Acute Pain | Nursing Care Plan for Disc Surgery

Nursing diagnosis: acute Pain related to physical agent: surgical manipulation, edema, inflammation, or harvesting of bone graft

Possibly evidenced by
Reports of pain
Autonomic responses: diaphoresis, changes in vital signs, pallor
Alteration in muscle tone
Guarding, distraction behaviors or restlessness

Desired Outcomes/Evaluation Criteria—Client Will
Pain Self-Control
Report pain is relieved or controlled.
Verbalize methods that provide relief.
Demonstrate use of relaxation skills and diversional activities.

Nursing intervention with rationale
1. Assess intensity, description, location, radiation of pain, and changes in sensation.
Rationale: Pain may be mild to severe with radiation to shoulders and occipital area (cervical) or hips and buttocks (lumbar). If bone graft has been taken from the iliac crest, pain may be more severe at the donor site. Numbness or tingling discomfort may reflect return of sensation after nerve root decompression or result from developing edema causing nerve compression.

2. Instruct in regular use of rating scale, such as 0 to 10.
Rationale: Standardized tool for rating pain helps in assessment and management of pain.

3. Review expected manifestations or changes in intensity of pain.
Rationale: Development or resolution of edema and inflammation during the immediate postoperative phase can affect pressure on various nerves and cause changes in degree of pain. Muscle spasms and improved nerve root sensation intensify pain, especially 3 days after procedure.

4. Encourage client to assume position of comfort, as indicated. Use logrolling for position change.
Rationale: Positioning is dictated by physical preference and type of operation; for example, head of bed may be slightly elevated after cervical laminectomy. Readjustment of position aids in relieving muscle fatigue and discomfort. Logrolling avoids tension in the operative areas, maintains straight spinal alignment, and reduces risk of displacing epidural patient-controlled analgesia (PCA) when used.

5. Provide back rub or massage. Avoid the operative site.
Rationale: Back rubs and massages relieve or reduce pain by alteration of sensory neurons and muscle relaxation.

6. Demonstrate and encourage use of relaxation skills, such as deep breathing, visualization, and so on.
Rationale: Deep breathing and visualization refocus attention, reduce muscle tension, promote sense of well-being, and control or decrease discomfort.

7. Provide liquid or soft diet; provide room humidifier; and encourage voice rest.
Rationale: Following anterior cervical laminectomy, such measures reduce discomfort associated with sore throat and difficulty swallowing.

8. Investigate client reports of return of radicular pain.
Rationale: Radicular pain suggests complications, such as collapsing of disc space and shifting of bone graft, which require further medical evaluation and intervention. Note: Sciatica and muscle spasms often recur after laminectomy, but should resolve within several days or weeks.

9. Administer analgesics, as indicated, for example: Opioids, such as morphine sulfate (MS), codeine, meperidine (Demerol), tramadol (Ultram), oxycodone (Percocet), and hydrocodone (Vicodin, Lortab)
Rationale: Opioids are used during the first few postoperative days. Nonopioid agents are incorporated as intensity of pain diminishes. Note: Opioids may be administered via epidural catheter and PCA.

10. Instruct client in use of PCA.
Rationale: PCA gives client control of medication administration (usually opioids) to achieve a more constant level of comfort, which may enhance healing and sense of well-being.