An intervertebral disc prolapse occurs when a tear in the outer ring of an intervertebral disc allows the inner nucleus pulposus to bulge out. The document discusses the anatomy and functions of intervertebral discs, causes and types of disc prolapses, symptoms, diagnostic tests, treatment options including medications, physical therapy, injections, and various surgical procedures. Nursing care focuses on preoperative teaching, postoperative monitoring for complications, managing pain, and providing education on mobility restrictions and home care.
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury.
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury.
When do we operate the degenerative disease ?
Pain not responding to conservative treatment, lasting more than 3 months
Non improving neurologic deficit
Persistence or deterioration of symptoms of intermitent claudication
Significant restriction of the common daily working and social activities
What is structure of lumber disc? What is disc bulge/prolapse/herniation? What is difference between disc bulge, disc prolapse, disc herniation or disc extrusion? What is criteria to diagnose lumber disc prolapse? How lumber disc herniation is treated medically or surgically? How lumber disc herniation is treated by conservative method? How lumber disc herniation is treated through physical therapy? What is physiotherapy after various disc surgeries? What is radiological method to diagnose disc prolapse?
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CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
2.
Is a hydrostatic, load bearing
structure between the
vertebral bodies from C2-3 to
L5-S1 .
Nucleus pulposus + annulus
fibrosus
Is relatively avascular.
L4-5, largest avascular
structure in the body.
6. Vital Functions of the IVD
Restricted intervertebral joint motion
Contribution to stability
Resistance to axial, rotational, and bending load
Preservation of anatomic relationship
7. Is a medical condition affecting the spine in
which a tear in the outer, fibrous ring (annulus
fibrosus) of an intervertebral disc allows the
soft, central portion (nucleus pulposus) to bulge
out beyond the damaged outer rings.
8. posterolateral disc herniation –
protrusion is usually posterolateral into vertebral canal, compress the roots
of a spinal nerve.
protruded disc usually compresses next lower nerve as that nerve crosses
level of disc in its path to its foramen. (eg.protrusion of fifth lumbar disc
usually affects S1 instead.
central (posterior) herniation:
less frequently, a protruded disc above second lumbar vertebra may
compress spinal cord itself or or may result in cauda equina syndrome.
lateral disc herniation:
may compress the nerve root above the level of the herniation
L4 nerve root is most often involved & patient typically have intense
radicular pain.
TYPES OF HERNIATION
9. Degeneration
Loss of fluid in nucleus pulposus
Protrusion
Bulge in the disc but not a complete rupture
Prolapse
Nucleus forced into outermost layer of annulus fibrosus- not a
complete rupture
Extrusion
A small hole in annulus fibrosus and fluid moves into epidural space
Sequestration
Disc fragments start to form outside of the disc area.
CLASSIFICATIONS OF HERNIATIONS
10. Schematic illustration
a) Normal
b) Bulging disk
c) Focal bulge or protrusion. The
nucleus material remains within the
outermost fibres of the annulus
fibrosus.
d) Prolapse or extrusion.
The nucleus material has penetrated
the annulus fibrosus but is contained in
front of the posterior
longitudinal ligament.
e) Sequester or free fragment.
11.
12. Repetitive mechanical activities – Frequent bending, twisting,
lifting, and other similar activities without breaks and proper
stretching can leave the discs damaged.
Living a sedentary lifestyle – Individuals who rarely if ever engage
in physical activity are more prone to herniated discs because the
muscles that support the back and neck weaken, which increases
strain on the spine.
Traumatic injury to lumbar discs-
commonly occurs when lifting while bent at the waist, rather
than lifting with the legs while the back is straight.
CAUSES
13. Obesity – Spinal degeneration can be quickened as a result of the
burden of supporting excess body fat.
Practicing poor posture – Improper spinal alignment while sitting,
standing, or lying down strains the back and neck.
Tobacco abuse – The chemicals commonly found in cigarettes can
interfere with the disc’s ability to absorb nutrients, which results
in the weakening of the disc.
CAUSES
15. symptoms of a herniated disc can
vary depending on the location
of the herniation and the types
of soft tissue that become
involved.
Herniated discs are not
diagnosed immediately, as the
patients come with undefined
pains in the thighs, knees, or
feet.
16. Location
The majority of spinal disc herniation cases occur in lumbar
region (95% in L4-L5 or L5-S1).
The second most common site is the cervical region (C5-C6, C6-
C7).
The thoracic region accounts for only 0.15% to 4.0% of cases.
17. Diagnosis is based on the history, symptoms, and physical
examination.
DIAGNOSIS
18. X-Ray : lumbo-sacral spine;
Narrowed disc spaces.
Loss of lumber lordosis.
Compensatory scoliosis.
CT scan lumber spine;
It can show the shape and size of the spinal canal, its contents, and the
structures around it, including soft tissues.
Bulging out disc.
MRI lumber spine;
Intervertebral disc protrusion.
Compression of nerve root.
19. NARROWED SPACE
BETWEEN L5 AND S1
VERTEBRAE,
INDICATING PROBABLE
PROLAPSED
INTERVERTEBRAL DISC -
A CLASSIC PICTURE
24. Physical therapy include modalities to
temporarily relieve pain (i.e. traction, electrical
stimulation massage).
Patient education on proper body mechanics.
Weight control.
Tobacco cessation.
Lumbosacral back support.
TREATMENT
25.
26. surgery
Surgery is generally considered only as a last resort,
or if a patient has a significant neurological deficit.
The presence of cauda equina syndrome is
considered a medical emergency requiring
immediate attention and possibly surgical
decompression.
27. The indications for surgery
1
• persistent pain and signs of sciatic tension after 2–3
weeks of conservative treatment.
2
• a cauda equina compression syndrome – this is an
emergency;
3
• neurological deterioration while under conservative
treatment;
28. INTRADISCAL ELECTROTHERMIC THERAPY (IDET)
It is a fairly advanced procedure in
which electrothermal catheter is
inserted to the intervertebral disc heats
the posterior annulus of the disk,
causing contraction of collagen fibers
IDET is a minimally invasive outpatient
surgical procedure developed over the
last few years to treat patients with
chronic low back pain that is caused by
tears or small herniations of their
lumbar discs.
29. NUCLEOPLASTY
Nucleoplasty is the most
advanced form of
percutaneous discectomy
developed to date.
Tissue removal from the
nucleus acts to
“decompress” the disc and
relieve the pressure exerted
by the disc on the nearby
nerve root
31. CHEMONUCLEOLYSIS-
Chemonucleolysis is the term
used to denote chemical
destruction of nucleus pulposus
[Chemo+nucleo+lysis].
This involves intradiscal
injection of
chymopapain which causes
hydrolysis of he cementing
protein of the nucleus pulposus.
This causes decrease in water
binding capacity leading to
reduction in size and drying the
disc.
33. LUMBAR FUSION
Fusion surgery helps two or
more bones grow together
into one solid bone. Fusion
cages are new devices,
essentially hollow screws
filled with bone graft, that
help the bones of the spine
heal together firmly.
lumbar fusion is only
indicated for recurrent
lumbar disc herniations, not
primary herniations
34. DISC ARTHROPLASTY
Artificial Disc Replacement (ADR),
or Total Disc Replacement (TDR),
is a type of arthroplasty.
It is a surgical procedure in which
degenerated intervertebral
discs in the spinal column are
replaced with artificial devices in
the lumbar (lower) or cervical
(upper) spine.
Used for cases of cervical disc
herniation
35. Assessment
determining the onset,
location, and radiation of pain,
paresthesias, limited movement,
diminished function of the neck, shoulders, and
upper extremities
NURSING MANAGEMENT
36. explanations about the surgery and reassurance that surgery
will not weaken the back.
Preoperative assessment also includes an evaluation of
movement of the extremities as well as bladder and bowel
function
To facilitate the postoperative turning procedure, the patient
is taught to turn as a unit (called logrolling)
Encouraged to take deep breaths, cough
PROVIDING PREOPERATIVE CARE
37. Vital signs are checked frequently and the wound is
inspected for hemorrhage
IV morphine -24-48
Sensation and motor strength of the lower extremities
are evaluated at specified intervals, along with the
color and temperature of the legs and sensation
of the toes.
Assess for CSF leakage
ASSESSING THE PATIENT AFTER SURGERY
39. Acute pain related to the surgical procedure
Nursing Interventions
The patient may be kept flat in bed for 12 to 24 hours in cervical
surgery
Pillow is placed under the head and the knee rest is elevated slightly
to relax the back muscles( cervical surgery)
Extreme knee flexion must be avoided
Administering the prescribed postoperative analgesic agent,
positioning for comfort, and reassuring the patient that the pain can
be relieved.
NURSING DIAGNOSIS
40. Impaired physical mobility related to the postoperative
surgical regimen
Nursing interventions
provide cervical collar cervical collar
provide L-S binders
The neck should be kept in a neutral(midline) position
Patients are assisted during position changes(log rolling)
41. Deficient knowledge about the postoperative course and home
care management
INTERVENTIONS
A cervical collar is usually worn for about 6 weeks.
Instructed about strategies for pain management and about signs
and symptoms of complications
The nurse assesses the patient’s understanding of these management
strategies
advised to avoid heavy work for 2 to 3 months after surgery.
Exercises are prescribed to strengthen the abdominal and erector
spinal muscles