NURSING DIAGNOSIS: Pain, acute
May be related to
- Physical agent: surgical manipulation, edema, inflammation, 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/restlessness
Desired Outcomes
Pain Control (NOC)
- Report pain is relieved/controlled.
- Verbalize methods that provide relief.
- Demonstrate use of relaxation skills and diversional activities.
8 Laminectomy Nursing Care Plan (NCP)
- Impaired Physical Mobility — Laminectomy Nursing Care Plan (NCP)
- Ineffective Tissue Perfusion — Laminectomy Nursing Care Plan (NCP)
- Risk for Trauma — Laminectomy Nursing Care Plan (NCP)
- Ineffective Breathing Pattern — Laminectomy Nursing Care Plan (NCP)
- Acute Pain — Laminectomy Nursing Care Plan (NCP)
- Constipation — Laminectomy Nursing Care Plan (NCP)
- Urinary Retention — Laminectomy Nursing Care Plan (NCP)
- Knowledge Deficit — Laminectomy Nursing Care Plan (NCP)
Acute Pain — Laminectomy Nursing Care Plan (NCP): Nursing Interventions & Rationale
| Nursing Interventions | Rationale |
| Assess intensity, description, and location/radiation of pain, changes in sensation. Instruct in use of rating scale(e.g., 0–10). | May be mild to severe with radiation to shoulders/occipital area (cervical) or hips/buttocks (lumbar). If bone graft has been taken from the iliac crest, pain may be more severe at the donor site. Numbness/tingling discomfort may reflect return of sensation after nerve root decompression or result from developing edema causing nerve compression. |
| Review expected manifestations/changes in intensity of pain. | Development/resolution of edema and inflammation in the immediate postoperative phase can affect pressure on various nerves and cause changes in degree of pain (especially 3 days after procedure, when muscle spasms/improved nerve root sensation intensify pain). |
| Encourage patient to assume position of comfort if indicated. Use logroll for position change. | Positioning is dictated by physical preference, type of operation (e.g., 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. |
| Provide back rub/massage, avoiding operative site. | Relieves/reduces pain by alteration of sensory neurons, muscle relaxation. |
| Demonstrate/encourage use of relaxation skills, e.g., deep breathing, visualization. | Refocuses attention, reduces muscle tension, promotes sense of well-being, and controls/decreases discomfort. |
| Provide soft diet, room humidifier; encourage voice rest following anterior cervical laminectomy. | Reduces discomfort associated with sore throat and difficulty swallowing. |
| Investigate patient reports of return of radicular pain. | Suggests complications (e.g., collapsing of disc space, shifting of bone graft) requiring further medical evaluation and intervention.Note: Sciatica and muscle spasms often recur after laminectomy but should resolve within several days or weeks. |
| Administer analgesics, as indicated:Narcotics, e.g., morphine, codeine, meperidine (Demerol), oxycodone (Tylox), hydrocodone (Vicodin), acetaminophen (Tylenol) with codeine; | Narcotics are used during the first few postoperative days, then nonnarcotic agents are incorporated as intensity of pain diminishes. Note: Narcotics may be administered via epidural catheter. |
| Muscle relaxants, e.g., cyclobenzaprine (Flexeril), diazepam (Valium). | May be used to relieve muscle spasms resulting from intraoperative nerve irritation. |
| Instruct patient/assist with PCA. | Gives patient control of medication administration (usually narcotics) to achieve a more constant level of comfort, which may enhance healing and sense of well-being. |
| Provide throat sprays/lozenges, viscous Xylocaine. | Sore throat may be a major complaint following cervical laminectomy. |
| Apply TENS unit as needed. | May be used for incisional pain or when nerve involvement continues after discharge. Decreases level of pain by blocking nerve transmission of pain. |