Risk for Spinal Trauma | Nursing Care Plan for Disc Surgery

Nursing diagnosis: Risk for Spinal Trauma

Risk factors may include
Temporary weakness of vertebral column
Balancing difficulties and changes in muscle coordination

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Risk Control
Maintain proper alignment of spine.
Recognize need for or seek assistance with activity, as appropriate.

Nursing intervention with rationale
1. Post sign at bedside regarding prescribed position.
Rationale: Promotes ongoing communication among the members of the healthcare team and reduces risk of inadvertent strain or flexion of operative area.

2. Provide bed board or firm mattress.
Rationale: Aids in stabilizing back.

3. Maintain brace-wearing schedule, as indicated.
Rationale: Braces may be used to decrease muscle spasm and support the surrounding structures during healing. Establishing a schedule generally enhances client compliance.

4. Limit activities, as prescribed, when client has had a spinal fusion.
Rationale: Restricted spinal movement promotes healing of fusion.

5. Logroll client from side-to-side. Have client fold arms across chest; tighten long back muscles, keeping shoulders and pelvis straight. Use pillows between knees during position change and when on side. Use turning sheet and sufficient personnel when turning, especially on the first postoperative day. Instruct client in these movements as self-care progresses.
Rationale: Logrolling maintains body alignment. It prevents twisting movements. Twisting movements potentially disrupt alignment, interfering with the overall healing process.

6. Assist out of bed: logroll to side of bed, splint back, and raise to sitting position. Avoid prolonged sitting. Move to standing position in single smooth motion.
Rationale: Gradual progression of activity with careful consideration of body alignment protects the surgical area. These maneuvers avoid twisting and flexing of back while arising from bed or chair.

7. Avoid sudden stretching, twisting, flexing, or jarring of spine.
Rationale: These precautions reinforce the importance of maintaining body alignment. These movements may cause vertebral collapse, shifting of bone graft, delayed hematoma formation, or subcutaneous wound dehiscence.

8. Monitor blood pressure (BP). Note reports of dizziness or weakness. Recommend client change position slowly.
Rationale: Presence of postural hypotension may result in fainting, falling, and possible injury to surgical site.

9. Have client wear firm, flat walking shoes when ambulating.
Rationale: Such shoes reduce risk of falls.

10. Apply lumbar brace or cervical collar, as appropriate.
Rationale: Braces or corsets may be used in and out of bed during postoperative phase to support spine and surrounding structures until muscle strength improves. Brace is applied while client is supine in bed. Spinal fusion generally requires a lengthy recuperation period in a corset and collar.