Nursing Care Plan | NCP Herniated Nucleus Pulposus (HNP)

Nursing diagnosis: acute/chronic Pain related to physical injury agents: nerve compression, muscle spasm

Possibly evidenced by
Reports of back pain, stiff neck, decreased tolerance for activity
Preoccupation with pain, self or narrowed focus, distraction
Walking with a limp, inability to walk; guarding behavior, leaning toward affected side when standing; altered muscle tone
Facial mask of pain
Changes in sleep patterns; physical or social withdrawal
Autonomic responses (when pain is acute)

Desired Outcomes/Evaluation Criteria—Client Will
Pain Control
Report pain is relieved or controlled.
Verbalize methods that provide relief.
Demonstrate use of therapeutic interventions, such as relaxation skills or behavior modification, to relieve pain.

Nursing intervention with rationale
1. Assess client’s perceptions of pain, attitude toward pain, and use of specific pain medications
Rationale: Perception of pain is influenced by age and developmental stage; underlying problem causing the pain; and cognitive, behavioral, and sociocultural factors. Client may have beliefs about medications, and may have high or low tolerance for pain and pain medications.

2. Perform comprehensive assessment of pain, noting location, duration, precipitating and aggravating factors, and severity using a 0 to 10 scale, or other scales as appropriate. Accept client’s description of pain.
Rationale: Pain assessment helps determine choice of interventions and provides basis for comparison and evaluation of therapy.

3. Note presence of behaviors associated with pain—changes in vital signs (with acute pain), crying, grimacing, sleep disturbances, withdrawal, or narrowed focus. Evaluate current and past medication use.
Rationale: Nonverbal evidence of pain. Observations may or may not be congruent with verbal reports, thus indicating need for further evaluation. For instance, the stoic client reporting a 3 on a 10-point pain scale may also be restless, agitated, and sleepless.

4. Maintain bedrest briefly during acute phase. Place client in semi-Fowler’s position with spine, hips, and knees flexed; supine with or without head elevated 10 to 30 degrees; or lateral position.
Rationale: Bedrest, usually prescribed for a very short time, such as 48 hours, in position of comfort decreases muscle spasm, reduces stress on structures, and facilitates reduction of disc protrusion.

5. Instruct in logrolling technique for position change if condition requires.
Rationale: Logrolling reduces flexion, twisting, and strain on back, especially when nerve impingement impairs client’s ability to move legs.

6. Assist with application of brace or corset. Instruct client in how to self-place brace with assistance, then independently.
Rationale: Braces or corsets are often used briefly during acute phase of ruptured disc or after surgery to provide support and limit flexion or twisting. Note: Prolonged use can increase muscle weakness and cause further disc degeneration and nerve impairment.

7. Limit activity during acute phase as indicated. Provide rest periods. Shorten rest intervals and duration as client improves.
Rationale: Gradual progression of activities decreases forces of gravity and motion, helping to relieve muscle spasms and reduce edema and stress on structures around affected disc.

8. Place needed items, such as call bell or phone, within easy reach.
Rationale: Easy access to commonly used items reduces risk of straining.

9. Provide comfort measures, such as backrubs, positional and stretching exercises, Therapeutic Touch (TT), and a quiet, calming environment.
Rationale: Nonpharmacological pain management is an essential nursing function in assisting the client to achieve pain-free periods.

10. Instruct in and assist with relaxation or visualization techniques, progressive muscle relaxation, and breathing exercises.
Rationale: These activities refocus attention away from pain, aid in reducing muscle spasms and tension, and promote tissue oxygenation and healing.