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.

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

Secondary diagnosis: major depression

Risk factors

Signs/symptoms

Diagnostic tests/ labs

Medical treatment

Nursing interventions

Signs and Symptoms:

Medical treatment

Diagnostic tests/labs

Nursing interventions

Signs and symptoms

Medical treatment

Diagnostic tests/labs

Nursing interventions

Overgrowth of bone (bone spurs from osteoarthritis)

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

Herniated disks

Thickened ligaments

Tumors

Spinal injuries/trauma

If serious: paralysis, incontinence

Being over the age of 50

Congenital spinal deformities (scoliosis)

X rays

MRI

CT scan

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

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

Alternative medicine: massage therapy, chiropractor, acupuncture

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

High blood pressure (SBP > 140)

Headaches

SOB

Nosebleeds

Lifestyle changes (regular exercise, alcohol limitations, losing weight or maintaining healthy weight, low-sodium diet)

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

Diuretics

ACE inhibitors

ARBs

Calcium channel blockers

Beta blockers

Aldosterone agonists

Vasodilators

Blood pressure readings

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

Physical exam (to rule out other health problems)

Lab tests (rule out thyroid disorders)

Psychiatric evaluation

Psychotherapy

SSRIs

SNRIs

Atypical antidepressants

Tricyclic antidepressants

Monoamine oxidase inhibitors (MAOIs)

Mood stabilizers, antipsychotics

Anti-anxiety medications

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