Nursing Care Plan for Low Back Pain : Assessment, Diagnosis, Interventions, Implementation and Evaluation

Definition of Pain

Pain is a sensory and emotional experience of the unpleasant consequences of tissue damage actual or potential. Nursing definition of pain is, anything that hurts the body that is said by the individual / person who experienced that there whenever the person is saying. The primary legislation in treating patients with pain is that all pain is real, although the cause is unknown. Therefore, the existence of pain is based only on patient report.


Definition of Low Back Pain

Low Back Pain (LBP) or lower back pain is a sensation of pain that is felt in the intervertebral discs, are generally lower lumbar, L4-L5 and L5-S1.


Etiology

Most lower back pain caused by one of a variety of musculoskeletal problems (eg, acute lumbosacral strain, lumbosacral ligament instability and muscle weakness, osteoarthritis of the spine, spinal stenosis, intervertebral disc problems, leg length inequality). Other causes include obesity, kidney disorders, pelvic problems, retroperitoneal tumors, abdominal aneurysm and psychosomatic problems. Most back pain due to musculoskeletal disorders will be aggravated by activity, whereas the pain due to other circumstances is not affected by the activity.


Clinical Manifestations

Patients usually complain of back pain is acute or chronic back pain and weakness. During the initial interview, review the location of pain, nature and propagation along nerve fibers (sciatica), also evaluated how the way patients, spinal mobility, reflexes, leg length, motor strength and sensory perception along with the degree of discomfort they experienced. Straight leg elevation in the state which resulted in pain suggests irritation of nerve fibers.


Diagnostic Evaluation

Necessary diagnostic procedures performed on patients suffering from lower back pain. Vertebral X-rays may reveal a fracture, dislocation, infection, osteoarthritis or scoliosis. Computed Tomography (CT) is useful to know the underlying disease, such as the existence of a hidden soft tissue lesions around the vertebral column and intervertebral disc problems. Ultrasound can help diagnose the narrowing of the spinal canal. MRI allows visualization of the nature and location of spinal pathology.


Nursing Assessment of Low Back Pain

Patients with back pain, led to describe the discomfort (eg, location, weight, duration, nature, propagation and associated leg weakness). A description of how the pain occur with certain actions or activities in which the weak muscles are used in excess and how patients handle it. Information on jobs and recreational activities can help identify areas for health education.

During this interview, the nurse can observe the patient's posture, abnormal position and how the road. On physical examination, reviewed the curvature of the spine, the iliac crest and shoulder symmetry. Paraspinal muscle spasm palpated and recorded presence and tenderness. Patients assessed the existence of obesity because it can cause lower back pain.


Nursing Diagnosis of Low Back Pain

1. Acute pain associated with musculoskeletal problems.

2. Impaired physical mobility related to pain, muscle spasm, and reduced flexibility.

3. Deficient knowledge related to body mechanics techniques to protect the back.

4. Ineffective Role Performance related to impaired mobility and chronic pain.

5. Imbalanced Nutrition: more than body requirements related to obesity.


Intervention and Implementation of Low Back Pain

1. Relieves Pain

To reduce pain nurses can encourage patients to bed rest and modification of the position is determined to improve lumbar flexion. Patients are taught to control and adjust the pains that go through the respiratory diaphragm and relaxation can help reduce muscle tension that contributes to lower back pain. Distract patients from pain with other activities such as reading books, watching TV and with imagination.

Massage of the soft tissue, gently is very useful for reducing muscle spasms, improve circulation and reduce the damming and reduce pain. When given the drug the nurse should assess the patient's response to each drug.

2. Improving physical mobility

Physical mobility is monitored through continuous assessment. Nurses assess how patients move and stand. Once back pain is reduced, self-care activities may be performed with minimal strain on the injured structure. Change of position should be done slowly and assisted if necessary. Circular motion and sway should be avoided. Patients are encouraged to switch activities lying, sitting and walking around for a long time. Nurses need to encourage patients comply with exercise programs according to established, that one just does not exercise effective.

4. Health education

Patients must be taught how to sit, stand, lie down and lifting objects properly.

5. Improving the performance of the role

Responsibilities associated with the role may have changed since the occurrence of lower back pain. Once the pain healed, patients can return to his role of responsibility again. But when the activity is impacting on the bottom of back pain occurs again, it may be difficult to return to the original responsibility without bearing the risk of chronic low back pain with disability and depression caused.

6. Changing nutrition and weight loss

Weight loss through eating way of adjustment can prevent recurrence of back pain, by means of the rational nutrition plan that includes changes in eating habits to maintain a desired weight.


Evaluation

1. Experienced pain relief

- Rest in comfort
- Change the position comfortably
- Avoidance of drug dependence

2. Shows the return of physical mobility

- Return to activity gradually
- Avoid positions that cause discomfort which causes muscle
- Plan rest breaks throughout the day

3. Demonstrate body mechanics that maintain back

- Improved posture
- Changing the position of its own to minimize back stress
- Demonstrating the use of good body mechanics
- Participate in training programs

4. Back to the responsibilities associated with roles

- Use techniques facing problems to adjust to stressful situations
- Shows the reduction in dependence on others for self care
- Back to work when the back pain has been healed
- Return to full productive lifestyle

5. Achieving the desired body weight

- Identify the need for weight loss
- Participate in the development of weight loss plan
- Faithful to the weight-loss program


References:

• Ruth F. Craven, EdD, RN, Fundamentals Of Nursing, Edition II, Lippincot, Philadelphia, 2000
• Brunner & Suddarth
• Wim de Jong

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