Learning Guide for HNP (Herniated Nucleus Pulposus) and spinal tumors
1. What are the early symptoms of pressure on the spinal cord r/t expanding spinal tumors?
Back and leg pain, coldness, numbness, tingling, paresthesias, progression leads to bowel and
bladder dysfunction, weakness and paralysis
2. List the 4 areas of the vertebrae in order from top to bottom and the number of vertebrae in
each area.
Cervical (C1-C7), Thoracic (T1-T12), lumbar (L1-L5), and Sacral (S1-S4)
3. What are the priority nursing diagnoses for a patient experiencing low back pain from HNP?
Pain, disturbed sleep pattern, ineffective individual coping , ineffective therapeutic regimen
management, disturbed body image
4. Following laminectomy surgery, the nurse should turn and reposition the patient by doing which
of the following?
a. Having the patient use the side rails of the bed.
b. Elevating the head of the bed 45 degrees, then turning the legs together towards the
floor, bending at the waist.
c. Logrolling the patient as a unit, keeping the body in proper alignment. After
laminectomy surgery it is critical that proper body alignment is maintained to prevent
postoperative complications such as neurological damage. Logrolling technique ensures
that the patient turns as a unit. All the other options put stress on the spine.
d. Turning the patient’s head and shoulders then hips.
5. What are some risk factors for low back pain?
Degenerative disc disease, poor muscle tone of the lower back, sedentary lifestyle,
obesity, poor body mechanics, smoking ,and/or stress
6. Explain the staging system for brain tumors.
GX = grade cannot be assessed (undetermined)
G1 = Well-differentiated (low grade)
G2 = Moderately differentiated (intermediate grade)
G3 = Poorly differentiated (high grade)
G4 = Undifferentiated (high grade)
7. Contrast the difference between extradural, intradural extramedullary, and intradural
intrameduallary spinal cord tumors. Which one has the worst prognosis?
Extradural: mostly malignant metastatic, seen early on xray
Intradural extramedullary: most frequent of intradural tumors, mostly benign, require MRI/CT
for detection
Intradural intramedullary: least frequent, require MRI/CT for detection
Intradural intramedullary has the worst prognosis
8. Provide some patient teaching guidelines for low back pain, include do’s and don’ts.
Do Not: lift anything above the knees, lean forward without bending the knees, exercise without
talking to the healthcare provider, stand in one position for prolonged time.
Learning Guide for HNP (Herniated Nucleus Pulposus) and spinal tumors
Do: Carry light items close to body, maintain appropriate BMI, use heat/cold to area of
discomfort, exercise per HCP recommendations, prevent straining by placing a foot on a step
during prolonged standing.