lumbar radiculopathy ru

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UNIVERSITY OF CEBU LAPU-LAPU AND MANDAUE

COLLEGE OF NURSING

TOPIC: Lumbar Radiculopathy

GENERAL OBJECTIVE: Within 2 hours of lecture-discussion, the BSN IV-B students will be able to enhance knowledge, improve skills and develop positive attitude towa

the topic- Lumbar Radiculopathy.

SPECIFICOBJECTIVES

CONTENTS METHODOLOGY

TIMEALLOTMENT

RESOURCES EVALUATI

Specifically, the

Level IV-Bstudents will be

able to:

1. discuss the

overview of lumbar

radiculopathy.

Prayer

Preconditioning Activity

Lecture-

discussion

15 minutes

A. HumanResources:

- Students

- CIs

B.Books:

Black andHawks. (2008).

MedicalSurgicalNursing:

Clinical

Managementfor Positive

Outcomes.

Post test

2. define related

terms

Lecture-

discussion

10 minutes Mosby’s

medicalDictionary

Post test

3. state the petient’s

demographic

data

II. DEMOGRAPHIC DATA:

Name : Mrs. T.A.B

Age : 74 years oldGender : female

Civil Status : marriedReligion : Roman Catholic

Occupation : housewife

Lecture-

discussion

10 minutes Post test



Height : 5’1” Weight : 50 kg

Date of Admission : February 12, 2012Time of Admission : 05:09 PM

Hospital : Chong Hua HospitalPatient # : 0000289413

Room # : C-317Residence : 233 M.D. Jakosalem St. Cebu City

Physician : Dr. Virginia Español

Chief Complaints : loss of appetite, weakness, gluteal painFinal Diagnosis : Lumbar radiculopathy

4. delineate on

patient’sGordon’s

FunctionalPattern;

GORDON’S FUNCTIONAL PATTERN

1. Health Perception Health Management Pattern

2. Nutritional Metabolic Pattern

3. Elimination Pattern

4. Activity Exercise Pattern

5. Sleep Rest Pattern

6. Cognitive Perceptual Pattern

7. Sexuality Reproductive Pattern.

8. Self Perception Self Concept Pattern

9. Role Relationship Pattern

10. Coping Stress Tolerance Pattern

11. Value Belief Pattern

Lecture-

discussion

20 minutes Post test



Physical Appearance

General Measurement:

Height: 5’1”

Weight: 50 kg

General Appearance:

Date of Assessment: February 15,2012

Time: 11:00 pm

Seen patient lying on bed, conscious, awake, coherent and responsive with an IVF of

#5 PNSS 1L regulated at 15 gtts/min with a remaining level of 800, well infused on the

left arm. Limited range of motion and slowed movement noted. Vital signs are as

follows:

T: 36.5 °C PR: 80 bpm RR: 20cpm BP: 130/80 mmHg

Physical Assessment

SKIN: brown complexion, old wrinkled skin, good skin turgor, no masses, tenderness,

warm to touch

HEAD AND HAIR: normocephalic, equally distributed grey and black hair, no lice



infestations, no flaking, no swelling or tenderness, no masses palpated.

EARS: symmetrical, pinna is in line wi th outer canthus of the eye, minimal cerumen

seen in the ear canal, no discharges, and no tenderness upon palpation

NOSE AND SINUSES: nasal septum in midline, no deformities, no discharges, noswelling, no masses and tenderness upon palpation.

MOUTH AND THROAT: moist lips, moist buccal mucousa, pinkish and moist gums,

tongue at midline and rest at the floor of the mouth, uvula at midline, (+) gag reflex, no

halitosis, no pain upon swallowing, tonsils are not inflamed.

NECK: centrally located, supple, no lesions, no lymphadenopathy, undistended jugular

vein, trachea at midline, smooth and firm, no tenderness, non-palpable lymph nodes,

no masses.

THORAX AND LUNGS: equal chest expansion, (-) adventitious sounds, RR= 20 cpm

CARDIOVASCULAR: distinct S1 and S2, no chest pain, no palpitations, no murmurs,

heart rate= 80 bpm

ABDOMEN: no lesions, umbilicus at midline, round fatty abdomen, symmetrical, bowel

sounds of 5 clicks/minute, no masses, (-) kidney punch left flank.



GENITALIA AND ANUS: grossly female, no discharges.

EXTREMITIES: short clean fingernails and toenails, pinkish nail beds, ( -) nail clubbing,

CRT= <2 secs, full active range of motion for upper extremities, weak lower extremities

CRANIAL NERVES

CN 1: identified smell of perfume and alcohol

CN 2: identified color of student nurse’s uniform (stripe white and red), unable to read

at

2 feet distance

CN 3: (+) PERRLA, (+) extra ocular movements

CN 4 and 6: (+) cardinal gaze

CN 5: felt wisp of tissue on her cheeks, able to chew upon eating food

CN 7: active and symmetrical facial muscles movement upon smiling and frowning

CN 8: able to repeat “hello” as whispered by the student nurse at 2 feet distance

CN 9 and 10: able to swallow, identified sweet taste of banana, (+) gag reflex

CN 11: good strength of sternocleidomastoid and trapezius muscles as indicated

through

instructing the patient to rotate head and elevate shoulders while student nurse

applies resistance on the shoulder



CN 12: able to protrude, elevate and depress the tongue

(See Appendix A for the genogram.)

5. review theanatomy and

physiology of the nervous

system.

Anatomy and Physiology of Pancreas, Cerebral Cortex and Hippocampus Lecture-discussion

20 minutes Seeley.Anatomy &

Physiology.pp.145-148

Post test

6. trace thepathophysiolog

y of lumbarradiculopathy.

See Appendix B for the conceptual framework.

Lecture-Discussion

15 minutes Black &Hawks.

Medical-Surgical

Nursing.pp.1067-1070

Post test

7. identify theideal and actual

management;

MEDICAL AND SURGICAL MANAGEMENT

A. LABORATORY EXAMINATIONS

IDEAL ACTUAL

Lecture-discussion

10 minutes patient’s data

Post test



B. DIAGNOSTIC EXAMS

IDEAL ACTUAL

Chest X-ray-this is done to find out any

abnormalities on the patient's chest

ECG-a recorded of electrical activity of

the heart, shows certain wavescalled P,Q,R,S,T and U waves

Magnetic resonance imaging

(MRI)-is a test that uses a magnetic field

and pulses of radio wave energy tomake pictures of organs and

structures inside the body.

Computerized axial tomographyscan (CT Scan)

- is an x-ray procedure thatcombines many x-ray images with

the aid of a computer to generatecross-sectional views and, if needed,

three-dimensional images of theinternal organs and structures of the

- chest x-ray

- ECG

- MRI

- CT scan



body. A CT scan is used to definenormal and abnormal structures in

the body and/or assist in proceduresby helping to accurately guide the

placement of instruments ortreatments.

See Appendix C for the laboratory results.

C. MEDICATIONS AND TREATMENT

IDEAL ACTUAL

.

D. SURGICAL MANAGEMENT

IDEAL ACTUAL

E. DIET



IDEAL ACTUAL

8. discuss theideal and actual

nursingmanagement;

IDEAL ACTUAL

Actual Nursing Management

1. Assessed patient’s condition.

2. Regulated IVF to 15 gtts/min.3. Bedside care done.

4. Vital signs taken and monitoredevery hour.

5. Neuro vital signs taken andmonitored every hour.

6. Intake and output taken andrecorded.

7. Assisted patient on repositioningself.

8. Provided safety measures by

raising side rails up.9. Assisted with activities of

toileting.10. Changed diaper.

11. Gave health teachings.12. Encouraged deep breathing

exercises.

13. Placed patient on seizure

precaution.14. Attended patient’s needs.

15. Provided adequate rest.

Lecturediscussion

5 minutes Smeltzer,Suzanne C. et

al.(2008).

Brunner and Suddharth’s

Textbook of Medical-

Surgical Nursing. 11

th

edition.

LippincottWilliams and

Wilkins

Post test



9. enumeratethe different

drugs andintravenous

fluidsadministered to

the patient;

(See Appendix D for Drug & IVF Study)

Lecture-discussion

10 minutes Spratto,George R. et

al.(2007). PDR

Nurse’s Drug

Handbook. 2007th edition

Post test

10. appreciate

the nursing careplans;

(See Appendix E)

Lecture-

discussion

10 minutes Doenges,

Marilynn E.et.al.(2008). Nurse’s

Pocket guide: Diagnosis,

Prioritized Interventions, Rationales.

11th edition.

Philadelphia

Post test

11. formulate a

discharge plan;

(See Appendix F) Lecture-

discussion

5 minutes Doenges,

Marilynn E.et.al.(2008). Nurse’s

Pocket guide:

Diagnosis, Prioritized

Interventions, Rationales.11th edition.

Philadelphia

Post test

12. identify theprognosis;

Lecture-discussion

3 minutes Post test



APPENDIX A



(Genogram)

APPENDIX B



(Pathophysiology)



APPENDIX C

(LABORATORY RESULTS)

LABORATORY AND DIAGNOSTIC TEST RESULTS

02/14/12

Sodium test



TEST RESULT REFERENCE UNIT IMPLICATION

Sodium (serum) 1110.0 134.0-148.0 Mmol/l hyponatremia

02/12/12

Electrocardiographic report

-sinus rhythm with non-specific ST-T wave changes

02/12/12

Complete blood count

TEST RESULT REFERENCE UNIT IMPLICATION

WBC 13.50 ↑ 4.8-10.8 10^3/uL infection

Platelet 522 ↑ 130-400 10^3/uL thromboembolism

PDW 8.3 ↑ 9.0-14.0 % Myeloproliferative

neoplasms

Neutrophil 81.4 ↑ 40-74 % Bacterial infection

Lymphocyte 15.3 ↑ 19-48 % Viral infection

Monocyte 2.0 ↓ 2.4-9.0 % Bone marrow injury

02/12/12

Lumbosacral Spine X-ray- APL, Cone down



Conclusions:

1. straightening of the lumbar lordosis due to muscular spasm

2. mild hypertrophic degenerative changes of the lumbar spine and lateral aspect of both iliac bones

3. generalized osteopenia/osteoporosis

4. atherosclerosis of the abdominal aorta

5. fecal stasis in some of the colonic segments

02/12/12

Chest X-ray- PA or AP

Conclusions:

1. clear lung fields

2. magnified cardiac silhouette with slightly accentuated upper pulmonary vascular markings due to positioning

3. tortuous and atheromatous aorta

4. hypertrophic degenerative changes of the thoracic spine

5. generalized osteopenia/ osteoporosis

02/15/12

Ultrasound report

Whole abdomen

Conclusions:

1. unremarkable GB, CBD and biliary radicles

2. normal sized liver with mild fatty infiltration and structural changes compatible with aging liver, and/or non specific, hepatic, parenchymal disease

3. essentially normal pancreas and spleen

4. bilateral fullness of the pelvo-calyceal structures, which may relate to any of the following:a. distal, partially obstructing processes, proximal to UVS at present

b. decreased ureteral peristalsis as seen in recent passage of a stone and/or UTI

5. normal sized uterus with physiologic endometrium.

6. Ovaries not seen, most likely atrophic

7. structurally unremarkable urinary bladder



8. atherosclerotic abdominal aorta

02/12/12

Clinical Neurophysiology Laboratory

Interpretation:

The nerve conduction study of both upper and both lower limbs is abnormal due to the:

1. absent of the action potential of both median sensory senses

2. absence of the action potential of both median motor nerves

3. severely decreased amplitude of the action potentials of the right peroneal motor nerve

4. decreased conduction velocities of both peroneal and both tibial motor nerves

5. absence of the F waves of the right peroneal motor nerve

6. prolonged F wave latencies of the left peroneal and both tibial nerves

7. absence of the H reflexes of both tibial nerves.

The needle (muscle) study is abnormal due to the:

1. presence of spontaneous potentials on certain limb muscles and certain paracervical muscles tested

2. difficulty in attaining relaxation of the paralumbosacral muscles

3. presence of the serrated muaps on certain limb muscles tested

4. decreased insertional activities on certain limb muscles tested.

The EMG-IVCV studies suggest the following conditions:

1. Pathology proximal to the dorsal root ganglia of both L4-S1 nerve roots. This is most likely bilateral L4-S1 radiculopathy with signs of acute and chronic denervation changes.

2. Pathology proximal to the dorsal root ganglia of right C5-C6 nerve roots. This is most likely right C5-C6 radiculopathy with signs of chronic denervation changes and signs of muscle

reinnervation.

3. Bilateral distal median neuropathy, sensory and motor, demyelinating and axonopathic at the level between the mid-palms and the distal creases of the wrists. This is most likely

bilateral carpal tunnel syndrome, severe.

02/14/12



CT-Scan report

Brain Plain-CT16

Conclusion:

Brain atrophy with suspicious areas of i schemia in the subcortical white matter of the left

posterior frontal lobe.

02/14/12

Magnetic Resonance Imaging Report

Conclusion:

1. Mild bilateral neural foramen stenosis of L2/L3, L3/L4 & L5/S1.

2. Severe central canal and moderate bilateral neural foramen stenosis at L4/L5.

3. Mild cervical kyphosis. This may be due to muscle spasm.

4. Markedly dilated urinary bladder.



APPENDIX E(NURSING CARE PLAN)



EVALUAT

1. Goal metPatient maint

free from signimpaired skin

breakdown asevidenced by

redness over bony promine

and capillary of less than 6

seconds over areas



APPENDIX D

(DRUG &IVF STUDY)

Drug Name Dosage and

Frequency

Mechanism of

Action

Indication Contraindication Side Effects Nursing Responsibilities

Generic Name:

Lactulose

Brand Name:

Lilac

Classification:

laxative

A. Patient’s dose

and Frequency:

-20 ml OD

B. Minimum

Dose and

Frequency:

- 2.5 ml OD

Produces osmoticeffect in colon.

Resulting

distention

promotes

peristalsis.

Decreases blood

ammonia build-up

that causes hepatic

encephalopathy,

probably as aresult of bacterial

degredation which

lowers pH of colon

Constipation Containdicated inpatients on low

galactose diet. Use

cautiously in

patients with

diabetes mellitus

because drug

contains lactose,

galactose and other

sugars.

GI:

Abdominal cramps

and distention,

belching, diarrhea,

flatulence, nausea

& vomiting

Important patient teachings:

- Replace fluid loss.

- Diarrhea may indicate overdose.- To minimize sweet taste, dilute with

water or fruit juice or give with food.- Advice patient to dilute drug with

food to improve taste.- Inform patient of adverse reactions

and tell him to notify prescriber.



How supplied:

A. Patient’s

supply:

- syrup

B. Other forms:- crystals for

reinsitution

C. Maximum

dose andFrequency:

- 300 ml OD

contents.

Spratto, George R.et al.(2007). PDR

Nurse’s Drug

Handbook. 2007th

edition

Drug Name Dosage and

Frequency

Mechanism of

Action

Indication Contraindication Side Effects Nursing Responsibilities

Generic Name:

Azithromycin

Brand Name:

Zithromax

A. Patient’s dose

andFrequency:

-

- 500 mg tablet

Birds to 50S

Subunit of

bacterial ribosome,

blocking protein

synthesis;bacteriostatic or

bactericidal,

depending on

Acute bacterial

exacerbation,

community

acquired

pneumonia,bacterial sinusitis,

nongonococcal

urethritis,

prevention of

Contraindicated in

patient

hypersensitive to

erythromycin or

other macrolides.

CNS: anxiety,

dizziness,

headache

CV: Torsades de

pointes,

prolonged QT

interval

Important nursing responsibilities:

- Don’t give drug I.M or by I.V bolusinjection.

- If patient vomits within 5 minutes of

drinking extended-release solution,consider additional antibiotic treatment.

- Don’t give with antacids.

- Tell patient that tablets or oralsuspension may be taken with or



Classification:

Antibiotic

How supplied:

A. Patient’ssupply:

- Tablet

B. Other forms:- Injection

- Powder for oral

suspension

B. Minimum

Dose andFrequency:

- 10 mg/ P.O daily

C. Maximumdose and

Frequency:

- 600 mg P.O

daily

concentration.

Spratto, George R.et al.(2007). PDR

Nurse’s Drug

Handbook. 2007th

edition

disseminated

mycobacterium

avium complex,

pelvic

inflammatory

disease, genital

ulcer disease, acute

otitis media,

chlamydialophthalmia

neonatorum.

EENT: Hearing

loss, tinnitus,

dyspepsia

GI: Abdominal

pain, diarrhea

nausea

GU: candiasis,

nephritis,vaginitis

without food, but that taking with foodmay decrease risk of nausea.

Type of IVF Content Classification Indication Contraindication How Supplied Nursing Interventions

0.9% SodiumChloride

Each 100ml contains900mg of Sodium

ChlorideElectrolytes in

1000ml:

Soduim…..154mmol Chloride….154mmol

Isotonic For replacement ormaintenance of fluid

and electrolytes

Renal/Circulatoryimpairment, older

adults, sodiumretention.

1000ml in plasticbottle

Before Administration:1.Do handwashing

2.Check the IVF sheet3.Check the Doctor’s order

4.Read the label of thebottle. Ensure solution is

the one ordered.5.Inspect the container for



Mosby.PDQ Nurses

for Today.p.9

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for Today.p.9

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for Today.p.9 Mosby.PDQ Nursesfor Today.p.9

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leaks.During Administration:

1.Close the clamp2.Administer the IV

solution.3.Hang the IVf bottle

slowly.4.Regulate the drops per

minute as prescribed.

After Administration:1.Do after care2.Document the name of

the Iv bottle, hooked, dateand time started.

3.Assess for any redness orany allergic reactions.

Monitor IVF and IV site.4.Refer to health care

provider if allergicreactions occur.

Mosby.PDQ Nurses for

Today.p.9



APPENDIX F

(INTERDISCIPLINARY DISCHARGEPLAN)



BIBLIOGRAPHY:

BOOKS:

Black, Joyce M. et al.(2008). Medical-Surgical Nursing .8th edition. C&E Publishing, Inc. Metro Manila, Philippines

Deglin, Judith H. et.al (2007) Davis’s Drug Guide for Nurses.10th edition. Philadelphia, Pennsylvania: E.A. Davis Company.

Doenges, Marilynn E. et.al.( 2006). Nursing Care Plans. 7th edition. Philadelphia

th



Doenges, Marilynn E. et.al.( 2008). Nurse’s Pocket guide: Diagnosis, Prioritized In terventions, Rationales . 11th

edition. Philadelphia

Kee, Joyce Lefever.et al.(2009). Pharmacology: A Nursing Process Approach . 6th

edition.Elsevier (Singapore) Winsland House I Singapore

Mosby, Elsevier.(2006). Mosby’s Pocket Dictionary. 5th edition. Singapore

Seeley, Stephens Tate.et al.(2007). Essentials of Anatomy and Physiology . 6th edition. Mc- Graw Hills International

Smeltzer, Suzanne C. et al.(2008). Brunner and Suddharth’s Textbook of Medical - Surgical Nursing. 11th

edition. Lippincott Williams and Wilkins

Spratto, George R. et al.(2007). PDR Nurse’s Drug Handbook . 2007th

edition

Electronics:

http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/

http://diabetes.webmd.com/guide/oral-medicine-pills-treat-diabetes

UNIVERSITY OF CEBU LAPU-LAPU AND MANDAUE

A.C. CORTES AVENUE, LOOC, MANDAUE CITY

COLLEGE OF NURSING








A RESOURCE UNIT

LUMBAR RADICULOPATHY

SUBMITTED BY:

Abubakar, Mirkhadz

Ampo, Nheil Christopher

Dignos, Edelyn

Engasca, Paramae

Fuentes, Roselyn

Gasta, Jan Anthony

Inoc, Creselda

Lazaga, Maria Melfa Mae

Lemosnero, Erika Charisse A.

Lubas, Laarni

Mariveles, Mark

Mondigo, Cathy LouRubi, Sergs Domique

Soquillo, Junafe

Vanesa, Napala

SUBMITTED TO:

Ms. Regina M. Omana, RN

Clinical Instructor

lumbar radiculopathy ru

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