NURS 676 Lumbar Herniation Treatment Case Study Essay

NURS 676 Lumbar Herniation Treatment Case Study Essay

NURS 676 Lumbar Herniation Treatment Case Study Essay

Lumbar Herniation Treatment Case Study
Nursing care plans are strategic approaches to providing holistic patient care by identifying patients’ needs and developing interventions. They are a way of communication between nurses, their patients, and other healthcare providers. Our patient, Diana, is set to undergo spinal fusion surgery for lumbar herniation treatment after other conservative treatments failed. She may experience immense pain post-surgery, and since she has been on methadone for the past five years, alternative pain management treatments need to be administered. Below is Diana’s care plan.

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Diagnosis

Lumbar disc herniation. Outcomes

After the spinal fusion surgery, the patient will:

1. Experience reduced pain.

2. Experience more mobility at the lumbosacral region.
Interventions

1. Assess for pain using pain scores such as numbers and pain faces scale.

2. Neurological assessment; to check for numbness, tingling sensations, and spinal reflexes. Rationales

1. Determining the degree of pain is essential for adequately managing pain.

2. Spinal fusion surgery may result in nerve root compression and spinal cord injury. Thus, neurological assessment is vital to detect postoperative damage.

Pain management should be done both perioperative and postoperative. Opioid therapy is still the mainstay treatment for postoperative spinal patients. Our patient has been on methadone for the past five years; thus, a further increase in opioid consumption may result in long-term adverse effects of opioid use. These debilitating effects include chronic constipation, sleep-related breathing problems, addiction, and dependence. Higher opioid doses increase the risk of opioid toxicity, overdose, and opioid use disorder. To combat this, non-opioid multimodal regimens for pain relief post-surgery are recommended.
These interventions can either be pharmacological or physical and behavioral. Pharmacological interventions include the use of Non-Steroidal Anti-inflammatory Drugs (NSAIDs). Studies have shown that acetaminophen, a non-selective cyclooxygenase (COX) enzyme inhibitor, is efficacious for postoperative pain relief. It also helps reduce inflammation and pyrexia following spinal fusion surgery. Concomitant use of NSAIDs and opioids has proven more effective as analgesics than the drugs used singly (Waelkens et al., 2021). Gabapentinoids, such as pregabalin, are also efficacious for pain relief post-surgery and help prevent progression from acute to chronic pain. Behavioral interventions such as acupuncture and acupressure have ameliorated pain post-spinal surgery.
Opioid use disorder is a triad consisting of an overpowering need for opioid use, increased opioid tolerance, and opioid withdrawal symptoms upon discontinuation. It may develop due to the administration of conventional doses of opioids; thus, higher doses are required to elicit the same pain-relieving effects, and therefore, high consumption of opioids for postoperative pain management should be limited. Concomitant administration of methadone with other opioids increases the risks of opioid toxicity and overdose. Methadone maintenance dose of 80mg daily should not be surpassed as doses beyond this produce euphoric effects and sedation (Murphy et al., 2019). These effects may increase the risk of addiction and dependence.
A nursing care plan is essential for optimal patient care and communication between various healthcare professionals and patients. Various interventions, including pharmacologic and behavioral, are required for pain relief following surgery. Opioid use for pain management must be treated with caution to avoid addiction and dependence and reduce overdose risks. Alternative analgesic regimens are recommended to avoid the detrimental effects associated with long-term opioid use.

References
Murphy, G. S., & Szokol, J. W. (2019, September 1). Intraoperative methadone in surgical patients: A review of clinical investigations. American Society of Anesthesiologists, 131, 678–692. https://doi.org/10.1097/ALN.0000000000002755
Waelkens, P., Alsabbagh, E., Sauter, A., Joshi, G. P., Beloeil, H., & PROSPECT Working group∗∗ of the European Society of Regional Anaesthesia and Pain therapy (ESRA) (2021). Pain management after complex spine surgery: A systematic review and procedure-specific postoperative pain management recommendations. European Journal of Anaesthesiology, 38(9), 985–994. https://doi.org/10.1097/EJA.0000000000001448

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Diana is a 52-year-old female retired nurse who has been on methadone maintenance for 5 years for prior heroin addiction. Her confirmed dose is methadone 80mg po daily. She has herniated discs at L4–L5 and L5–S1. She has failed conservative treatment with physical therapy, chiropractic spinal manipulations, epidural steroid injects, and long-term NSAID use. She presents to the clinic for spinal fusion consultation. However, she is worried about having too much pain and having to take too many pain medications after surgery. What is your plan of care for Diana? Discuss different pain management options, including ways to reduce the risks associated with long-term opioid therapy and opioid use disorder and overdose.