SLIPPED (HERNIATED) DISC

A Case Study
Presented to the
Faculty of the College of Nursing
Metropolitan Medical Center College of Arts, Science and Technology

In Partial
Fulfilment of the requirements
for Nursing Care Management 107

Submitted by:

Agaloos, Jojilyn T.
Ceña, Glaiza V.
Chua, Gerold M.
Dela Cruz, Christopher Carl A.
Demillo, Jeremy C.
Diala, Diana Rose S.
Fonacier, Fritzel M.
Lozano, Kathleen Kaye D.
Narvaez, Anjona

Level IV – A1

2nd Semester (S.Y. 2018-2019)

INTRODUCTION
Many people have back pain that keeps on returning. Usually it is hard to say what the exact cause is. But
if you have pain that radiates down your leg and into your foot, it may be a sign of a slipped spinal disk, or
“herniated disk.”
The spinal disks are located between the spinal vertebrae. They have an elastic casing made of cartilage
and a gel-like center (nucleus pulposus). A slipped disk occurs if the spinal disk tissue pushes out, or
"herniates," between the vertebrae. This herniated tissue may put pressure on the spinal nerves and irritate
them.
A slipped disk can be very unpleasant. But the good news is that the symptoms usually go away on their
own within less than six weeks in most people with this problem. But not everybody who has a slipped disk
will have symptoms.
Symptoms
A slipped disk can cause very sudden and severe shooting pain. Slipped disks in the lumbar region are the
main cause of sciatica (sciatic nerve pain). Sciatica describes pain that radiates down one leg and into the
foot. As well as the typical radiating pain, a slipped disk can also lead to pain in the low back region.
In rare cases, numbness in the buttocks or signs of paralysis may develop in addition to the pain and
restricted movement. These symptoms are signs of a more serious problem, like nerve damage. Immediate
medical attention is needed if the functioning of the bladder or bowels is affected too. That is called "cauda
equina syndrome" (CES), and is a medical emergency.
But a slipped disk doesn't always lead to noticeable symptoms. This can be seen in studies in which adults
who didn't have back pain were examined using magnetic resonance imaging (MRI). More than 50 out of
100 people who were examined had a bulging disk. In about 20 out of 100 of them, the core of the disk had
already broken through several layers of its casing or had even entered the surrounding tissue, but without
causing any noticeable symptoms
Prevalence
It is estimated that 1 to 5% of all people will have back pain caused by a slipped disk at some point in their
lives. Slipped disks are more common in people over the age of 30, and are about twice as common in men
as they are in women.
ANATOMY AND PHYSIOLOGY
The Vertebral Column

The vertebral column is also known as the spinal column or spine It consists of a sequence of vertebrae
(singular = vertebra), each of which is separated and united by an intervertebral disc. Together, the
vertebrae and intervertebral discs form the vertebral column. It is a flexible column that supports the head,
neck, and body and allows for their movements. It also protects the spinal cord, which passes down the
back through openings in the vertebrae.
Regions of the Vertebral Column
The vertebral column originally develops as a series of 33 vertebrae, but this number is eventually reduced
to 24 vertebrae, plus the sacrum and coccyx. The vertebral column is subdivided into five regions, with the
vertebrae in each area named for that region and numbered in descending order. In the neck, there are
seven cervical vertebrae, each designated with the letter “C” followed by its number. Superiorly, the C1
vertebra articulates (forms a joint) with the occipital condyles of the skull. Inferiorly, C1 articulates with the
C2 vertebra, and so on. Below these are the 12 thoracic vertebrae, designated T1–T12. The lower back
contains the L1–L5 lumbar vertebrae. The single sacrum, which is also part of the pelvis, is formed by the
fusion of five sacral vertebrae. Similarly, the coccyx, or tailbone, results from the fusion of four small
coccygeal vertebrae. However, the sacral and coccygeal fusions do not start until age 20 and are not
completed until middle age.
General Structure of a Vertebra
The body is the anterior portion of each vertebra and is the part that supports the body weight. Because of
this, the vertebral bodies progressively increase in size and thickness going down the vertebral column.
The bodies of adjacent vertebrae are separated and strongly united by an intervertebral disc.

The vertebral arch forms the posterior portion of each vertebra. It consists of four parts, the right and left
pedicles and the right and left laminae. Each pedicle forms one of the lateral sides of the vertebral arch.
The pedicles are anchored to the posterior side of the vertebral body. Each lamina forms part of the
posterior roof of the vertebral arch. The large opening between the vertebral arch and body is the vertebral
foramen, which contains the spinal cord. In the intact vertebral column, the vertebral foramina of all of the
vertebrae align to form the vertebral (spinal) canal, which serves as the bony protection and passageway
for the spinal cord down the back. When the vertebrae are aligned together in the vertebral column,
notches in the margins of the pedicles of adjacent vertebrae together form an intervertebral foramen, the
opening through which a spinal nerve exits from the vertebral column

Seven processes arise from the vertebral arch. Each paired transverse process projects laterally and
arises from the junction point between the pedicle and lamina. The single spinous process (vertebral
spine) projects posteriorly at the midline of the back. The vertebral spines can easily be felt as a series of
bumps just under the skin down the middle of the back. The transverse and spinous processes serve as
important muscle attachment sites. A superior articular process extends or faces upward, and an inferior
articular process faces or projects downward on each side of a vertebrae. The paired superior articular
processes of one vertebra join with the corresponding paired inferior articular processes from the next
higher vertebra. These junctions form slightly moveable joints between the adjacent vertebrae. The shape
and orientation of the articular processes vary in different regions of the vertebral column and play a major
role in determining the type and range of motion available in each region.

In disc herniation, it’s the intervertebral disc that causes the problem. The disc consists of the annulus
fibrosus (a complex series of fibrous rings) and the nucleus pulposus (a gelatinous core containing collagen
fibers, elastin fibers and a hydrated gel). The vertebral canal is formed by the vertebral bodies,
intervertebral discs and ligaments on the anterior wall and by the vertebral arches and ligaments on the
lateral wall. The spinal cord lies in this vertebral canal.

A tear can occur within the annulus fibrosus. The material of the nucleus pulposus can track through this
tear and into the intervertebral or vertebral foramen to impinge neural structure. A disc herniation can cause
mechanical irritation of these structures which in turn can cause pain. This is presented as low back pain
with possible radiculopathy if a nerve is affected. The disc can protrude posteriorly and impinge the roots of
the lumbar nerves or it can protrude posterolaterally and impinge the descending root.

A disc has few blood vessels and some nerves. These nerves are mainly restricted to the outer lamellae of
the annulus fibrosus. In the lumbar region, the level at which a disc herniates does not always correlate to
the level of nerve root symptoms. When the herniation is in the posterolateral direction the affected nerve
root is the one that exits at the level below the disk herniation. This is because the nerve root at the hernia-
level has already exited the transverse foramen. A foraminal herniation on the other hand affects the nerve
root that is situated at the same level.
 Predisposing factors
Precipitating factors
Genetics
Weight, Occupation, activities
Male

Degenerative process due to

aging Frequent lifting of heavy items

Degenerative process due to Exerts great pressure on the

aging spinal column

Nucleus pulposus slipped

Bulging of the nucleus

pulposus

Inflammatory response

Releases Cytokines

Causes swelling on the

affected side

Compression of the nerves on

the lumbar

Decreases impulse sent and

Stimulates lower back pain
receive in the lumbar area

Numbness and decreases

range of motion
BIOGRAPHICAL DATA

Personal Data
Name: Mr. JR
Age: 38 y/o
Gender: M
Birth Date: 4-1-1980
Birth Place: Pasig
Marital Status: Married
Nationality: Filipino
Religion: Catholic
Address: 1817 F. Varona St. Tondo, Manila
Occupation: CRO
Ward/Room/Bed: 16th flr- Room # 1624
Admission Date and Time: 2-24-2019 @ 5:31:00 pm
Date Handled: Feb 27, 2019
Admission No.: 40323
Admitting Physician: Dr. M. Gan
Admitting Diagnosis: Slipped Disc
Chief Complaint: Lower back pain
Informant: Wife
Health History
PRESENT HEALTH HISTORY:
Patient is a known case of slipped disc in lumbar area since 2013 and undergone rehab. Few hours upon
admission, patient felt low back pain precipitated when he lifted his baby from bed. Dull in quality, non-
radiating, 8/10, continuous , associated with occasional numbness on left leg. Medicated with Mefenamic
acid 500mg/tab which afforded temporary relief. Persistent of pain prompted result.
PAST HEALTH HISTORY:
According to the patient, he verbalized that he doesn’t have any history of Hypertension, Diabetes Mellitus,
and Asthma. Also, he also stated that he doesn’t have history of allergies whether on food or medications.
(-) on any surgical procedures but, (+) on Slipped Disc since 2013.
FAMILY HISTORY:
The client stated that his family has a history of Hypertension but he didn’t recall on whose side it has.
Either mother of father’s side. But other than that, he verbalized that there’s no other diseases such as
Diabetes Mellitus, Asthma and Cancer that his family has.
Lifestyle and Health Practices
The patient is known to be a non-smoker but occasionally drinks alcohol beverages. He denies for illicit
drug use. He’s a basketball player at their place and company and one reason why he got his Slipped Disc.
The client used to hang out with his friends and teammates and often uses his free time in playing
basketball.
Patterns in seeking health care
The client stated that whenever he feels the on and off lower back pain that he can’t tolerated, he decides
to have a check up and approves for possible confinement in hospital.
REVIEW OF SYSTEMS:
INTEGUMENTARY SYSTEM
Student Nurse: “Sir, may napansin po ba kayong pag babago sa balat ninyo?”
Patient: “Wala naman… “
CARDIOVASCULAR SYSTEM
Student Nurse: “Nakakaranas po ba kayo ng paninikip ng dibdib?”
Patient: “Hindi naman…”
RESPIRATORY SYSTEM
Student Nurse: “May mga pagkakataon po ba a nahihirapan o naghahabol kayo sa hininga?
Patient: “Wala naman...”
GASTROINTESTINAL SYSTEM:
Student Nurse: “Nakakaranas po ba kayo ng hirap sa pag dumi?”
Patient: “Hindi naman...”
GENITOURINARY SYSTEM
Student Nurse: “Sa pag ihi po?”
Patient: “Wala naman din...”
HEMATOLOGIC SYSTEM
Student Nurse: “Mabilis po ba kayong magkasugat o magkapasa?”
Patient: “Hindi naman..”
NEUROLOGICAL SYSTEMS:
Student Nurse: “Nakakaranas po ba kayo ng pagka hilo?”
Patient: “Hindi naman..”
MUSCULOSKELETAL SYSTEM
Student Nurse: “Nakakaramdam po ba kayo ng pananakit mg katawan?”
Patient: “Oo...”
Student Nurse: “Saan banda po sumasakit at tska tuwing kalian po siya sumasakit?”
Patient: “Tuwing gagalaw ako, nahihirapan akong gumalaw, para akong nanghihina di tulad ng dati.
Sumasakit yung dito sa may bandang balakang ko...”
Student Nurse: “Kung sa 1-10 po 10 ang pinakamasakit.. ilan po yung sakit na nararamdaman niyo?
Patient: ‘Mga nasa 4 lang…”
PHYSICAL ASSESSMENT
BODY TECHNIQUE NORMAL ACTUAL REMARKS
PARTS USED FINDINGS FINDINGS
Skin Inspection &  Whitish pink or brown in
palpation color, dark skin tone Fair in skin color, no Normal
depending on patient’s race; lesions, smooth,
no evidence of even firm, no edema
discoloration. present
 No areas of increased
vascularity, ecchymosis and
bleeding.
 No lesions except for
birthmarks or nevi.
 Dry with minimum
perspiration; smooth, even
and firm; no edema present.
Hair Inspection  Color varies from dark black Hair is black in color, Normal
to pale blonde; evenly evenly distributed, no
distributed; no lesions in lesions in the scalp.
scalp; thin, coarse, straight,
thick or curly hair.
Nails Inspection  Pink to brown cast; 2-3 ;2-3 seconds Normal
seconds capillary refill; capillary refill;
smooth, flat and slightly smooth, flat and
rounded. slightly rounded.
Head Inspection  Normocephalic and Normocephalic and Normal
symmetrical, smooth, symmetrical, smooth,
nontender without masses nontender without
and depression. masses and
depression.
Face Inspection  Facial features should be Facial features are Normal
symmetrical; shape can be symmetrical, oval
round, oval or slightly shape; no involuntary
squared; no involuntary movements; no
movements; no edema and edema and
disproportion. disproportion
Neck Inspection  Symmetrical neck muscles; Symmetrical neck Normal
head in full ROM without muscles; head in full
discomfort; no palpable ROM without
masses or enlargement of discomfort; no
lymph nodes and thyroid palpable masses or
glands. enlargement of
lymph nodes and
thyroid glands.
Eyes Inspection  Eyes are aligned; no Eyes are aligned; no Normal
involuntary movement of involuntary
either eyes movement of either
 Both eyes move smoothly eyes, both move
and symmetrically symmetrically; no
 No drooping, infections or drooping, infections
tumors or tumor
 Pink and moist conjunctiva Pink and moist Normal
 Pupil – deep black; round, conjunctiva
and equal in diameter, Pupil- deep black;
constrict briskly to direct round; constrict
light briskly to direct light.
 Ears Inspection  The patient has no hearing
difficulty
 Match the flesh color of the
entire skin; proportional; no
pain or tenderness
Nose Inspection  Symmetrical in the midline
of the face; no lesion,
swelling, bleeding and
masses
Mouth Inspection  Lips – pink and moist with
no evidence of lesions or
inflammation
 Tongue – midline in the
mouth; pink, moist and
rough; no lesions and
swelling, moves freely
 Gums – pale red strippled
surface; no swelling or
bleeding with teeth
Thorax Inspection&  No accessory muscles are
Auscultation used in normal breathing
 Vesicular breath sounds
The patient has no Normal
hearing difficulty; no
pain or tenderness.
Symmetrical in the Normal
midline of the face;
no lesion, swelling,
bleeding and masses
Lips – pink and moist Normal
with no evidence of
lesions or
inflammation
Tongue- no lesions
and swelling
Gums- no swelling or
bleeding with teeth
No accessory Normal
muscles are used in
normal breathing;
Normal breath
sounds

Chest Inspection&  Symmetrical; no vibrations, Symmetrical; no Normal

Auscultation thrills and expansions noted vibrations, thrills and
 Regular rhythm expansions noted;
 Distinguishable s1 and s2; regular rhythm
no murmurs
Abdome Inspection  Flat or rounded; Flat or rounded; Normal
n symmetrical bilaterally; no symmetrical
discoloration bilaterally; no
 Umbilicus – depressed and discoloration
beneath abdominal surface Umbilicus –
depressed and
beneath abdominal
surface
Upper Inspection  Able to perform full ROM Able to perform full Normal
Extremiti  No swelling or inflammation ROM; No swelling or
es  Has 5 fingers on each hand; inflammation; no
no numbness or paralysis numbness or
paralysis

Lower Inspection  Able to perform full ROM Able to perform Abnormal

Extremiti  No swelling or inflammation
es  Has 5 fingers on each foot;
no numbness or paralysis
active and passive A lumbar strain is the most
ROM; with muscle common cause of back
stiffness at L5 to S1; stiffness. This occurs as a
result of an injury to the
back muscles and
ligaments that support the
spinal column.
https://www.verywellhealt
h.com/back-pain-
symptoms-stiffness-
2549270
DIAGNOSTIC TEST
Magnetic Resonance Imaging is a medical imaging technique used in radiology to form pictures of the
anatomy and the physiological processes of the body in both health and disease. MRI scanners use strong
magnetic fields, magnetic field gradients, and radio waves to generate images of the organs in the body.
Date: 2/25/2019
Procedure: Mri of the lumbar Spine
Clinical Manifestation: Low Back Pain
Comparison: None
Findings:
There is straightening of the lumbar lordosis.
Vertebral body heights are maintain.
Conus medullaris at L1-L2.
No spinal/ paraspinal mass noted.
IMPRESSION:
Staightened lumbar spine likely to muscle spasm.
Diffuse disc bulgers, more pronounced in L5-S1 with disc sequuestrationat this level causing mild right
nueral forminal narrowing, severe left nueral foraminal narrowing, and moderate to severe spinal
canalnarrowing.
MEDICAL AND SURGICAL MANAGEMENT
Often no diagnostic tests are needed for adequate treatment. In certain situations, imaging studies or
laboratory tests of blood and urine may provide your doctor further information necessary to establish a
diagnosis. If needed at all, they may not be necessary immediately for a diagnosis. Sometimes they are
ordered later if basic treatments fail to improve your condition.
Plain X-rays (and even computerized axial tomography, CAT scans) cannot depict a prolapsed
disc and can only identify bony abnormalities.
 X-rays are best used to evaluate back pain that is from causes other than a prolapsed
disc, such as bony displacement, tumor, or broken bone. Most young or middle-aged
people without a history to suggest trauma or suspicion of a tumor are best served
without the expense and radiation associated with obtaining these X-rays. In most cases,
the bones seen on X-ray are normal.
Magnetic Resonance Imaging (MRI) or myelogram (which involves injecting a contrast dye into
the spinal column).
 Ideal for diagnosing a deformed disc and how a specific nerve is affected. In the absence
of signs or symptoms suggesting severe nerve damage, however, these studies are very
rarely necessary early in the course of the evaluation. This is because of the fact that the
findings rarely affect initial treatment decisions. Your doctor may obtain these tests after a
course of treatment fails to provide you relief over a period of four to six weeks.
Bone Scan
 Can detect infection, healing fractures, or tumors. This test is rarely ordered as part of an
emergency evaluation but may be part of a further evaluation to find the cause of your
symptoms.

A herniated disk can press on the nerves in your spine and cause pain, weakness, and numbness in your
neck, back, arms, and legs. Sometimes these symptoms can be severe enough to disrupt your life. Most of
the time, though, the problems from your herniated disk should start to improve on their own within a few
weeks.

Rest

 Take it easy for a few days. Rest can relieve swelling and give your back time to heal. While your
back hurts, avoid exercise and other activities where you have to bend or lift.
 .
Your doctor might suggest that you rest in bed Bed rest is fine for a short period of time, but don't
stay off your feet for longer than 1 or 2 days. You need to keep moving so your joints and muscles
don't stiffen up.
 You can also use ice and heat to help relieve your pain. Just place an ice pack or warm wet towel
on the area of your back that is sore. You can alternate hot and cold, or use whichever feels best.

Physical Therapy

Some exercises can help improve the symptoms of a herniated disc. A physical therapist can teach you
which ones strengthen the muscles that support your back. Physical therapy programs also include:

• Stretching exercises to keep your muscles flexible

• Aerobic exercises -- such as walking or riding a stationary bicycle

• Massage
• Ice and heat

• Ultrasound therapy

Electrical muscle stimulation

SURGERY

Most people with a herniated disk don't need surgery. Rest and other treatments should start to improve
your symptoms within 4 to 6 weeks. But if your pain doesn’t improve, surgery might be an option.

Talk to your doctor about surgery if:

• You’re not getting relief from pain relievers, injections, and physical therapy.

• Your symptoms keep getting worse.

• You have trouble standing or walking.

You can't control your bowels or bladder.

Diskectomy. During this procedure, your surgeon removes your damaged disk to relieve pressure on your
nerves. He can perform the surgery in a couple of ways:

• Your surgeons performs open diskectomy is via a cut in your back or neck.

• Microdiscectomy is done through a much smaller incision. Your surgeon inserts a thin tube with a
camera on one end to see and remove the damaged disk.

Lumbar laminotomy. Sometimes your surgeon will also need to remove a small piece of bone called the
lamina from the vertebra. The lamina forms a protective cover over your spinal cord. Removing part or all of
it helps the surgeon access your herniated disk. It also can relieve pressure on your nerves and eliminate
leg pain and sciatica.

 The lamina can be removed during the diskectomy. Or, you might have it taken out in a separate
surgery.

Spinal fusion. After a diskectomy or laminotomy, your surgeon may fuse together the two vertebrae on
either side of the disk to stabilize your spine. This is called spinal fusion. Fusing the two disks will stop the
bones from moving and prevent you from having any more pain.

Artificial disk surgery. Only a few people are good candidates for artificial disk surgery because it only
works on certain disks in your lower back. But if your doctor thinks this is an option, he will replace your
damaged disk with one made of plastic or metal. The new disk will help keep your spine stable and let you
move more easily.
MEDICAL MANAGEMENT
Intravenous Therapy
Intravenous fluid regulation is the control of the amount of fluid you receive intravenously, or
through your bloodstream. The fluid is given from a bag connected to an intravenous line. This is a thin
tube, often called an IV, that’s inserted into one of your veins.

Fluids are administered this way for various reasons, all of which require control of the amount
given. Without control, the rate of fluid administration relies on gravity alone. This can result in receiving
either too much or too little fluid.Intravenous infusions are commonly referred to as drips. The intravenous
route is the fastest way to deliver fluids and medications throughout the body.

Purposes:
There are several reasons why you might need to have fluids administered intravenously. For instance,
some treatments rely on IV delivery. These include:
1. rehydration after becoming dehydrated from illness or excessive activity
2. treatment of an infection using antibiotics
3. cancer treatment through chemotherapy drugs
4. management of pain using certain medications
D5W250+ 200mg tramaline
Type: Isotonic
Indication: Infusion is used to maintain fluid balance in conditions such as severe dehydration.
Action: replace lost fluids and provide carbohydrates to the body. Dextrose 5% in water is used to
treat low blood sugar (hypoglycemia), insulin shock, or dehydration (fluid loss).
Tramaline- For Neuropathy, Nerve Pain and Lower Leg Issues
DATE/TIME IVF CC/HR Remarks
2-24-2019 D5W250+ 200mg tramaline 10 gtts/min CONSUMED
2-25-2019 D5W250+ 200mg tramaline 10 gtts/min CONSUMED
2-27-2019 D5W250+ 200mg tramaline 10 gtts/min
Diet
Dietary regulation depends on the severity of the disease. Therapeutic diets involve modification of
food intake to supplement the needs of the client’s body. The eating pattern of the client is prepared by the
nutritional components necessitated by a client’s disease state or nutritional status, or to prepare a client for
procedure.
Diet as tolerated
Diet as tolerated is a diet planned to meet the nutritional needs of the client.
DRUG STUDY
Name of Drug Route/Dosage & Therapeutic use Action Contraindication Adverse Effects Nursing
Frequency Considerations
Generic Name: Oral Route Diclofenac is a potent inhibitor of Gi:ulcer,bleeding,hepatic,r CNS: Monitor for increased
Diclofenac Potassium used to cyclooxygenase, enal impairment Dizziness, headache, drowsiness. serum sodium and
Dose:50mg/tab
relieve pain, thereby decreasing Special Senses: potassium in patients
Brand Name:
BID swelling the synthesis of Tinnitus. Skin: Rash, pruritus. receiving potassium-
Cataplam
(inflammation), prostaglandins. GI: sparing diuretics.
classificationNSAIDS and joint stiffness Contraindication:Asp Dyspepsia, nausea, vomiting,
Monitor weight and
caused irin,asthma or abdominal pain, cramps, constipation,
report gains greater than
by arthritis allergy. diarrhea,
1 kg (2 lb)/24 h.
CV:
Fluid retention, hypertension, CHF. Monitor for signs and
Respiratory: symptoms of GI irritation
Asthma. and ulceration.
Body as a Whole:
Back, leg, or joint pain.
Generic Name: Oral Route treatment of Binds with high Hypersensitivity to the dizziness, Monitor hypersensitivity
Pregabalin neuropathic pain affinity to the alpha2- active substance or to any ataxia, of pt to drug and other
75mg/tab
in adults. As delta site( an of the excipients disturbance in attention, component. -monitor for
Brand Name:
OD adjunctive auxiliary subunit of memory impairment, decreased platelet count
Lyrica
therapy of partial voltage-gated tremor and
Monitor for elevated
Classification: seizures with or calcium channels) in dysarthria
creatine kinase
anticonvulsants without CNS tissues
secondarily
generalization in
patient aged 12
Nursing Management:

 Encourage the patient to move his legs, as allowed.

 Work closely with the physical therapy department.
 Schedule activity and procedures with rest periods. Encourage participation in ADLs within
individual limitations.
 Provide and assist with passive and active ROM exercises depending on physical therapist.
 Assist with activity and progressive ambulation.
 Review proper body mechanics and techniques for participation in activities.
 Monitor V/S as per doctors order.
 Encourage Diversionary therapy.
 Maintain Quiet Environment.
 Maintain Clients privacy.
 Advice patient to find his comfort lying spot to prevent stimulation of pain.

TOP 3 NURSING PRIORITIES:

1. Impaired physical mobility related to limitations Imposed By Condition; Pain as evidenced
by decreased muscle strength or control, limited ROM, numbness and weakness
2. Alteration in comfort related to pain
3. Risk for injury
 CUES NURSING RATIONALE PLANNING NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION

Subjective: Impaired physical Impaired physical Short Term Goal: Independent: Short Term Goal:
mobility related to mobility limits
“ nahihirapan na After 4 to 8 hours of -Encourage the -patient participation After 8 hours of
limitations Imposed independent,
akong gumalaw nursing interventions patient to move his promotes nursing interventions
By Condition; Pain purposeful physical
ngaun di tulad dati the client will be able legs, as allowed independence and the client was able
as evidenced by movement of the
dahil baka lalong to: sense of control to:
body or of one or
sumakit itong likod decreased muscle
more extremities. It -Demonstrate -Review proper body -Reduces risk of -Demonstrated
ko“ as verbalized by strength or control,
can be transient, techniques or mechanics and muscle strain, injury,
the client techniques or
limited ROM, recurring or more behaviors that techniques for pain and increases
permanent problem. behaviors that
numbness and enable resumption of participation likelihood of patient
enable resumption of
weakness activities activities involvement in
activities such as
progressive activity
passive or active
Objective:
-Provide and assist -It helps strengthens ROM
- Decreased muscle with passive and muscles and flexors
Goal partially met
strength or control active ROM exercise of spine also
Reference:
promotes good body Long Term Goal:
- Limited ROM Long Term Goal: mechanics
Medical Surgical
After 4 days of
-Numbness Nursing 10th After 3 to 4 days of -Encourage -Patient participation nursing interventions
edition: nursing interventions
-Weakness participation in ADL’s promotes the client able to:
the client will be able within individual independence and
pp- 1889
to: limitations sense of control -Maintained and
increased
-Maintain or increase
strength and function strength and function
of affected body part Dependent: -To ensure the of affected body part
such as performing consistent regimen such as performing
-Work closely with
full ROM of leg and back full ROM
the physical therapy
strengthening
department Goal partially met
exercise
Discharge Plan
Medication:

Brand Name Classification Action

Tramadol ( Tramal) Narcotics To treat moderate to severe

pain.

Exercise:

Any exercise that do not stress your back muscles may help decrease your pain. Examples of low-stress
exercises are walking, swimming, and biking. Avoid heavy lifting while your back is healing. Try not to sit for
long periods of time. Talk to your healthcare provider before you start any new exercise program.

Treatment:
Health Teaching:

Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping
or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines,
vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the
pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Out Patient Referral:

Refer patient to Physical Therapist to maintain or improve the quality of life.

Diet:
An anti-inflammatory diet can help reduce the pain associated with bulging discs. Fiber-rich foods and
green vegetables are critical to reducing inflammation. Reducing red meat consumption and eating more
fish can help provide your body with the nutrients it needs to recover from a bulging disc.