외과 실습 간호진단 - Thoracic spinal stenosis (흉추 척추관 협착증)

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1. Thoracic spinal stenosis (흉추 척추관 협착증)

Thoracic spinal stenosis는 척수의 통로인 척추관이 비정상적으로 좁아짐으로써 척수 자체나 그에서 비롯된 신경들이 눌리고 억제되어 허리 통증, 여러 신경학적 장애를 일으키는 질환입니다. 이 환자는 2019년 1월부터 양측 엉덩이부터 허벅지까지 심한 땡기는 증상과 다리의 힘이 떨어져 스스로 걷기가 힘들어 병원에 방문하여 Thoracic spinal stenosis 진단을 받았습니다. 이에 따라 decompressive laminectomy 수술을 받았습니다.
2. decompressive laminectomy

decompressive laminectomy는 척추 뒤의 후궁의 일부 뼈를 절제하여 압박을 받고 있는 신경을 감압하는 수술입니다. 이 환자는 Thoracic spinal stenosis 진단을 받고 이 수술을 받았습니다.
3. 수술 후 통증 관리

이 환자는 수술 후 심한 통증을 호소하였습니다. 통증 사정 결과 움직이면 아픔, 찌르는 듯이 아픔, NRS상 5점의 통증을 호소하였습니다. 진통제 Tridol 1AMP 1회 IV 투여 중이었습니다.
4. 수술 후 변비 관리

이 환자는 수술 후 계속 침상에 누워만 있었고, 보호자 동반 하에 침상용변실에 갔으나 변을 보지 못했습니다. 입원 후 지금까지 대변을 보지 못했으며, 복부불편감을 호소하였습니다. 이는 부동과 부족한 음식 섭취로 인한 변비 위험성과 관련이 있습니다.
5. 수술 후 영양 관리

이 환자는 식욕이 없고 밥을 거의 먹지 않았습니다. 모발이 가늘고 윤기가 없으며, 피부는 탄력성이 떨어져 있고 푸석푸석하고 거친 상태였습니다. 혈액검사 결과 빈혈 소견이 있었습니다. 이는 영양부족과 관련이 있습니다.

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1. Thoracic spinal stenosis (흉추 척추관 협착증)

Thoracic spinal stenosis is a condition where the spinal canal in the thoracic (upper back) region narrows, putting pressure on the spinal cord. This can lead to a variety of symptoms such as back pain, numbness, weakness, and difficulty walking. The causes of thoracic spinal stenosis can include degenerative changes, bone spurs, herniated discs, and spinal injuries. Proper diagnosis through imaging tests and a thorough physical examination is crucial for determining the appropriate treatment approach. Conservative treatments like physical therapy, medications, and epidural injections may be tried first, but in more severe cases, decompressive surgery like laminectomy may be necessary to relieve the pressure on the spinal cord. It's important for patients to work closely with their healthcare team to understand the risks and benefits of different treatment options and develop a comprehensive management plan tailored to their individual needs and goals.
2. decompressive laminectomy

Decompressive laminectomy is a surgical procedure used to treat spinal stenosis by removing a portion of the vertebral bone (lamina) to create more space for the spinal cord and nerves. This can help alleviate symptoms like pain, numbness, and weakness caused by the compression. The surgery involves making an incision in the back, removing the lamina, and potentially trimming any bone spurs or other structures that may be contributing to the stenosis. Recovery time can vary, but patients typically experience some immediate relief of symptoms, though full recovery may take several weeks or months. It's important for patients to follow their surgeon's instructions carefully during the recovery process to ensure proper healing and minimize the risk of complications. Overall, decompressive laminectomy can be an effective treatment option for severe cases of spinal stenosis that do not respond to conservative therapies.
3. 수술 후 통증 관리

Effective pain management is crucial for patients recovering from decompressive laminectomy surgery. The surgery itself can cause significant post-operative pain, which needs to be carefully managed to facilitate the healing process and improve patient outcomes. A multimodal approach to pain management, utilizing a combination of medications, physical therapy, and other non-pharmacological interventions, is often recommended. This may include the use of opioid analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and adjuvant medications like gabapentin or pregabalin to target different pain pathways. Additionally, techniques like ice therapy, heat therapy, and gentle exercises can help reduce pain and promote recovery. It's important for patients to work closely with their healthcare team to develop a personalized pain management plan, monitor their progress, and adjust the treatment as needed. Proper pain control can not only improve the patient's comfort but also facilitate their participation in physical therapy and other rehabilitation activities, ultimately leading to better long-term outcomes.
4. 수술 후 변비 관리

Constipation is a common complication following decompressive laminectomy surgery, and it is important to proactively manage this issue to prevent further complications and discomfort. Several factors can contribute to post-operative constipation, including the use of opioid pain medications, decreased physical activity, and changes in dietary habits. A comprehensive approach to managing post-operative constipation should involve a combination of dietary modifications, hydration, and pharmacological interventions as needed. Patients should be encouraged to increase their intake of fiber-rich foods, stay well-hydrated, and engage in gentle physical activity as tolerated. Over-the-counter laxatives or stool softeners may also be recommended by the healthcare team to help regulate bowel movements. Regular monitoring and prompt treatment of constipation can help prevent more serious complications, such as impaction or bowel obstruction, and improve the overall recovery process for patients undergoing decompressive laminectomy.
5. 수술 후 영양 관리

Proper nutrition is essential for patients recovering from decompressive laminectomy surgery. The surgical trauma and the body's healing process can increase the body's nutritional needs, making it important for patients to focus on consuming a balanced, nutrient-rich diet. Key considerations for post-operative nutrition management include: 1. Protein intake: Adequate protein is necessary for tissue repair and muscle recovery. Patients should aim for 1.2-1.5 grams of protein per kilogram of body weight per day, obtained from a variety of sources like lean meats, poultry, fish, eggs, dairy, and plant-based proteins. 2. Calorie needs: Patients may require increased caloric intake to support the healing process, often in the range of 25-30 kcal per kilogram of body weight per day. This may need to be adjusted based on the individual's activity level and progress in recovery. 3. Micronutrients: Vitamins and minerals like vitamin C, zinc, and iron play important roles in wound healing and immune function. Patients should focus on consuming a variety of fruits, vegetables, and other nutrient-dense foods. 4. Hydration: Adequate hydration is crucial for maintaining proper bodily functions and supporting the healing process. Patients should aim to drink at least 8 cups of fluids per day, including water, broths, and juices. Close collaboration with a registered dietitian can help patients develop a personalized nutrition plan to optimize their recovery and long-term health outcomes following decompressive laminectomy surgery.

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