis,vaginitis
without food, but that taking with foodmay decrease risk of nausea.
Type of IVF Content Classification Indication Contraindication How Supplied Nursing Interventions
0.9% SodiumChloride
Each 100ml contains900mg of Sodium
ChlorideElectrolytes in
1000ml:
Soduim…..154mmol Chloride….154mmol
Isotonic For replacement ormaintenance of fluid
and electrolytes
Renal/Circulatoryimpairment, older
adults, sodiumretention.
1000ml in plasticbottle
Before Administration:1.Do handwashing
2.Check the IVF sheet3.Check the Doctor’s order
4.Read the label of thebottle. Ensure solution is
the one ordered.5.Inspect the container for
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 24/29
Mosby.PDQ Nurses
for Today.p.9
Mosby.PDQ Nurses
for Today.p.9
Mosby.PDQ Nurses
for Today.p.9 Mosby.PDQ Nursesfor Today.p.9
Mosby.PDQ Nursesfor Today.p.9
Mosby.PDQ Nursesfor Today.p.9
leaks.During Administration:
1.Close the clamp2.Administer the IV
solution.3.Hang the IVf bottle
slowly.4.Regulate the drops per
minute as prescribed.
After Administration:1.Do after care2.Document the name of
the Iv bottle, hooked, dateand time started.
3.Assess for any redness orany allergic reactions.
Monitor IVF and IV site.4.Refer to health care
provider if allergicreactions occur.
Mosby.PDQ Nurses for
Today.p.9
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 25/29
APPENDIX F
(INTERDISCIPLINARY DISCHARGEPLAN)
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 26/29
BIBLIOGRAPHY:
BOOKS:
Black, Joyce M. et al.(2008). Medical-Surgical Nursing .8th edition. C&E Publishing, Inc. Metro Manila, Philippines
Deglin, Judith H. et.al (2007) Davis’s Drug Guide for Nurses.10th edition. Philadelphia, Pennsylvania: E.A. Davis Company.
Doenges, Marilynn E. et.al.( 2006). Nursing Care Plans. 7th edition. Philadelphia
th
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 27/29
Doenges, Marilynn E. et.al.( 2008). Nurse’s Pocket guide: Diagnosis, Prioritized In terventions, Rationales . 11th
edition. Philadelphia
Kee, Joyce Lefever.et al.(2009). Pharmacology: A Nursing Process Approach . 6th
edition.Elsevier (Singapore) Winsland House I Singapore
Mosby, Elsevier.(2006). Mosby’s Pocket Dictionary. 5th edition. Singapore
Seeley, Stephens Tate.et al.(2007). Essentials of Anatomy and Physiology . 6th edition. Mc- Graw Hills International
Smeltzer, Suzanne C. et al.(2008). Brunner and Suddharth’s Textbook of Medical - Surgical Nursing. 11th
edition. Lippincott Williams and Wilkins
Spratto, George R. et al.(2007). PDR Nurse’s Drug Handbook . 2007th
edition
Electronics:
http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/
http://diabetes.webmd.com/guide/oral-medicine-pills-treat-diabetes
UNIVERSITY OF CEBU LAPU-LAPU AND MANDAUE
A.C. CORTES AVENUE, LOOC, MANDAUE CITY
COLLEGE OF NURSING
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 28/29
A RESOURCE UNIT
LUMBAR RADICULOPATHY
SUBMITTED BY:
Abubakar, Mirkhadz
Ampo, Nheil Christopher
Dignos, Edelyn
Engasca, Paramae
Fuentes, Roselyn
Gasta, Jan Anthony
Inoc, Creselda
Lazaga, Maria Melfa Mae
Lemosnero, Erika Charisse A.
Lubas, Laarni
Mariveles, Mark
Mondigo, Cathy LouRubi, Sergs Domique
Soquillo, Junafe
Vanesa, Napala
SUBMITTED TO:
Ms. Regina M. Omana, RN
Clinical Instructor
5/14/2018 Lumbar Radiculopathy Ru - slidepdf.com
http://slidepdf.com/reader/full/lumbar-radiculopathy-ru 29/29