NURSING DIAGNOSIS: Knowledge deficit

regarding the surgical procedure, routines associated with surgery, physical preparation for laminectomy and spinal fusion (if planned), sensations that normally occur following surgery and anesthesia, and postoperative care.

Desired Outcome
The client will verbalize an understanding of the surgical procedure, preoperative care, and postoperative sensations and care.
Nursing Actions and Selected Purposes/Rationales
  1. Refer to Standardized Preoperative Care Plan, Diagnosis 4, actions a.1-4, for information to include in preoperative teaching.
  2. Provide additional information regarding postoperative care:
    1. if a laminectomy without spinal fusion is planned:
      1. explain that progressive activity will probably begin the evening of or morning after surgery
      2. reinforce physician's explanation about wearing a soft cervical collar (following a cervical laminectomy) or a back brace or corset (following a lumbar laminectomy) if client is expected to need one while the surgical area heals (some physicians order this stabilization device to provide additional support to the operative area for a few weeks postoperatively if the surgery is fairly extensive and/or the client has a tendency to be too active)
    2. if a laminectomy with spinal fusion is planned:
      1. explain that progressive activity usually begins 1-3 days after surgery depending on physician preference and extensiveness of the surgery
      2. reinforce physician's explanation about the type of stabilization device that will need to be worn while the surgical area heals (usually a rigid cervical collar or halo brace following a cervical fusion and a back brace following a lumbar fusion)
    3. if client has muscle weakness or numbness or tingling in the affected extremity, explain that it may take weeks to months to resolve after surgery due to surgical trauma and the time it takes the peripheral nerves to heal.
  3. Allow time for questions and clarification of information provided.
  4. Allow time for client to practice putting on and removing stabilization device if available preoperatively.
Desired Outcome
The client will demonstrate the ability to perform activities designed to prevent postoperative complications.
Nursing Actions and Selected Purposes/Rationales
  1. Refer to Standardized Preoperative Care Plan, Diagnosis 4, action b.1, for instructions on ways to prevent postoperative complications.
  2. Provide additional instructions about ways to prevent postoperative complications:
    1. instruct client how to logroll and stress the importance of turning in this manner after surgery (the length of time logrolling is necessary increases if a fusion was performed)
    2. instruct client to avoid extreme flexion, hyperextension, and twisting of the cervical or lumbar spine postoperatively
    3. demonstrate the correct way to change from a lying to standing position (e.g. keeping spine in proper alignment, utilizing arm and leg muscles)
    4. reinforce physician's or physical therapist's instructions about exercises to strengthen arm, shoulder, neck, back, leg, and abdominal muscles (increased strength of these muscles decreases strain on the spine)
    5. demonstrate proper body alignment and good body mechanics and stress the importance of lifelong adherence to these principles.
  3. Allow time for questions, clarification, and return demonstration.