Nursing Care Plan for Laminectomy

The surgical removal of a portion of a vertebra (posterior arch) is called laminectomy. It is done to remove a herniated nucleus pulposus, tumor, bone fragments that cause pressure and chronic pain. It may be performed on the cervical or lumbar region. Fusion is the removal of bone fragments from the iliac crest or tibia and implantation of the fragments at the surgical site to treat instability of the spine resulting from degenerative processes, and fractures.

Nursing Diagnoses: Pain related to physical injuring agents caused by surgical trauma resulting in irritated spinal nerves, edema. Impaired physical mobility related to musculoskeletal impairment caused by spinal surgery, pain and imposed restriction of movements.

Expected Outcomes: Pain relieved or controlled, progressive return of mobility evidenced by verbalizations that pain decreased or absent, and ambulation and self-care activities resumed.

Nursing Intervention with Rationale:
I. Assess for:
A. Burning, numbness, tingling in legs, muscle spasms.
Rationale: Results from spinal nerve root irritation.

B. Ability to or fear of movement in bed.
Rationale: Indicates for complications of immobility.

II. Monitor, Describe, Record:
A. Neurological signs every 4 hours.
Rationale: Possibility of spinal fluid leakage and infection.

B. Vital signs every 4 hours, peripheral pulses and capillary refill time every 4 hours.
Rationale: Indicates changes caused by ineffective ventilation if cervical approach is done or respiratory distress; circulatory disturbance in extremities.

III. Perform or Provide
A. Flat in bed for 24 hours in spinal proper alignment; 10 days to 2 weeks if fusion done
Rationale: Promotes comfort and proper alignment until healed; raising head of bed puts strain on or may be dislodge bone graft.

B. Logroll when turning, avoid twisting; instruct to fold arms on chest and use turning sheet with staff assisting.
Rationale: Maintains body alignment and prevents twisting of trunk.

C. Position in supine or side-lying with pillow to back, under, or between legs; sitting should be in straight-bak chair.
Rationale: Provides comfort and support.

D. Ambulate with assistance after 24 hours or as appropriate.
Rationale: Promotes circulation and breathing post-operatively.

E. Apply brace, cast, or collar before ambulation to stabilize surgical site.
Rationale: Brace may be used if a fusion is done, cervical collar immobilizes neck if cervical laminectomy done.

IV. Teach Patient or Family
A. Proper body mechanics and alignment for lying, standing, stooping or bending, walking, sitting.
Rationale: Prevents injury to spine or recurrent spinal problems or pressure on spinal nerves.

B. Use of straight-back chair and straight-back seat for driving.
Rationale: Maintains proper back alignment.

C. How to roll out of bed while pushing on mattress and splint the back when sitting or rising from a chair.
Rationale: Prevents back injury.

D. Application of cervical brace or cast, brace to lumbar region.
Rationale: Immobilized neck if cervical approach done.