8 Laminectomy (Disc Surgery) Nursing Care Plans

Laminectomy is a surgical procedure performed to relieve pressure on the spinal cord and nerves by removing a portion of the vertebral lamina. This procedure is commonly performed on patients who suffer from spinal stenosis, herniated discs, or spinal tumors. As a nurse, it’s essential to understand laminectomy nursing care plans and nursing diagnoses to provide the best possible care for your patients.

What is laminectomy?
Nursing Care Plans and Management
Recommended Resources
See also

What is laminectomy?

Laminectomy is a surgery that involves the excision of a vertebral posterior arch and is commonly performed for injury to the spinal column or to relieve pressure/pain in the presence of a herniated disc. Also known as decompression surgery, the procedure may be done with or without the fusion of vertebrae.

Nursing Care Plans and Management

Nursing care planning and goals for patients who underwent disc surgery (laminectomy) include maintaining tissue perfusion and neurological function, promoting comfort and healing, preventing or minimizing complications, assist with the return of normal mobility.

Nursing Problem Priorities

The following are the nursing priorities for patients who underwent disc surgery (laminectomy):

Pain management
Enhancing mobility
Preventing injury and infections

Nursing Assessment

Assess for the following subjective and objective data:

Impaired coordination, limited ROM
Reluctance to attempt movement
Decreased muscle strength/control
Paresthesia; numbness
Decreased ROM, muscle strength
Difficulty breathing
Shortness of breath
Nasal flaring
Pursed-lip breathing
Use of accessory muscles for ventilation
Reports of pain
Autonomic responses: diaphoresis, changes in vital signs, pallor
Alteration in muscle tone
Guarding, distraction behaviors/restlessness

Assess for factors related to the cause of problems related to disc surgery (laminectomy):

Neuromuscular impairment
Limitations imposed by the condition
Pain
Diminished/interrupted blood flow (e.g., edema of the operative site, hematoma formation)
Hypovolemia
Temporary weakness of vertebral column
Balancing difficulties, changes in muscle coordination
Tracheal/bronchial obstruction/edema
Decreased lung expansion, pain
Physical agent: surgical manipulation, edema, inflammation, harvesting of bone graft
Pain and swelling in the surgical area
Immobilization decreased physical activity
Altered nerve stimulation, ileus
Emotional stress, lack of privacy
Changes/restrictions of dietary intake

Nursing Diagnosis

Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with laminectomy based on the nurse’s clinical judgement and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.

Nursing Goals

Goals and expected outcomes may include:

The client will demonstrate techniques/behaviors that enable the resumption of activities.
The client will maintain or increase the strength and function of the affected body part.
The client will report/demonstrate normal sensations and movement as appropriate.
The client will maintain proper alignment of the spine.
The client will recognize the need for/seek assistance with activity as appropriate.
The client will maintain a normal/effective respiratory pattern free of cyanosis and other signs of hypoxia, with ABGs within an acceptable range.
The client will report relief/control of pain.
The client will verbalize methods that provide relief.

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients who undergone laminectomy may include:

1. Enhancing Physical Mobility

Patients who undergo laminectomy, a surgical procedure to remove a portion of the vertebral bone called the lamina, may experience physical mobility problems due to several factors. These can include postoperative pain, muscle weakness or imbalance, limited range of motion in the spine, and potential complications such as nerve damage or scar tissue formation. These factors can contribute to difficulties in activities such as walking, bending, lifting, and overall functional mobility, requiring rehabilitation and physical therapy to address and improve the patient’s physical mobility.

Encourage the patient to move his legs, as allowed.
Patient participation promotes independence and a sense of control.

Work closely with the physical therapy department.
To ensure a consistent regimen of leg-and-back-strengthening exercises.

Schedule activities and procedures with rest periods. Encourage participation in ADLs within individual limitations.
Enhances healing and builds muscle strength and endurance. Patient participation promotes independence and a sense of control.

Provide and assist with passive and active ROM exercises depending on the surgical procedure.
Strengthens abdominal muscles and flexors of the spine; promotes good body mechanics.

Assist with activity and progressive ambulation.
Until healing occurs, activity is limited and advanced slowly according to individual tolerance.

Review proper body mechanics and techniques for participation in activities.
Reduces the risk of muscle strain, injury, and pain and increases the likelihood of patient involvement in the progressive activity.

2. Promoting Effective Tissue Perfusion

Tissue perfusion may be a concern for patients who have undergone laminectomy due to the potential impact on blood flow to the surgical site and surrounding tissues. The surgical procedure and associated tissue trauma can disrupt blood vessels, leading to temporary or prolonged impairment of tissue perfusion.

Watch for any deterioration in neurologic status. Check neurological signs periodically and compare with baseline. Assess movement and sensation of lower extremities and feet (lumbar) and hands or arms (cervical).
Although some degree of sensory impairment is usually present, deterioration and changes may reflect the development or resolution of spinal cord edema and inflammation of the tissues secondary to damage to motor nerve roots from surgical manipulation; or tissue hemorrhage compressing the spinal cord, requiring prompt medical evaluation intervention.

Monitor vital signs. Note color, warmth, and capillary refill.
Hypotension (especially postural) with corresponding changes in pulse rate may reflect hypovolemia from blood loss, restriction of oral intake, nausea, and vomiting.

Monitor I&O and Hemovac drainage (if used).
Provides information about the circulatory status and replacement needs. Excessive and prolonged blood loss requires further evaluation to determine the appropriate intervention.

Monitor blood counts like hemoglobin (Hb), hematocrit (Hct), and red blood cells (RBCs).
Aids in establishing replacement needs, and monitors the effectiveness of therapy.

Palpate operative site for swelling. Inspect dressing for excess drainage and test for glucose if indicated.
Change in the contour of the operative site suggests hematoma and edema formation. An inspection may reveal frank bleeding or dural leak of CSF (will test glucose-positive), requiring prompt intervention.

Check the tubing frequently for kinks and secure the vacuum.
To make sure the tubing is patent and free from twists and kinks.

Keep the patient flat on the back for several hours.
Pressure to the operative site reduces the risk of hematoma.

Administer IV fluids or blood as indicated.
Fluid replacement depends on the degree of hypovolemia and duration of oozing, bleeding, and CSF leaking.

3. Preventing Trauma Risk and Injury

Trauma and injury prevention for patients who have undergone laminectomy involves providing education about proper body mechanics, such as using correct lifting techniques and avoiding excessive bending or twisting of the spine. Patients should also be advised to take precautions to prevent falls, such as keeping their environment clear of hazards and using assistive devices if necessary. Furthermore, patients should follow postoperative instructions regarding activity restrictions and gradually reintroduce physical activities under the guidance of healthcare professionals to minimize the risk of trauma or injury to the surgical site and promote safe recovery.

Check BP; note reports of dizziness or weakness. Recommend patient change position slowly.
The presence of postural hypotension may result in fainting, falling, and possible injury to the surgical site.

Post a sign at the bedside regarding the prescribed position.
Reduces the risk of inadvertent strain and flexion of the operative area.

Provide a bedboard or firm mattress.
Aids in stabilizing back.

Maintain cervical collar postoperatively with cervical laminectomy procedure.
Decreases muscle spasms and supports the surrounding structures, allowing normal sensory stimulation to occur.

Limit activities when the patient has had a spinal fusion.
Following surgery, spinal movement is restricted to promote healing of fusion, requiring a longer recuperation time.

Logroll patient from side to side. Have the patient fold arms across the chest, and tighten long back muscles, keeping shoulders and pelvis straight. Use pillows between knees during position changes and when on the side. Use a turning sheet and sufficient personnel when turning, especially on the first postoperative day.
Maintains body alignment while turning, preventing twisting motion, which may interfere with the healing process.

Assist out of bed: logroll to the side of the bed, splint back and raise to a sitting position. Avoid prolonged sitting. Move to a standing position in a single smooth motion.
Avoids twisting and flexing of the back while arising from a bed or chair, protecting the surgical area.

Avoid sudden stretching, twisting, flexing, or jarring or spine.
May cause vertebral collapse, shifting of bone graft, delayed hematoma formation, or subcutaneous wound dehiscence.

Have the patient wear firm and flat walking shoes when ambulating.
Reduces the risk of falls.

Apply a lumbar brace or cervical collar as appropriate.
A brace or corset may be used in and out of bed during the immediate postoperative phase to support the spine and surrounding structures until muscle strength improves. The brace is applied while the patient is supine in bed. Spinal fusion generally requires a lengthy recuperation period in a corset or collar.

Refer to physical therapy. Implement the program as outlined.
Strengthening exercises may be indicated during the rehabilitative phase to decrease muscle spasms and strain on the vertebral disc area.

4. Promoting Effective Breathing Pattern

Promoting effective breathing patterns for patients who underwent laminectomy involves encouraging deep breathing exercises, such as diaphragmatic breathing, to improve lung expansion and prevent complications like atelectasis or pneumonia. Additionally, providing adequate pain management to alleviate discomfort and allowing patients to assume comfortable positions that support optimal respiratory function can further facilitate effective breathing patterns postoperatively.

Observe for edema of the face and neck (cervical laminectomy), especially the first 24–48 hr after surgery.
Tracheal edema and compression or nerve injury can compromise respiratory function.

Listen for hoarseness. Encourage voice rest.
This may indicate laryngeal nerve injury, which can negatively affect cough (ability to clear the airway).

Auscultate breath sounds, and note the presence of wheezes or rhonchi.
Suggests the accumulation of secretions and the need to engage in more aggressive therapeutic actions to clear the airway.

Monitor and graph ABGs or pulse oximetry.
Monitors the effectiveness of breathing patterns or therapy.

Administer supplemental oxygen, if indicated.
May be necessary for periods of respiratory distress or evidence of hypoxia.

Remind the patient to cough, deep breathe, and use blow bottles or an incentive spirometer.
Facilitates movement of secretions and clearing of lungs; reduces the risk of respiratory complications (pneumonia).

5. Relieving Acute Pain and Pain Management

Pain management for patients who underwent laminectomy involves a comprehensive approach to address their postoperative pain. This may include the use of analgesic medications, such as opioids or nonsteroidal anti-inflammatory drugs (NSAIDs), along with non-pharmacological interventions like ice or heat therapy, positioning, relaxation techniques, and physical therapy to alleviate pain and promote their comfort and recovery.

Assess intensity, description, location, radiation of pain, and changes in sensation. Instruct in the use of a rating scale (0–10).
May be mild to severe with radiation to shoulders and occipital area (cervical) or hips and buttocks (lumbar). If the bone graft has been taken from the iliac crest, pain may be more severe at the donor site. Numbness and tingling discomfort may reflect the return of sensation after nerve root decompression or result from developing edema causing nerve compression.

Review expected manifestations and changes in the intensity of pain.
Development and resolution of edema and inflammation in the immediate postoperative phase can affect pressure on various nerves and cause changes in the degree of pain (especially 3 days after the procedure, when muscle spasms and improved nerve root sensation intensify pain).

Investigate patient reports of the return of radicular pain.
Suggests complications (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.

Encourage the patient to assume a position of comfort if indicated. Use logroll for a position change.
Positioning is dictated by physical preference, and type of operation (the head of the 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 the risk of displacing epidural patient-controlled analgesia (PCA) when used.

Provide backrub massage, avoiding the operative site.
Relieves and reduces pain by alteration of sensory neurons, and muscle relaxation.

Demonstrate and encourage the use of relaxation skills like deep breathing, and visualization.
Refocuses attention, reduces muscle tension, promotes a sense of well-being, and decreases discomfort.

Provide a soft diet, and room humidifier; encourage voice rest following anterior cervical laminectomy.
Reduces discomfort associated with a sore throat and difficulty swallowing.

Administer analgesics, as indicated:

Narcotics: morphine, codeine, meperidine (Demerol), oxycodone (Tylox), hydrocodone (Vicodin), acetaminophen (Tylenol) with codeine
Narcotics are used during the first few postoperative days, then non-narcotic agents are incorporated as the intensity of pain diminishes.

Muscle relaxants: cyclobenzaprine (Flexeril), and diazepam (Valium)
May be used to relieve muscle spasms resulting from intraoperative nerve irritation.

Instruct patient and assist with patient-controlled analgesia (PCA).
Gives patient control of medication administration (usually narcotics) to achieve a more constant level of comfort, which may enhance healing and a sense of well-being.

Provide throat sprays or lozenges, viscous Xylocaine.
A sore throat may be a major complaint following cervical laminectomy.

Apply transcutaneous electrical nerve stimulation (TENS) unit as needed.
May be used for incisional pain or when nerve involvement continues after discharge. Decreases the level of pain by blocking nerve transmission of pain.

6. Managing Constipation

Constipation management for patients who underwent laminectomy involves implementing strategies to prevent and relieve constipation. This includes promoting adequate hydration, encouraging a high-fiber diet or fiber supplements, promoting physical activity and mobility, and, if necessary, administering stool softeners or laxatives under medical guidance to facilitate regular bowel movements and prevent discomfort.

Observe and document abdominal distension and auscultate bowel sounds.
Distension and absence of bowel sounds indicate that the bowel is not functioning, possibly because of a sudden loss of parasympathetic enervation of the bowel.

Use fraction or child-size bedpan until allowed out of bed.
Promotes comfort, and reduces muscle tension.

Provide privacy.
Promotes psychological comfort.

Encourage early ambulation.
Stimulates peristalsis, facilitating the passage of flatus.

Begin progressive diet as tolerated.
Solid foods are not started until bowel sounds have returned or flatus has been passed and the danger of ileus formation has abated.

Provide a rectal tube, suppositories, and enemas as needed.
May be necessary to relieve abdominal distension, and promote the resumption of normal bowel habits.

Administer laxatives, and stool softeners as indicated.
Softens stools promote normal bowel habits and decrease strain.

7. Preventing Urinary Retention

Preventing urinary retention in patients who have undergone laminectomy involves implementing strategies to promote normal bladder function. This includes encouraging regular voiding, maintaining adequate hydration, facilitating early ambulation and mobility, and monitoring for signs of urinary retention such as bladder distension or discomfort, promptly addressing any issues that arise to prevent complications and ensure normal urinary function.

Assess for bowel and bladder functions.
To know if the bowel and bladder are not functioning.

Observe and record the amount and time of voiding.
Determines whether the bladder is being emptied and when interventions may be necessary.

Palpate for bladder distension.
This may indicate urine retention.

Give plenty of fluids.
Maintains kidney function and prevents renal stasis.

Use a fracture bedpan for the patient on complete bed rest.
Promotes comfort, and reduces muscle tension.

Stimulate bladder emptying by running water, pouring warm water over the peritoneal area, or having the patient put a hand in warm water as needed.
Promotes urination by relaxing the urinary sphincter.

Catheterize for bladder residual after voiding, when indicated. Insert and maintain indwelling catheter as needed.
Intermittent or continuous catheterization may be necessary for several days postoperatively until the swelling is decreased.

8. Initiating Health Teachings and Patient Education

Health teachings for patients who underwent laminectomy involve providing education on postoperative care and self-management. This includes instructions on wound care, pain management techniques, activity restrictions, proper body mechanics, and the importance of following up with healthcare providers to monitor progress and address any concerns, empowering patients to actively participate in the recovery process.

Identify signs and symptoms requiring notification of healthcare provider (fever, increased incisional pain, inflammation, wound drainage, decreased sensation, and motor activity in extremities).
Prompt evaluation and intervention may prevent complications and permanent injury.

Assess the current lifestyle, job, finances, activities at home, and leisure.
Knowledge of the current situation allows the nurse to highlight areas for possible intervention, such as referral for occupational or vocational testing and counseling.

Recall particular condition and prognosis
Individual needs dictate tolerance levels and limitations of activity.

If the patient requires myelography:

Question them carefully about allergies to iodine, iodine-containing substances, or seafood.
Such allergies may indicate sensitivity to the test’s radiopaque dye.

Tell the patient to expect some pain. Reassure that he’ll receive a sedative before the test.
To keep the patient as calm and comfortable as possible.

After the test, urge the patient to remain in bed with his head elevated, especially if metrizamide was used.
To relieve the patient from discomfort and frustration of low back pain.

Drink plenty of fluids and monitor I&O.
Provides information about the circulatory status and replacement needs.

Watch for seizures and allergic reactions.
Expeditious diagnostic evaluation of unrecognized dural tears during surgery must be instituted immediately to avoid untoward sequelae.

Discuss the possibility of unrelieved and renewed pain.
Some pain may continue for several months as activity level increases and scar tissue stretches. Pain relief from the surgical procedure could be temporary if other discs have a similar amount of degeneration.

Discuss the use of heat (warm packs, heating pads, or showers).
Increased circulation to the back and surgical area transports nutrients for healing to the area and aids in the resolution of pathogens and exudates out of the area. Decreases muscle spasms that may result from nerve root irritation during the healing process.

Discuss the judicious use of cold packs before and after stretching activity, if indicated.
May decrease muscle spasms in some instances more effectively than heat.

Avoid tub baths for 3–4 wk, depending on physician recommendation.
Tub baths increase the risk of falls and flexing and twisting of the spine.

Review dietary and fluid needs.
Should be tailored to reduce the risk of constipation and avoid excess weight gain while meeting nutrient needs to facilitate healing.

Review and reinforce incisional care.
Correct care promotes healing and reduces the risk of wound infection. Note: This information is especially critical for the patient’s SO and caregiver in this era of early discharge (sometimes 24 hr after surgery).

Discuss the necessity of follow-up care.
Long-term medical supervision may be needed to manage problems and complications and to reincorporate individuals into desired and altered lifestyles and activities.

Review the need for an immobilization device, as indicated.
Correct application and wearing time are important to gain the most benefit from the brace.

Listen and communicate with the patient regarding alternatives and lifestyle changes. Be sensitive to the patient’s needs.
Low back pain is a frequent cause of chronic disability. Many patients may have to stop or modify work and have long-term or chronic pain creating relationship and financial crises. Often the patient is viewed as being a malingerer, which creates further problems in social or work relationships.

Document overt and covert expressions of concern about sexuality.
Although the patient may not ask directly, there may be concerns about the effect of this surgery on both the ability to cope with the usual role in the family and community and the ability to perform sexually.

Provide a written copy of all instructions.
Useful as a reference after discharge.

Identify community resources as indicated (social services, rehabilitation, and vocational counseling services).
A team effort can be helpful in providing support during the recuperative period.

Recommend counseling, sex therapy, and psychotherapy, as appropriate.
Depression is common in conditions for which a lengthy recuperative time (2–9 mo) is expected. Therapy may alleviate anxiety, assist the patient to cope effectively, and enhance the healing process. The presence of physical limitations, pain, and depression may negatively impact sexual desire and performance and add additional stress to the relationship.

Discuss return to activities, stressing the importance of increasing as tolerated.
Although the recuperative period may be lengthy, following the prescribed activity program promotes muscle and tissue circulation, healing, and strengthening.

Encourage initiation of a regular exercise program (walking, stretching).
Promotes healing, strengthens abdominal and erector muscles to provide support to the spinal column, and enhances general physical and emotional well-being.

Discuss the importance of good posture and avoidance of prolonged standing and sitting. Recommend sitting in a straight-backed chair with feet on a footstool or flat on the floor.
Prevents further injuries and stress by maintaining proper alignment of the spine.

Stress the importance of avoiding activities that increase the flexion of the spine such as climbing stairs, automobile driving, and riding, bending at the waist with knees straight, lifting more than 5 lb, engaging in strenuous exercise or sports. Discuss limitations on sexual relations and positions.
Flexing and twisting of the spine aggravate the healing process and increase the risk of injury to the spinal cord.

Encourage lying-down rest periods, balanced with activity
Reduces general and spinal fatigue and assists in the healing or recuperative process.

Explore limitations and abilities.
Placing limitations into perspective with abilities allows the patient to understand own situation and exercise choices.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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