Nursing measures of lumbar disc herniation

Lumbar disc herniation is one of the most common diseases of low back and leg pain in clinic, and now the onset age of lumbar disc herniation is getting younger and younger. So how to care for patients with lumbar disc herniation is correct? Next, I would like to introduce the nursing measures for lumbar disc herniation.

Nursing measures of lumbar disc herniation

Insomnia nursing

Such patients suffer from different degrees of insomnia due to severe pain, and insomnia will aggravate the pain response. Therefore, special attention should be paid to such patients in the evening nursing, and visitors should be persuaded to leave the ward as soon as possible, and patients should be told not to drink strong tea, coffee and other foods that affect sleep. It can instruct patients to drink milk, relax and listen to light music before going to bed and other methods that help them sleep. If necessary, you should use appropriate sleep AIDS according to your doctor's advice.

Diet nursing

Because the patient has pain, fever and consumes a lot of calories, the pain makes the patient not want to eat. Therefore, the patient is instructed to eat a small amount of meals and mix them reasonably, so as to eat a diet with high calorie, high protein and high vitamins, eat more fruits, drink more water and eat more vegetables rich in cellulose, keep the stool unobstructed and avoid the pain caused by defecation. If the patient has abdominal distension, the anal canal should be emptied or senna leaves should be given to make tea.

Postural nursing

The patient is in a forced posture, and the turning movement often stops suddenly because of pain. During the pain interval or after taking painkillers, the patient should be turned over. When turning over, you should move gently. If necessary, you should wear a waist protector to keep your waist fixed. You should not bend or twist. The patient's shoulders and hips should be turned over by hand at the same time, and a soft pillow should be pressed against his back, and the contaminated sheets should be replaced at any time to make the patient feel comfortable. Because patients are absolutely bedridden, their self-care ability is declining, so it is necessary for nursing staff to carefully care, strengthen basic nursing work, and guide and encourage patients to exercise their limbs during pain intervals to prevent disuse muscular atrophy and joint stiffness.

Drug nursing

Prepare to master the time and dosage of medication, and pay attention to the observation of drug reactions and complications. Interdiscitis is caused by a low-grade purulent bacterial infection in intervertebral space. Because the nucleus pulposus tissue is mainly nourished by interstitial fluid and lacks blood supply, it is difficult to achieve effective bactericidal concentration locally. At present, early, sufficient and effective antibiotic therapy combined with glucocorticoid application is the main method to treat intervertebral disc inflammation, which usually lasts for 3 weeks. Therefore, it is necessary to input antibacterial drugs on time and in sufficient quantity.

Rehabilitation guidance

1 week After hormone withdrawal, symptoms and signs disappeared, body temperature and erythrocyte sedimentation rate were normal, and patients began to exercise back muscles. After waist protection, they got out of bed and moved, and the amount of activity should be increased as appropriate. Normal activities could not be carried out until the involved intervertebral disc space was fused. Due to osteoporosis in this period, patients will not bend over without load for at least 6 months to prevent fractures caused by accidents such as wrestling. Pay attention to increasing the intake of calcium diet or taking calcium orally properly.

Nursing care of lumbar disc herniation

1. Patients in the acute stage must lie on the hard bed and rest for 2 ~ 3 weeks to reduce the burden on the lumbar spine and avoid sedentary. Nurses should take good care of their daily life. Pay attention to keep warm and prevent catching cold, which is an important inducement of lumbar disc herniation. In order to prevent catching cold, you can give waist hot compress and spectrum analyzer irradiation.

2. After the patient's pain is relieved, he can gradually increase the amount of activity, but at each activity, the waist? Be sure to use waist protection equipment and pay attention to avoid sudden stress on the waist. It is also necessary to master the correct way to get out of bed: the patient should first roll to one side of the bed, raise the head of the bed, put his legs on one side of the bed, support himself with his arms, sit on one side of the bed before standing up, put his feet on the ground, and return to the bed in the opposite order.

3. After the patient's pain is relieved, he will start to exercise the back muscle function and strengthen the protective function of the back muscle. Functional exercises include five-point exercises and three-point exercises. The five-point method is: with the head, elbow and heel as the support points, vigorously lift the buttocks. After the function of back muscles is strengthened, three-point exercises supported by head and heel can be used. Exercise should be gradual and gradually increased to avoid fatigue.

4. Diet should be light, drink plenty of water, and eat more fiber-rich vegetables and fruits to prevent constipation. Avoid cold and greasy food. Do a good job in psychological care, introduce relevant knowledge, explain the influence of emotions on diseases, and keep patients happy.

5. Lie on the hard bed and rest immediately. The best bed is a hard bed, with a thin mattress and moderate hardness, and the height of the bed is slightly lower, so that patients can land on their feet as soon as they sit up. If you sleep on Simmons mattress now, it depends on the quality of your mattress. You should choose the kind that people will not collapse when lying on it.

Symptoms and manifestations of lumbar disc herniation

(1) Symptoms of lumbar disc herniation Symptoms of low back pain: More than 90% of patients have such symptoms. The range of pain is mainly in the lower waist and lumbosacral region, and persistent dull pain is the most common. The pain can be relieved in supine position, and aggravated in standing position and sitting position.

(2) Symptoms of lower limb radiation pain: The symptoms of lumbar disc herniation are along the lower waist, buttocks, posterior thigh, anterior or posterolateral leg to the heel. The nature of pain is mainly radioactive tingling. Radiation pain of lower limbs can occur before low back pain or after low back pain symptoms appear. These two situations vary from person to person.

(3) Symptoms of hypoesthesia and motor function of lower limbs: The sensory and motor functions of the somatosensory area dominated by nerve roots are weakened or even lost due to nerve root damage. The common symptoms of lumbar disc herniation are: skin numbness, chills, skin temperature drop and so on. In severe cases, muscle atrophy and even muscle paralysis may occur.

Exercise method of lumbar disc herniation

Self-exercise method:

Method 1: Bow your waist. Stand with your legs together, arch forward and squeeze your waist and hips until you reach the limit, then retract. This is repeated 15 times.

Method 2: Beat your waist. Stand, legs slightly apart, left and right hands half clenched fists, and then beat back the lumbar disc herniation. Do it 50 times, and the intensity should be tolerable.

Method 3: Walk backwards. Walk back with your chest out, swing your hands back and forth naturally, take a bigger step and meditate for 500 steps. Walk outdoors on the flat ground in sunny days and indoors in rainy days.

Massage method:

Massage is very simple, and the muscles on both sides of the lumbar process are generally stiff. After massage and relaxation, it is advisable to apply activated wine twice a day, which is very helpful to promote microcirculation and eliminate soft tissue inflammation. Hang the horizontal bar for 5 minutes every day. When sleeping at night, patients can put a folded towel under the lumbar spine and gradually increase it with the progress of treatment to correct lumbar keyboard protrusion.

Reverse method:

The reverse back method is to use the patient's own weight to continuously pull below the waist for a period of time, so as to enlarge the intervertebral space, and then make the passive waist sway back and forth and left and right, thus releasing the adhesion of nerve roots and creating opportunities for the prominent tissues to return. The operation method is as follows:

Step 1: The doctor and the patient stand back to back and bend their elbows, with their elbows hooked together, and the hips of the doctor are opposite to the hips of the patient. Then the doctor bends forward slightly, puts the patient on his back, and puts the doctor's hip against the patient's waist.

Step 2: On the basis of the previous step, the doctor gradually increases the amplitude and speed of waist bending, and rhythmically pushes back and forth quickly, 30 to 40 times each time.

Step 3: On the basis of step 2, the patient's waist has been stretched to a certain extent, and then the doctor shakes his body from side to side to make the patient swing from side to side at the same time, and this is repeated 20 to 30 times.

During the whole anti-retrogression treatment, if the patient feels tired, he can rest for a while and then continue to complete the operation. In order to consolidate the curative effect and prevent recurrence, patients need to rest in hard bed for 3 weeks after anti-back treatment. Avoid waist buckling and gradually start back muscle exercise when resting in bed.

Main factors leading to lumbar disc herniation

Degradation is the basic factor.

With the increase of age, the water content of annulus fibrosus and nucleus pulposus gradually decreases, which reduces the tension of nucleus pulposus and thins the intervertebral disc. At the same time, hyaluronic acid and keratinized sulfate decreased, low molecular weight glycoprotein increased, fibrosis and collagen fiber deposition increased, nucleus pulposus lost elasticity, intervertebral disc structure relaxed and cartilage plate cystic change. MRI confirmed that 15-year-old adolescents can have intervertebral disc degeneration.

harm

The accumulated injury force is the main cause of intervertebral disc degeneration and the inducement of intervertebral disc herniation. In the cumulative injury, repeated bending and twisting actions are most likely to cause disc injury, so this disease is closely related to some occupations and types of work.

hereditary factor

The incidence of colored people is low; About 32% of adolescent patients under 20 years old have a positive family history.

be pregnant

Common inducing factors

① Increased abdominal pressure, such as severe cough and forced defecation during constipation.

② Improper posture, when the waist is in flexion position, sudden rotation is easy to induce nucleus pulposus protrusion.

(3) Sudden load, when you are not fully prepared, suddenly increase the waist load, which is easy to cause nucleus pulposus protrusion.

(4) Lumbar trauma, acute trauma can spread to fibrous ring, cartilage plate and other structures, and promote the degeneration of nucleus pulposus.

⑤ Occupational factors, such as long-term sedentary and bumpy drivers, are easy to induce disc herniation.

⑥ Height and weight.

⑦ Environmental factors, such as cold and wet cold.

Symptoms of lumbar disc herniation

1. Low back pain and radiation leg pain

It is the first symptom of most patients with this disease, and the incidence rate is about 9 1%. Most patients have low back pain before leg pain, some patients have low back pain and leg pain at the same time, and a few patients only have leg pain. Lumbar and leg pain caused by lumbar disc herniation has the following characteristics.

① Radiation pain of nerve root

① Lumbar 4 ~ 5 intervertebral disc protrusion compresses lumbar 5 nerve root, and the pain spreads to anterolateral calf, instep and toe along hip and thigh.

② Lumbar 5 ~ sacrum 1 intervertebral disc protrusion compresses sacrum 1 nerve root, and the pain radiates to posterolateral leg, heel, sole and lateral foot. Leg pain is also called sciatica because the nerve roots of lumbar 5 and sacrum 1 participate in the composition of sciatica.

③ Lumbar 3 ~ 4 intervertebral disc protrusion compresses the lumbar 4 nerve root, causing femoral neuralgia, and the pain radiates to the anterolateral thigh, the anterolateral knee and the anterolateral calf.

⑵ Pain is related to abdominal pressure: increasing abdominal pressure and cerebrospinal fluid pressure can aggravate low back pain and leg pain, such as coughing, sneezing, defecation and exertion.

⑶ Pain is related to activities: after activities and fatigue, the pain is aggravated, bed rest is reduced, and in severe cases, it is difficult to move.

⑷ Relationship between pain and posture: In order to relieve pain, patients are often forced to take a certain posture, mostly in a healthy lateral position with bent hips and knees, and a few patients are in a lateral position with bent legs, supine position with bent legs, kneeling position on the bed, squatting position, etc.

(5) Relationship between pain and weather change: Some patients have worse pain when it is windy and rainy or the temperature drops suddenly, and the pain is relieved when the weather is warm.

2. numbness and weakness

When the involved nerve roots are seriously damaged, muscle strength and sensation are weakened, and hyperalgesia may occur in light cases, and muscle paralysis and weakness may occur in severe cases.

3. Functional changes of urination and defecation

When disc herniation severely compresses the dural sac, cauda equina nerve damage can cause constipation, difficulty in defecation, frequent urination, urgency, urinary retention or incontinence, loss or disappearance of perineal sensation and sexual dysfunction.

4. Waist performance

Stiff waist, limited mobility or lateral bending deformity.

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