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T.E., a 72 yo female admitted for lumbar stenosis with neurogenic…
T.E., a 72 yo female admitted for lumbar stenosis with neurogenic claudication
Pathophysiology:
Narrowing of the spinal canal that eventually compresses the nerves that innervate the lower back and legs. This process occurs over many years. The neurogenic claudication is d/t the narrowing of the spinal canal and is pain that radiates down the leg while walking.
Secondary diagnosis: HTN
Signs and Symptoms:
High blood pressure (SBP > 140)
Headaches
SOB
Nosebleeds
Medical treatment
Lifestyle changes (regular exercise, alcohol limitations, losing weight or maintaining healthy weight, low-sodium diet)
Diuretics
ACE inhibitors
ARBs
Calcium channel blockers
Beta blockers
Aldosterone agonists
Vasodilators
Diagnostic tests/labs
Blood pressure readings
Nursing interventions
Encourage patient to follow a healthy diet and regular exercise schedule in order to lower BMI if patient is overweight or obese
Encourage regular exercise
Promote cessation of smoking
Educate patient about a low-sodium diet and increasing potassium in the diet
Help patient find effective stress management techniques and resources to lower stress
Educate patient about the importance of managing kidney disease, diabetes and other chronic conditions well to aid in lower BP
Encourage patient to limit drinks to one drink a day for women and two drinks a day for men
Educate patients about the complications of unmanaged HTN: heart attack, stroke, aneurysm, HF, kidney dysfunction, metabolic syndrome, vision loss, dementia, cognitive impairments
Secondary diagnosis: major depression
Signs and symptoms
Feeling sad, tearful, empty, hopeless
Loss of interest in normal activities
Sleep disturbances
Angry outbursts, irritability, frustration
Fatigue, lack of motivation to do things
Anorexia or increased appetite
Anxiety, agitation, restlessness
Slowed thinking, speaking, body movements
Ruminating over past failures, feeling shameful, guilty, worthless
Cognitive impairment
Frequent thoughts of death, suicide
Idiopathic back pain, headaches
Medical treatment
Psychotherapy
SSRIs
SNRIs
Atypical antidepressants
Tricyclic antidepressants
Monoamine oxidase inhibitors (MAOIs)
Mood stabilizers, antipsychotics
Anti-anxiety medications
Diagnostic tests/labs
Physical exam (to rule out other health problems)
Lab tests (rule out thyroid disorders)
Psychiatric evaluation
Nursing interventions
Educate patient on coping resources
Provide resources for patient to get regular therapy help from chaplain, social worker, and psychiatrist
Talk to patient about struggles if patient is open and encourage patient to verbalize feelings and emotions
Encourage patient to participate in activities that bring the patient joy, satisfaction and meaning. Help patient find these activities.
Encourage patient to practice healthy relational interactions
Help patient stay on top of medications and educate patient about when to report side effects and decreases in effectiveness
Risk factors
Overgrowth of bone (bone spurs from osteoarthritis)
Herniated disks
Thickened ligaments
Tumors
Spinal injuries/trauma
Being over the age of 50
Congenital spinal deformities (scoliosis)
Signs/symptoms
Numbness or tingling in lower extremities
Lower extremity weakness
Neurogenic claudication (pain or cramping of lower extremities during activity or standing, is relieved by sitting or bending forward)
Back pain
If serious: paralysis, incontinence
Diagnostic tests/ labs
X rays
MRI
CT scan
Medical treatment
Surgery (laminectomy, laminotomy, laminoplasty, minimally invasive surgery)
Medications: pain relievers, antidepressants (for chronic pain), anti-seizure drugs (to reduce neurogenic pain), opioids (short-term pain relief)
Physical therapy
Corticosteroids
Percutaneous image-guided lumbar decompression
Alternative medicine: massage therapy, chiropractor, acupuncture
Nursing interventions
Educate patients about the medications they are taking and the side effects they need to watch out for
Educate patient about staying on top of long term pain management medication so that they do not need to use opioids for short term flare-ups of pain
Aid in post-op recovery of spinal surgery
Educate the patient about maintaining a healthy lifestyle to avoid further pain and complications
Healthy diet
Healthy weight (to take stress of the lower vertebrae)
Using assistive devices (walkers, canes)
Regular exercise as tolerated or ordered by the physical therapist
Using hot/cold therapy
Using NSAIDs and aspirin to reduce pain and inflammation before switching to something more powerful (steroids, opioids, antidepressant medications, etc.)
Help ease concerns about the surgery by explaining the procedure and the recovery process and what benefits and risks the surgery entails