D.Y.

Patil Education Society (Institution deemed to be university)

D.Y. Patil College of Nursing, Kolhapur

LESSON PLAN
ON
prolapsed Intervertebral disc
Submitted to: Mr.Rohan Phape
Asst Prof, Dept of Medical
Surgical Nursing

Submitted by: Mrs. Susmita Mark Dhanawade

M.Sc. (N) 1st Year
Speciality Medical Surgical Nursing

Submitted on:
Programme : M.Sc. Nursing
Subject :Medical Surgical Nursing
Topic : Intervertebral Disc Prolapsed
Group : B.Sc (N) – II Year, 3rd Semister
Teaching method :Lecture cum discussion
A.V. Aids :Black board, projector, posters, roller board, pamphlets.
Student teacher : Mrs.Susmita Mark Dhanawade
Guide :Mr. Rohan Phape
Evaluator : Mr. Rohan Phape
Venue : B.Sc. (N) II Year Lecture Hall
Date :
Time :

Previous Knowledge of the students:

Students have some knowledge regarding spinal cord and anatomy and physiology.
.
General objective:
At the end of the class students will be able to gain adequate knowledge about intervertebral disc prolapse its definition,
causes, signs and symptoms, risk factors, pathophysiology, management and diagnostic evaluation.
Specific Objectives:
At the end of this session, the student will be able to,
- Define intervertebral disc prolapse.

- Enlist into logical factors of intervertebral disc prolapse.

- List down the risk factors of intervertebral disc prolapse.

- Explain in detail about the pathophysiology of intervertebral disc prolapse.

- Enumerate the signs and symptoms of intervertebral disc prolapse.

- Discuss about the diagnostic evaluation of intervertebral disc prolapsed.

- Discuss about the management of the intervertebral disc prolapse.

Bibliography:

1. Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s textbook of medical-
surgical nursing (12th ed.). Philadelphia: Lippincott Williams & Wilkins.

2. Sommers m, Johnson s, beery t. DISEASES AND DISORDERS DISEASES AND DISORDERS A Nursing
Therapeutics Manual. 3rd ed. Philadelphia: F. A. Davis Company; 2007.

3. Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s textbook of medical-
surgical nursing (10th ed.). Philadelphia: Lippincott Williams & Wilkins.

4. Williams l, hopper p. Understanding medical surgical nursing. 5th ed. Philadelphia: f.a. Davis company; 2011.

5. Kasper, Braunwald, Fauci, Harrison’s principles of internal medicine. 16th ed. New Delhi: McGraw-Hill medical
publishing division; 2005.
Sr.No. Time Specific Content Teacher’s Student’s AV aids Evaluation
Objectives Activity Activity
1. 2 SELF INTRODUCTION
mins Good morning, sir, good morning students myself
Mrs. Susmita Dhanawade student of M.Sc. nursing 1st
year. As a part of my nursing education curriculum
today I m going to engage your class.
2. Explain Listening PPT
Anatomy and Physiology:
3min ing and
The human spine consists of 33 vertebra, but some of answerin
them grow together in adults. There are 7 cervical g
questions
(neck), 12 thoracic (chest region), 5 lumbar (lower
back), 5 sacral and 5 coccygeal (tail bone region)
vertebra. The vertebras are held in place by muscles
and strong connective tissue called ligaments. Most
vertebras have fibrous intervertebral discs between
them to absorb shock and enable the spine to bend.
Between two vertebral bodies there is a cartilaginous
connection that is called intervertebral disc. Because it
is situated between two vertebral bodies, it is called
inter-vertebral disc. Vertebral body and intervertebral
disc are firmly joined together.
3.

3 Define DEFINITION: Roller

Sr.No. Time Specific Content Teacher’s Student’s AV aids Evaluation
Objectives Activity Activity
mins interver Explain bord
tebral It is a condition where the central gelatinous part of ing
disc
the intervertebral disc moves out of its position. It is
collapse Listening
. usually a consequence of gradual changes in the disc, and
answerin
which ultimately lead to its prolapse.
g
questions
4. 4 Enumer CAUSES Explain Listening Hand
mins ate the ing and outs
causes  Degenerative changes in disc due to aging. answerin
of However, in very old individuals, the discs may g
interver questions
tebral undergo fibrosis and therefore, prolapse is rare
disc  History of preceding trauma such as a fall or a
prolaps
e. blow to the back
 Lifting something heavy which puts pressure on
the back
 Pushing something heavy
 Contact sports which can lead to injury, so
athletes are at greater risk of disc prolapse
Sr.No. Time Specific Content Teacher’s Student’s AV aids Evaluation
Objectives Activity Activity

5. 4 In list SIGN AND SYMPTOMS Explain Listening Pamphl

mins the ing and ets
signs Low Backache: answerin
and g
Herniated disc causes severe backache, especially with
sympto questions
ms of movement. The spine is held rigid and in extreme
interver
cases, patients may not be able to do daily routine
tebral
disc work. In prolapse occurring over a prolonged period,
collapse
the pain is dull and worsens with exertion, forward
.
bending, or sitting or standing in one position for a
long time. It reduces with rest.

Sciatic Pain: If the disc prolapse occurs at the upper

back, the pain may radiate to the front of the thigh.
The radiation may begin with walking and is relieved
by rest.

- Muscle spasm, tingling sensation, weakness

or atrophy.
Sr.No. Time Specific Content Teacher’s Student’s AV aids Evaluation
Objectives Activity Activity
- loss of bladder or bowel control.
- Asymptomatic.
- Slow and deliberate, tip-toe walking.
- Spine, trunk deviation.
- Antalgic or Trendelenburg gait.
- Paraspinal muscle spasm.
- Deepresion of deep tendon reflexes.
- Aggrevation of pain by straining (Cough,
Defecation, Bending, lifting and straight leg
raising)
6. 4 List RISK FACTORS Explain Listening PPT
mins down  Weight. Excess body weight causes extra stress ing and
the risk on the disks in the lower back. answerin
factors g
of  Occupation. People with physically demanding questions
interver jobs have a greater risk of back problems.
tebral
disc  Genetics. Some people inherit a predisposition
relapse. to developing a herniated disk.
Sr.No. Time Specific Content Teacher’s Student’s AV aids Evaluation
Objectives Activity Activity
 Smoking.
 Frequent driving.
 Being sedentary.

7. 8 Explain PATHOPHYSIOLOGY Explain Listening PPT

mins in detail ing and
about The disc consists of the annulus fibrosus (a complex answerin
the series of fibrous rings) and the nucleus pulposus (a g
pathoph questions
ysiolog gelatinous core containing collagen fibers, elastin
y of fibers and a hydrated gel). The vertebral canal is
interver
tebral formed by the vertebral bodies, intervertebral discs
disc and ligaments on the anterior wall and by the
prolaps
e. vertebral arches and ligaments on the lateral wall.
The spinal cord lies in this vertebral canal .

The pathophysiology of herniated discs is believed

to be a combination of the mechanical compression
of the nerve by the bulging nucleus pulpous and the
local increase in inflammatory chemokines.
Sr.No. Time Specific Content Teacher’s Student’s AV aids Evaluation
Objectives Activity Activity

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.

The changes consist of nuclear degeneration,

nuclear displacement and stage of fibrosis.

8. 5 DIAGNOSTIC EVALUATION Explain Listening PPT

mins ing and
 History collection answerin
g
Age, Past and Present history, Occupation, questions
Gender etc.

 Physical examination

Spinal Examination

 Imaging-

 MRI Scan
Sr.No. Time Specific Content Teacher’s Student’s AV aids Evaluation
Objectives Activity Activity
 CT Scan

 Back X-ray Scan

9. 10 Discuss MANAGEMENT Explain Listening PPT
mins about MEDICAL ing and
the Acute cervical and lumbar radiculopathies due to answerin
manage g
herniated disc are primarily managed with non-
ment of questions
interver surgical treatments.
tebral
disc
prolaps  NSAIDs and physical therapy are the first-
e. line treatment modalities.
 Oral steroids like prednisone, methyl
prednisone.
 Benzodiazepines of low dose.
 Translaminar epidural injections and
selective nerve root blocks are the second
line modalities. These are good modalities
for managing disabling pain.
 Patients who fail conservative treatment or
Sr.No. Time Specific Content Teacher’s Student’s AV aids Evaluation
Objectives Activity Activity
patients with neurological deficits need
timely surgical consultation
 Antispasmodic Drug (eg. Akineton,
Bentyl, Neosol, Norflex)
 Muscle Relaxant drugs (eg Baclofen,
Tizanidine, Metaxalone )

SURGICAL

As always surgical treatment is the last resort.

 Surgical treatments for a herniated disc

include laminectomieswith discectomies,
microdiscectomies depending on the
cervical or lumbar area.
 Patients with a herniated disc managed via
anterior cervical decompression and
Sr.No. Time Specific Content Teacher’s Student’s AV aids Evaluation
Objectives Activity Activity
fusion. This patient is managed
with artificial disk replacement.
 Other alternative surgical approaches to
requires complete discectomy and fusion.
 Nucleoplasty
 Chemonucleolysis
 Disk arthroplasty

NURSING MANAGEMENT

Nursing care of the medical client focuses on

o assisting the client to adjust his or her lifestyle to

reduce the risk of further back injuries.
o Teach the clients regarding the client safe methods
to lift and bend, how to lie down and rise up from
bed to avoid twisting,
o Advice to take NSAID’S correctly to reduce the
risk of gastric ulceration. If client requires opoids
Sr.No. Time Specific Content Teacher’s Student’s AV aids Evaluation
Objectives Activity Activity
for pain, instruct the client to eat high-fiber foods
to reduce constipation, to avoid alcohol, and to not
operate machinery or drive.
o Preoperative assessment should include motor and
sensory function of extrimities and psychological
readiness for surgery.
o Postoperatively

1. A head-to- toe assessment is done.

2. Evaluate the pain and response to analgesia.
3. Assess the neurological status by asking the
client to move his or her legs and comparing
the result with those of the baseline
evaluation.
4. Ask client about the numbness or tingling
sensation or pain. If progressive weakness or
paralysis of the lower extremities, loss of the
sphincter control, anal numbness or urinary
Sr.No. Time Specific Content Teacher’s Student’s AV aids Evaluation
Objectives Activity Activity
retention (caudaequina syndrome) occurs,
notify the physician immediately.
5. Compressive devices on the legs are used to
improve the venous return.
6. Assess the wound for bulging or clear
drainage which may indicate CSF leakage.

PROGNOSIS:

Most people will improve with conservative

treatment. A small percentage may continue to have
chronic back pain even after treatment.It may take
several months to a year or more to resume all
activities without pain or strain to the back. People
with certain occupations that involve heavy lifting or
back strain may need to change job activities to avoid
recurrent back injury.
Sr.No. Time Specific Content Teacher’s Student’s AV aids Evaluation
Objectives Activity Activity
1. 3 SUMMARY Summa Listening PPT
mins I would like to summarize my topic. So, today in this rizing
lecture we have learned about the intervertebral disk
prolapse, its definition, causes, signs and symptoms,
risk factors, pathophysiology, diagnostic evaluation
and management
2.
CONCLUSION

2 I would like to conclude my topic. So, today we have Conclu Listening PPT
mins ding
learned about intervertebral disk prolapse. I hope this
lecture will be helpful for you in your academics as
well as in the clinical sector.

1) ASSIGNMENT:

Write about the nursing management for prolapsed intervertebral disc.