Nursing Care of the Postoperative Spine Patient Care
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Transcript of Nursing Care of the Postoperative Spine Patient Care
![Page 1: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/1.jpg)
Nursing Care of the Postoperative Spine
Patient CareMichael D Smith MD
Twin Cities OrthopedicsOctober 2012
Objectivesbull Discuss indications for surgerybull Present perioperative
complications to watch forbull Review practical surgeon concerns
regarding nursing assessment biased toward cervical spine
procedures
Indications for Spinal Surgery
The Big Threebull Neurologic compressionbull Instabilitybull Deformity
Pain -Indication for Surgery
bull Pain- unmanageable and associated with compression deformity or instability
bull Degenerative findings- common and incidental
Disc Herniation
Grade 1-4 based on
morphology and extension
beyond PLL
Neurological Indicationsbull Pain
numbness weakness tingling from cord or root compression
Instability
bull Spine unable to tolerate daily loads without excessive motion
bull Degenerative acquired post-traumatic neoplastic congenital
Traumatic
Instability
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 2: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/2.jpg)
Objectivesbull Discuss indications for surgerybull Present perioperative
complications to watch forbull Review practical surgeon concerns
regarding nursing assessment biased toward cervical spine
procedures
Indications for Spinal Surgery
The Big Threebull Neurologic compressionbull Instabilitybull Deformity
Pain -Indication for Surgery
bull Pain- unmanageable and associated with compression deformity or instability
bull Degenerative findings- common and incidental
Disc Herniation
Grade 1-4 based on
morphology and extension
beyond PLL
Neurological Indicationsbull Pain
numbness weakness tingling from cord or root compression
Instability
bull Spine unable to tolerate daily loads without excessive motion
bull Degenerative acquired post-traumatic neoplastic congenital
Traumatic
Instability
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 3: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/3.jpg)
Indications for Spinal Surgery
The Big Threebull Neurologic compressionbull Instabilitybull Deformity
Pain -Indication for Surgery
bull Pain- unmanageable and associated with compression deformity or instability
bull Degenerative findings- common and incidental
Disc Herniation
Grade 1-4 based on
morphology and extension
beyond PLL
Neurological Indicationsbull Pain
numbness weakness tingling from cord or root compression
Instability
bull Spine unable to tolerate daily loads without excessive motion
bull Degenerative acquired post-traumatic neoplastic congenital
Traumatic
Instability
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 4: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/4.jpg)
Pain -Indication for Surgery
bull Pain- unmanageable and associated with compression deformity or instability
bull Degenerative findings- common and incidental
Disc Herniation
Grade 1-4 based on
morphology and extension
beyond PLL
Neurological Indicationsbull Pain
numbness weakness tingling from cord or root compression
Instability
bull Spine unable to tolerate daily loads without excessive motion
bull Degenerative acquired post-traumatic neoplastic congenital
Traumatic
Instability
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 5: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/5.jpg)
Disc Herniation
Grade 1-4 based on
morphology and extension
beyond PLL
Neurological Indicationsbull Pain
numbness weakness tingling from cord or root compression
Instability
bull Spine unable to tolerate daily loads without excessive motion
bull Degenerative acquired post-traumatic neoplastic congenital
Traumatic
Instability
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 6: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/6.jpg)
Neurological Indicationsbull Pain
numbness weakness tingling from cord or root compression
Instability
bull Spine unable to tolerate daily loads without excessive motion
bull Degenerative acquired post-traumatic neoplastic congenital
Traumatic
Instability
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 7: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/7.jpg)
Instability
bull Spine unable to tolerate daily loads without excessive motion
bull Degenerative acquired post-traumatic neoplastic congenital
Traumatic
Instability
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 8: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/8.jpg)
Traumatic
Instability
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 9: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/9.jpg)
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 10: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/10.jpg)
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 11: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/11.jpg)
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 12: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/12.jpg)
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 13: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/13.jpg)
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 14: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/14.jpg)
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 15: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/15.jpg)
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 16: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/16.jpg)
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 17: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/17.jpg)
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 18: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/18.jpg)
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 19: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/19.jpg)
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 20: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/20.jpg)
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 21: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/21.jpg)
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 22: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/22.jpg)
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 23: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/23.jpg)
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 24: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/24.jpg)
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 25: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/25.jpg)
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 26: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/26.jpg)
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 27: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/27.jpg)
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 28: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/28.jpg)
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 29: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/29.jpg)
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 30: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/30.jpg)
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 31: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/31.jpg)
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 32: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/32.jpg)
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 33: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/33.jpg)
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 34: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/34.jpg)
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 35: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/35.jpg)
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 36: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/36.jpg)
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 37: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/37.jpg)
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 38: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/38.jpg)
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 39: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/39.jpg)
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 40: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/40.jpg)
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 41: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/41.jpg)
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 42: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/42.jpg)
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 43: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/43.jpg)
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 44: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/44.jpg)
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 45: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/45.jpg)
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 46: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/46.jpg)
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 47: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/47.jpg)
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 48: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/48.jpg)
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 49: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/49.jpg)
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 50: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/50.jpg)
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-
![Page 51: Nursing Care of the Postoperative Spine Patient Care](https://reader035.fdocuments.us/reader035/viewer/2022062410/56815d32550346895dcb2c06/html5/thumbnails/51.jpg)
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
- Nursing Care of the Postoperative Spine Patient Care
- Objectives
- Indications for Spinal Surgery The Big Three
- Pain -Indication for Surgery
- Slide 5
- Disc Herniation Grade 1-4 based on morphology and extension beyond PLL
- Neurological Indications
- Instability
- Traumatic Instability
- Degenerative Instability
- Cervical Deformity
- Perioperative Complications
- Risk Factors for Complications
- Demographics for Mortality
- Risk Factors for Mortality Unproven
- Common Cervical Spine Procedures
- Surgical Technique-Anterior DecompressionFusion
- Operative Approach
- Incision Localization
- Exposure Superficial Dissection
- Exposure Deep Dissection
- Completed Exposure
- Fusion Bone Graft Insertion
- Slide 24
- Typical ACDF Fixation
- Cervical Corpectomy
- Slide 27
- Cervical Disc Replacement
- Posterior Procedures
- Posterior Procedure Positioning
- Slide 31
- Indications and Need for Nursing Care
- Phases of Nursing Care
- Slide 34
- Phase of Nursing Care
- Complications
- Postoperative Edema
- Nursing Concerns
- Slide 39
- Esophageal Perforation
- Slide 41
- Displaced Bone Graft
- Slide 43
- Mental Health Issues
- Anxiety Disorders
- Slide 46
- Depression
- Depression The 3 Rs
- Substance Abuse 240M in Risk Group
- Coping Skill Set Point Readjusted
- Postoperative Anxiety
- Thank You
- Slide 53
- CONFLICT OF INTEREST
-