Assessment and Diagnostic Test for Herniated Nucleus Pulposus


Assessment of the client with herniated nucleus pulposus by Marillyn E. Doenges , 2001:

1. Activity / rest
Client has a history of work that needs to lift heavy objects, sitting for long periods of driving. Requires board or hard mattress during sleep, decreased range of motion of the extremity in one part of the body. Not being able to do activities that are usually performed. Atrophy of the muscles in the body are affected and disturbances in walking.

2. Elimination
Constipation, experiencing pain in defecation, presence of incontinence / urinary retention

3. Neurosensory
Tingling, stiffness, weakness of limbs, decreased deep tendon reflexes, muscle weakness, hypotonia, tenderness / paravertebralis muscle spasms and decrease the perception of pain.

4. Pain / discomfort
Pain like a knife wound that will be worsened by coughing, sneezing, crouching, lifting, defecation, lifting legs or neck flexion. Pain that there is no ending or the presence of more severe episodes of pain is intermittent, pain radiating to the legs, buttocks (lumbar) or shoulder / arm, stiffness in the neck (cervical).
Heard of the "crick " arises when the shoulder pain / when trauma or feel "broken back", limited to mobilization / bent forward.
Attitude : by way of leaning on the affected body part. Changes in gait, walking with a limp. Waist lifted the affected body part.

5. Security
A history of problems "back" just happened.

6. Learning
Monotonous or hyperactive lifestyle.
Discharge planning : may require assistance in transportation, personal care and completing chores.

Assessment and Diagnostic Test for Herniated Nucleus Pulposus

Diagnostic Test
  • Spinal X-ray : showed degenerative changes in the spine / intervertebral space or rule out other pathological suspicion such as tumors , osteomyelitis .
  • Electromyography : can localize lesions at the level of primary spinal nerve roots are exposed .
  • Epidural Venography : can be done in cases where the accuracy of miograph limited .
  • Lumbar puncture : the exclusion of associated conditions , infection , presence of blood .
  • Lasegue 's sign ( test by lifting the leg straight ahead ) to support the initial diagnosis of a herniated intervertebral disc when it appeared pain in the posterior leg .
  • CT Scan : can indicate spinal canal narrowing , the potential for the intervertebral disc .
  • MRI : non- invasive examination that can indicate changes in bone and tissue and can strengthen the evidence of disc herniation .
  • Myelogram : may be normal or show the " narrowing " of the disc space to determine the location and size of the herniation specifically .

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