{
  "name": "Laminectomy (Disc Surgery)",
  "slug": "laminectomy",
  "url": "https://nursingplex.com/care-plans/laminectomy",
  "category": "Surgery & Perioperative",
  "summary": "Spinal surgery care with log-rolling, neurovascular checks and body-mechanics education.",
  "nursing_diagnoses": [
    "Acute pain",
    "Impaired physical mobility",
    "Risk for injury"
  ],
  "overview": [
    "Laminectomy removes part of a vertebral lamina to decompress the spinal cord or nerve roots, most often for herniated intervertebral disc or spinal stenosis. It may be combined with discectomy or spinal fusion with instrumentation and bone graft.",
    "The main early risks are neurologic deterioration from hematoma or edema, cerebrospinal fluid leak from a dural tear, and injury from improper movement of the operative spine. Fusion patients face additional restrictions to protect the graft.",
    "Nursing care emphasizes frequent neurovascular checks of the affected extremities, strict log-rolling and body mechanics, effective analgesia, and structured education on lifting, bending and twisting restrictions."
  ],
  "key_facts": [
    {
      "label": "Log roll",
      "text": "Turn the patient as one unit with the spine aligned; never allow twisting at the waist."
    },
    {
      "label": "CSF leak",
      "text": "Clear or halo-ringed drainage on the dressing, plus positional headache, suggests dural tear — keep the patient flat and notify the surgeon."
    },
    {
      "label": "Neuro checks",
      "text": "Compare movement, sensation, strength and pulses in both legs against the preoperative baseline every 2–4 hours."
    },
    {
      "label": "BLT restriction",
      "text": "No bending, lifting over about 10 pounds, or twisting during early recovery."
    }
  ],
  "nursing_priorities": [
    "Detect neurologic deterioration or hematoma early.",
    "Maintain spinal alignment during all movement.",
    "Control pain and muscle spasm.",
    "Monitor for CSF leak, infection and urinary retention.",
    "Teach body mechanics and activity restrictions for safe healing."
  ],
  "assessment": {
    "subjective": [
      "Reports of back or leg pain, numbness or tingling and how they compare with before surgery",
      "Complaints of positional headache",
      "Reports of difficulty urinating or loss of bowel control",
      "Concerns about returning to work and lifting"
    ],
    "objective": [
      "Motor strength, sensation and pulses in both lower extremities compared with baseline",
      "Dressing for bleeding or clear halo-ringed drainage",
      "Bladder distention or inability to void after catheter removal",
      "Abdominal distention and bowel sounds",
      "Fever, wound redness or drainage"
    ],
    "related_factors": [
      "Surgical manipulation of spinal structures and nerve roots",
      "Postoperative edema or hematoma compressing neural tissue",
      "Muscle spasm around the operative site",
      "Immobility and anesthesia effects"
    ]
  },
  "goals": [
    "The client will maintain or improve motor and sensory function compared with baseline.",
    "The client will report pain controlled to an acceptable level.",
    "The client will demonstrate correct log-rolling and safe body mechanics.",
    "The client will remain free from CSF leak, infection and urinary retention."
  ],
  "interventions": [
    {
      "title": "Neurologic monitoring",
      "points": [
        "Perform bilateral lower-extremity motor, sensory and circulation checks every 2–4 hours.",
        "Report new or worsening weakness, numbness, severe pain or loss of bladder/bowel control immediately.",
        "Assess the dressing for excessive bleeding or clear fluid with a halo ring.",
        "Keep the patient flat and notify the surgeon if CSF leak is suspected."
      ]
    },
    {
      "title": "Positioning and mobility",
      "points": [
        "Log-roll with adequate staff and a draw sheet, keeping shoulders and hips aligned.",
        "Place a pillow between the knees when side-lying and support the back when sitting.",
        "Assist out of bed by rolling to the side and pushing up with the arms.",
        "Apply a prescribed brace before getting out of bed if ordered.",
        "Encourage progressive ambulation and avoid prolonged sitting."
      ]
    },
    {
      "title": "Comfort and elimination",
      "points": [
        "Give scheduled analgesia and muscle relaxants; apply ice to the incision as ordered.",
        "Assess voiding after catheter removal and check residual volumes if output is poor.",
        "Provide stool softeners and fluids to avoid straining.",
        "Encourage deep breathing and leg exercises to prevent pulmonary and vascular complications."
      ]
    }
  ],
  "patient_teaching": [
    "Follow the no bending, lifting or twisting rule for the period the surgeon specifies.",
    "Demonstrate log-rolling, safe chair transfers and correct lifting posture for later.",
    "Report new leg weakness, numbness, saddle anesthesia or loss of bladder control urgently.",
    "Attend physical therapy and increase walking distance gradually."
  ]
}