cp sciatica

8/11/2019 Cp Sciatica

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Table of Contents

I. Introduction-----------------------------------------------------------------------------

a. Overview of the case----------------------------------------------------------------

b. Objective of the study---------------------------------------------------------------

c. Scope & Limitation-------------------------------------------------------------------

II. Health History---------------------------------------------------------------------------

a. Profile of the patient-----------------------------------------------------------------

b. amily & Personal Profile----------------------------------------------------------

III. Data Base & History

a. Chief Complains ---------------------------------------------------------------------

b. !istory of Present "llness----------------------------------------------------------

IV. Developmental Data-------------------------------------------------------------------

V. Medical Management-----------------------------------------------------------------

a. #edical Orders & rationale--------------------------------------------------------

b. $ru% Study----------------------------------------------------------------------------

VI. Anatomy & physiology----------------------------------------------------------------

VII. Pathophysiology-----------------------------------------------------------------------

VIII. Nursing Assessment-----------------------------------------------------------------

I. Nursing Management----------------------------------------------------------------

a. "deal ursin% #ana%ement-----------------------------------------------------

b. 'ctual ursin% #ana%ement----------------------------------------------------

. !e"errals & #ollo$-up----------------------------------------------------------------

I. %valuation & Implication------------------------------------------------------------

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I. Introduction

a. vervie$ o" the case

'ciaticais a set of symptoms includin% pain that may be caused by %eneral

compression or irritation of one of five spinal nerve roots that %ive rise to each sciatic

nerve( or by compression or irritation of the left or ri%ht or both sciatic nerves. The pain

is felt in the lower bac)( buttoc)( or various parts of the le% and foot. "n addition to pain(

which is sometimes severe( there may be numbness( muscular wea)ness( pins and

needles or tin%lin% and difficulty in movin% or controllin% the le%. Typically( the symptoms

are only felt on one side of the body. Pain can be severe in prolon%ed e*posure to cold

weather.

'lthou%h sciatica is a relatively common form of low bac) pain and le% pain( the true

meanin% of the term is often misunderstood. Sciatica is a set of symptoms rather than a

dia%nosis for what is irritatin% the root of the nerve( causin% the pain. This point is

important( because treatment for sciatica or sciatic symptoms often differs( dependin%

upon the underlyin% cause of the symptoms and pain levels. Sciatica is also referred to

as Lumbar +adiculopathy( which involves compression of the sciatic nerve roots caused

by a herniated ,torn or protrudin% disc in the lower bac).

(. ()ective o" the study

This case study aims to present all the details about patients condition( its causative

factors( and its dama%e to human physiolo%y and so with its underlyin% complication if

left untreated. This can be achieved throu%h research( with the use of the clients

hospital records( article referred and other materials and interviewin% the client durin%

hospitali/ation also to formulate a complete and comprehensive definition of the causes.

0nderstand the medical principles that accompany Sciatica. 0sed insi%ht on appropriate

nursin% care and mana%ement that a client with the same ailments which is needed in

the future.

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c. 'cope & *imitation o" the study

The scope of this study shows the overview of the patients condition( the anatomy

and patholo%y of the system affected by the said condition( the different dia%nostic test

and the interpretation of each result( the dru% study of the different dru%s administered

to the client to aid her condition( the appropriate nursin% mana%ement as well as its

rationale for the wellness of the client and lastly the nursin% interventions %iven durin%

the duration of our rotation. The study is limited only on the basic conditions of Sciatica

that was manifested by the client. The nursin% interventions %iven were only

fundamental care to the client just prior to our limited )nowled%e and s)ills and more

importantly( the study ensures the confidentiality of all the information divul%ed by thepatient.

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II. Health History

a. Pro"ile " Patient

Name + 1duardo C. 2utierre/ 3r.

Address + 4one 5 Pata% Ca%ayan de Oro City

Birthday + September 6 7855

Birth Place + Ca%ayan $e Oro City

Age + 9: years old

ccupation + Soldier

Income per month + ;


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III. DAA BA'% HI'!/

Name o" patientA 1duardo 2utierre/ 3r.'e0+male Age+9: y=o !eligion++oman Catholic

ivil 'tatusA #arried IncomeA ;


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IV. Developmental Data

#reud,s heory o" Psychose0ual Development

Genital phaseThe fifth and last sta%e of psycho-se*ual development( the %enital sta%e( lasts

from puberty onward ,i.e. startin% at 7; years of a%e. "t is said to continue until

development stops( which is supposedly at 7> years of a%ewhen adulthood starts. This

sta%e represents a major portion of life and the basic tas) for the individual is

detachment from parents. "t is also the time when the individual tries to come to terms

with unresolved residues of early childhood. "n this sta%e( the focus is a%ain on the

%enitals( li)e in the phallic sta%e( but this time the ener%y is e*pressed in terms of adultse*uality. 'nother crucial difference between these two sta%es is that( while phallic

%ratification is lin)ed with satisfaction of primary drives( the e%o in the %enital sta%e is

well-developed. "t uses secondary( process thin)in%( which allows for symbolic

%ratification. This symbolic %ratification may include the formation of love relationships(

development of families( or acceptance of responsibilities associated with adulthood.

%ri4son,s heory o" Psychosocial Development

are+ 5enerativity vs. 'tagnation 6Middle Adulthood7 89 to :9 years;

Psychosocial CrisisA 2enerativityvs. Sta%nation #ain IuestionA JKill " produce somethin% of real valueJ

DirtueA Care

+elated 1lements in SocietyA parentin%( educatin%( or other productive socialinvolvement

2enerativity is the concern of establishin% and %uidin% the ne*t %eneration. Socially-valued wor) and disciplines are e*pressions of %enerativity. Simply havin% orwantin% childrendoes not in and of itself achieve %enerativity.

$urin% middle a%e the primary developmental tas) is one of contributin% to society andhelpin% to %uide future %enerations. Khen a person ma)es a contribution durin% thisperiod( perhaps by raisin% a family or wor)in% toward the betterment of society( a senseof %enerativity- a sense of productivity and accomplishment- results. "n contrast( a

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http://en.wikipedia.org/wiki/Genital_stagehttp://en.wikipedia.org/wiki/Generativityhttp://en.wikipedia.org/wiki/Stagnationhttp://en.wikipedia.org/wiki/Childrenhttp://en.wikipedia.org/wiki/Generativityhttp://en.wikipedia.org/wiki/Stagnationhttp://en.wikipedia.org/wiki/Childrenhttp://en.wikipedia.org/wiki/Genital_stage


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person who is self-centered and unable or unwillin% to help society move forwarddevelops a feelin% of sta%nation- a dissatisfaction with the relative lac) of productivity.Central tasks of Middle Adulthood

1*press love throu%h more than se*ual contacts. #aintain healthy life patterns.

$evelop a sense of unity with mate.

!elp %rowin% and %rown children to be responsible adults.

+elinMuish central role in lives of %rown children.

'ccept childrenNs mates and friends.

Create a comfortable home.

He proud of accomplishments of self and mate=spouse.

+everse roles with a%in% parents.

'chieve mature( civic and social responsibility.

'djust to physical chan%es of middle a%e.

0se leisure time creatively.

Love for others

1isdom+ %go Integrity vs. Despair 6seniors7 :9 years on$ards;

Psychosocial CrisisA 1%o "nte%rityvs. $espair #ain IuestionA J!ave " lived a full lifeJ

DirtueA Kisdom

's we %row older and become senior citi/ens we tend to slow down our productivity ande*plore life as a retired person. "t is durin% this time that we contemplate ouraccomplishments and are able to develop inte%rity if we see ourselves as leadin% asuccessful life. "f we see our life as unproductive( or feel that we did not accomplish our

life %oals( we become dissatisfied with life and develop despair( often leadin% todepression and hopelessness.The final developmental tas) is retrospectionA people loo) bac) on their lives andaccomplishments. They develop feelin%s of contentment and inte%rity if they believe thatthey have led a happy( productive life. They may instead develop a sense of despair ifthey loo) bac) on a life of disappointments and unachieved %oals.

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http://en.wikipedia.org/wiki/Ego_Integrityhttp://en.wikipedia.org/wiki/Despairhttp://en.wikipedia.org/wiki/Ego_Integrityhttp://en.wikipedia.org/wiki/Despair


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Drug Study

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VI. Drugstudy

Name o"Drug

Date lassi"ication

Dose2#re3uency2

!oute

Mechanismo" Action

'peci"icIndication6$hy drugis ordered;

ontra-indication

'ide%""ects2o0ic

%""ects

NursingPrecaution

Pre%abalin

,Lyrica

7;=7;=7;

Painreliever(antisei/ures

:


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conseMuence(inflammationand itsaccompanyin%pain( fever(swellin% andtenderness arereduced.

"tule!e% "!d&!som!&"e"*!ess+

ameA 1duardo 2utierre/ 3r.

Name o"Drug

Date lassi"ication Dose2#re3uency

2!oute

Mechanism o"Action

'peci"icIndication6$hy drug

is

ordered;

ontra-indication

'ide%""ects2o0ic

%""ects

NursingPrecaution

Dit Hcomple*

7;=79=7;

Ditamins'nd#inerals

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and myelinsynthesis

diarrhea.+espiAPulmonaryedema.S)inAitchin%(transitorye*anthema(urticaria.

reaction9. 2ivedru%s withmeal tominimi/e 2"distress.

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The spinal cordcomes off the base of the brain( runs

throu%hout the cervical and thoracic spine( and ends at the

lower part of the thoracic spine.Therefore( spinal cord injury or

dama%e may accompany trauma or diseases of the cervical spine or thoracic

spine.The spinal cord does not run throu%h the lumbar spine ,lower bac). 'fter

the spinal cord stops in the lower thoracic spine( the nerve rootsfrom the

lumbar and sacral levels come off the bottom of the cord li)e a Jhorses tailJ

,cauda eMuina and e*it the spine ,view the spinal nerve roots with #igure


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(esity.Hy increasin% the stress on your spine( e*cess body wei%ht may contribute tothe spinal chan%es that tri%%er sciatica.ccupation.' job that reMuires you to twist your bac)( carry heavy loads or drive amotor vehicle for lon% periods may play a role in sciatica( but thereNs no conclusiveevidence of this lin).

Prolonged sitting.People who sit for prolon%ed periods or have a sedentary lifestyleare more li)ely to develop sciatica than active people are.Dia(etes.This condition( which affects the way your body uses blood su%ar( increasesyour ris) of nerve dama%e.

Trauma

(,eh&ul"r "&de!t)

piriformis muscle

Shorte!s or s'"sm

Com'resses S&"t& !er#e

Tin%lin% pain

s=s umbness %oin% down to lower e*tremities

intense pain when wal)in% or prolon% sittin%

I. Nursing Assessment

Nursing 'ystem !evie$ hart

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%%N+Q R impaired vision Q R blindQ R pain redden Q R draina%eQ R %ums Q R hard of hearin% Q R deafQ R burnin% Q R edema Q R lesion teethQ R assess eyes ears noseQ R throat for abnormalityQ * R no problem

!%'P+Q R asymmetric Q R tachypnea Q R barrel chestQ R apnea Q R rales Q R cou%hQ R bradypnea Q R shallow Q R rhonchiQ R sputum Q R diminished Q R dyspneaQ R orthopnea Q R labored Q R whee/in%Q R pain Q R cyanoticQ R assess resp. rate( rhythm( pulse bloodQ R breath sounds( comfortQ* R no problemA!DIVA'=*A!+Q R arrhythmia Q R tachycardia Q RnumbnessQ R diminished pulses Q R edema Q R fati%ueQ R irre%ular Q R bradycardia Q R mur murQ R tin%lin% Q R absent pulses Q R pain

'ssess heart sounds( rate rhythm( pulse( bloodPressure( circ.( fluid retention( comfort

Q *R no problem5A'!IN%'INA* !A+Q R obese Q R distention Q R massQ R dyspa%ea Q R ri%idity Q R painQ R assess abdomen( bowel habits( swallowin%Q R bowel sounds( comfortQ *R no problem5%NI > =!INA!/ AND 5/N%Q R pain Q R urine Q R color Q R va%inal bleedin%Q R hematuria Q R dischar%e Q R nucturiaQ R assess urine freMuency( control( color( odor( comfortQ R %yne bleedin%Q R dischar%eQ * R no problemN%=!+Q R paralysis Q R stuporus Q R unsteady Q R sei/ureQ R lethar%ic Q R comatose Q R verti%o Q R treamorsQ R confused Q R vision Q R %ripQ R assess motor( function( sensation( LOC( stren%thQ R %rip( %ait( coordination( speech Q * R no problemM='=*'?%*%A* and '?IN+Q R appliance Q R stiffness Q R itchin% Q R petechieQ R hot Q R draina%e Q R prosthesis Q R swellin%Q R lesion Q R poor tur%or Q R cool Q R flushedQ R atrophyQ =R pain Q R ecchymosis Q R diaphoretic moistQ R assess mobility( motion %ait( ali%nment( joint functionQ R s)in color( te*ture( tur%or( inte%rityQ R no problem

N=!'IN5 A''%''M%N II

SUBJECTIVE OBJECTIVE

COMMUNICATION:- . /e"r&!g loss- . #&su"l h"!ges

- .l"sses - .

"!gu"ge

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m"*"*&t" m"! *o

ug m"*" du!go!g

"s #erb"l&ed by

the '"t&e!t

ed!ess

r&ght eye

"&! lumb"r

"re" r"d&"t&!g

to loer

umb!ess r&ght


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-. de!&ed - .Co!t"t le!s - ./e"r&!g

"&de u'&l s&e 3mm - .S'eeh

d&:ult&ese"t&o!'u'&l e;u"lly rou!d "!d

re"te to l&ght "ommod"t&o!

OXYGENATION:- . Dys'!e"- . smo*&!g h&story

1 '"* " d"y- . ough- . S'utum-. De!&ed

es'+ -.regul"r - . &rregul"rDesr&be symmetr&"l to le


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ELIMINATION:su"l boel '"tter! r&!"ry


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"b&l&ty to- .=mbul"te- .H"the selxtrem&t&es

-x .KI l&m&t"t&o!s l&m&ted r"!geo< mot&o!

COMFORT/ SLEEP/ AWAKE:- ."&! Comme!ts

(lo"t&o!


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Nursi!

M""!#$#%22


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. N=!'IN5 A!% P*AN

ameA 1duardo 2utierre/ jr.

Cues ursin% $ia%nosis Objectives "nterventions +ationale 1valuation

'u()ective+? 2alisod )o%la)aw )ay sa)it

jud )aau a)on%

li)od padulon% saa)on% tiil@ asverbali/ed by thepatient

()ectives+@restless andmoderatelyan*ious

"mpaired physicalmobility related topain( muscle

spasm( andreduced fle*ibility.

'hort-term 5oal+'t the end of;hours of nursin%

intervention( thepatient will be abletoA>lessen felt pain.

*ong-term 5oal+'t the end of7;hoursof nursin%intervention( thepatient will be abletoAreduce pain withevidence pain

scale of 6=7$eep Hreathin%e*ercise advised

durin% onset ofpain

>'dviseddiversionalactivities

>'dvised to avoidliftin% heavyobjects

'deMuate restprovided

Dependent+2ive prescribepain relievers li)ePre%abalin

this will reducethe pain

$ivert attentionfrom pain felt

To avoid addin%more injury

to help rela* themuscle andconserve ener%yalso sleepin% mayalleviate pain.

To treat intensepain

't the end of7;hours of nursin%intervention( the

patient was abletoA report pain scaleof B=7'dvised diversional activities>'dvised to avoid liftin% heavy objectsKas instructed to have 'deMuate rest

E

't the end of 7;hours of nursin% intervention( the patient wasable toA report pain scale of :=7verbali/e pain is relieved.

>decrease guarding and facial grimace>pain scale from 7/10 to 3/10*ong-term 5oal+

't the end of 6days of nursin% intervention( the patient will beable to Awal) and stand normally without pain

I

Independent+Kas 1ncoura%ed deep breathin% on onset of pain

>promoted bed rest>Was 1ncoura%e freMuent chan%e in position(assist to move inbedKas provide a Muite environment

E

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O

@restless and moderately an*ious

@ appears tensed and nervous

A an*iety

P'hort-term5oal+

't the end of 6hours of nursin% intervention( the patient will beable to A>report reduce an*iety*ong-term 5oal+

't the end of >hours of nursin% intervention( the patient will beable toArest well and comfortable

I

Independent+

>allowed patient to verbali/e feelin%s

>was provided accurate information re%ardin% situation>+eplaced sharp objects ,)nifes( for)s( etc. with safer items.

E

't the end of 6hours of nursin% intervention( the patient was

able to A>report relief of an*iety

I. !e"errals & #ollo$- up

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There are many important thin%s you can do to help minimi/e the li)elihood of

potential dama%e associated with serious complications as a result of Sciatica. Stay

informed about your condition and about new and developin% therapies. 2et support from

family( friends( counselors and other patients to maintain the very best Muality of life.Tal)

with your physician about your particular situation and what to loo) for. Kor) closely with

your healthcare providers( and do what is necessary to safe%uard your health( you can

develop a plan for what can be done to prevent complications or to treat complications if

they occur. Hoth patients and physicians have every reason to believe that the

understandin% of sciatica and the ability to mana%e sciatica and its complications will

continue to improve. This offers a very real promise that the outcomes also will continue to

improve.

II. %valuation & Implication

The si%nificance of this study promul%ates a comprehensive learnin%( s)ills and

responsibilities on the said case. "t includes a thorou%h collaborative discussion and

interaction between me( as a student nurse and my client at the #edical Kard at 'P#C.

$ifferent nursin% assessment and interventions( both ideal and actual was presented in

order to show a comparison and variability of each procedure done. ot only on the nursin%

part was presented( a comprehensive medical and dia%nostic procedures was alsocompared( both actual and ideal to show the essence of every care %iven. $urin% the

discussion of anatomy and physiolo%y( and its pathophysiolo%y related to the condition( the

case will thorou%hly deviate from the normal flow of the story and yet further analysis is

reMuired since no actual Pathophysiolo%y was thorou%hly discussed to e*plain the theory

presented. 'll the essential data reMuired are presented and tabulari/ed in order to ease up

the readers upon readin%.

The whole discussion will truly %ive innovations to the related education and field studies

and will somewhat aid the readers to enli%hten their minds about sciatica.

's a student nurse e*posed in the clinical area( )nowin% the si%nificance of each

nursin% practice will promote a %reat alteration in our future profession. 1very case

encountered whether complicated or not deals a lot for us because we deal with life here

and yet simple problem can lead onto hu%e complication if no intervention will be done

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immediately. " really appreciate the si%nificance of this case in relation to my chosen field of

studies for it made my mind twist for awhile leavin% my head open-ended Muestion of how a

simple trauma can cause a serious e*perience and cause of sciatica. Hut later on( " develop

and find the answer to my Muestion upon further studyin%.

!andlin% and %ivin% care to a client under this condition truly challen%e my )nowled%e( s)ills

and attitude as a student nurse vital si%ns( especially the blood pressure was the most

si%nificant responsibility to be done. 't the clinical area( shift to shift monitorin% of inta)e

and output was also done to provide and monitor the metabolism of my client. +e%ular

monitorin% of "D fluid was also done to maintain fluid balance and replenish the clients body

in a desired manner and as prescribed. !ealth teachin% and demonstratin% the proper

breathin% e*ercise( includin% the rationale of each procedure done was also shared to my

client to show competitiveness in my tas) and chosen course.

The study will provide data that can be potentially used up in durin% a future

research related to sciatica. Throu%h the comprehensive discussion and comparison of

every actual and ideal care %iven( it will be helpful in doin% client education on patient under

the same manner. 'lthou%h a new innovation of the said topic is presented( " also

recommend a further research for a better data and enhancements of the topic. The said

topic can also be used as a basis for studies and maybe helpful enou%h in the upcomin%

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