Intervertebral Discs are the cartilage plates that form a cushion between the vertebral bodies. Hard and fibrous materials that are combined in one capsule. Such as ball bearings in the middle of the disc called the nucleus pulposus. HNP is a rupture of the nucleus pulposus. (Brunner & Suddarth, 2002)
Hernia nucleus pulposus into the vertebral bodies can be above or below, can also directly into the vertebral canal. (Priguna Sidhartha, 1990)
Pathophysiology
Nucleus pulposus protrusion or rupture is usually preceded by degenerative changes that occur in the aging process. Loss of protein polysaccharides in lowering the water content of the disc nucleus pulposus. Fractional developments are spread across the annulus weakens the defense in the nucleus herniation. Setela trauma * falls, accidents, and recurring minor stress such as lifting) cartilage can be injured.
In most patients, symptoms are typical of immediate trauma and shorter, and these symptoms are caused by injury to the disc that is not visible for several months or years. Later in the degeneration of the disc, capsule, leading to spinal cord or may rupture and allow the nucleus pulposus or pushed against the yolk of dural spinal nerve as it appears from the spinal column.
Hernia nucleus pulposus into the vertebral canal means that the nucleus pulposus presses on the roots which, together with the arteria radikularis are in a bundle dura. This occurs when a disc herniation on lateral side. When the herniasinya amid no roots are exposed. Moreover, because the L2 level and continue down the spinal cord was not there anymore, then herniation in the midline will not cause compression of the anterior column.
After a herniated nucleus pulposus of the intervertebral residual duct through lysis so that the two corpora vertebrae overlap without bumps.
Clinical Manifestations
Pain can occur in any part such as cervical spine, thoracic (rarely) or lumbar. Clinical manifestations depend on the location, speed of development (acute or chronic) and the effect on surrounding structures. Severe lower back pain, chronic and recurrent (relapsed).
Diagnostic Examination
1. Spinal RO: Shows degenerative changes in spine
2. MRI: to localize a small disc protrusion though mainly for lumbar spinal disease.
3. CT Scan and Mielogram if clinical symptoms and patologiknya not seen on MRI
4. Electromyography (EMG): to localize the specific spinal nerve roots are exposed.
Management
1. Surgery
Objective: Reduce the pressure on the nerve roots to reduce the pain and alter neurologic deficit.
Kinds:
a. Discectomy: Lifting fragment herniation or the exit of the intervertebral discs
b. Laminectomy: Lifting the lamina to expose the neural elements in the spinal canal, allowing the surgeon to inspect the spinal canal, pathology and identify and eliminate lift cord compression and the roots
c. Laminotomi: Division of vertebral lamina.
d. Discectomy with fusion.
2. Immobilizing
By removing the drawstring cervical immobilization, traction, or brace.
3. Traction
Cervical traction is accompanied by an associated buffer head on the pulley and the load.
4. Relieves Pain
Moist heat compresses, analgesics, sedatives, muscle relaxants, anti-inflammatory drugs and corticosteroids, if necessary.
Assessment
1. Anamnesa
Chief complaints, history of current treatment, past medical history, family health history
2. Physical examination
Assessment of the patient's problem consists of onset, location and spread of pain, paresthesias, limited mobility and limited function of the neck, shoulders and upper extremities. Assessment of the cervical spinal region include palpation aimed to assess muscle tone and rigidity.
3. Examination Support
Nursing Diagnosis Emergent
1. Compression b.d nerve pain, muscle spasm
2. Impaired physical mobility bd pain, muscle spasm, and damage restrictive therapy neuromuskulus
3. Anxiety b.d ineffective individual coping
4. Lack of knowledge bd lack of information about the condition, prognosis and treatment measures.
Intervention
1. B.d nerve compression pain, muscle spasm
a. Assess complaints of pain, the location, duration of attacks, precipitating factors / which aggravate. Set scale of 0-10
b. Maintain bed rest, semi-Fowler position with the spinal bones, hips and knees in a state of flexion, supine position
c. Use logroll (board) during a change of position
d. Auxiliary mounting brace / corset
e. Limit your activity during the acute phase in accordance with the requirements
f. Teach relaxation techniques
g. Collaboration: analgesics, traction, physiotherapy
2. Impaired physical mobility bd pain, muscle spasm, and damage restrictive therapy neuromuskulus
a. Provide / assist patient to perform passive range of motion exercises and active
b. Assist patients in activities of progressive ambulation
c. Provide good skin care, massage the point that depressed after rehap position changes. Check the condition of skin under the brace with a specific time period.
d. Record the response of emotional / behavioral in immobilizing
e. Demonstrate the use of auxiliary equipment such as sticks.
f. Collaboration: analgesic
3. Anxiety b.d ineffective individual coping
a. Assess the patient's anxiety level
b. Provide accurate information
c. Give the patient the opportunity to reveal problems such as the possibility of paralysis, the effect on sexual function, changes in roles and responsibilities.
d. Assess the secondary problems that may impede the desire to heal and may impede the healing process.
e. Involve the family
4. Lack of knowledge bd lack of information about the condition, prognosis
a. Explain the process of disease and prognosis, and restrictions on activities
b. Give information about your own body mechanics to stand, lift and use ancillary shoes
c. Discuss about treatment and side effects.
d. Suggest to use the board / mat powerful, tiny little flat pillow under the neck, side sleeping with knees flexed, avoid the tummy.
e. Avoid the use of heaters in a long time
f. Give information about the signs that need attention such as pain puncture, loss of sensation / the ability to walk.
REFERENCES
1. Smeltzer, Suzanne C., Textbook of Medical Surgical Nursing Brunner & Suddarth Vol 8 issue 3, Jakarta: EGC, 2002
2. Doengoes, ME, Nursing Care Plans Guidelines for Planning and Documenting Patient Care, 2nd Edition, Jakarta: EGC, 2000.
3. Tucker, Susan Martin, Standard of Care 5 edition, Jakarta: EGC, 1998.
4. Long, Barbara C., Medical Surgical Nursing, New York: Foundation for Nursing Education Alumni Association Pajajaran, 1996.
5. Priguna Sidhartha, Neuromuskuloskeletal Pain in Practice, Jakarta: Dian Rakyat, 1996.
6. Chusid, IG, correlative neuroanatomical and Functional Neurology, Yogyakarta: Gajah Mada University Press, 1993
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