10. Laminectomy: excision of dorsal arch of vertebrae with or without spinal fusion of two or more vertebrae with a bone graft from iliac crest, to stabilize spin See Clinical Pathway for Posterior Spinal Fusion.
    1. Analysis/nursing diagnosis:
    1. Pain related to edema of surgical procedure.
    2. Impaired physical mobility related to pain and discomfort resulting from surgery.
    2. Nursing care plan/implementation:
    1. Goal: relieve anxiety.
       1. Answer questions, explain routines.
    2. Goal: prevent injury postoperatively.
       1. Monitor vital signs:
          1. Neurological signs, check sensation and motor strength of limbs.
          2. Respiratory status (risk for respiratory depression with cervical laminectomy).
       2. Monitor I&O (urinary retention common, especially with cervical laminectomy); may need catheterization. Encourage fluids.
       3. Monitor bowel sounds (paralytic ileus common with lumbar laminectomy).
       4. Monitor dressing for possible bleeding.
       5. Bed position as ordered:
          1. For lumbar laminectomy: head of bed flat; supine with slight flexion of legs; with pillow between knees for turning and side-lying position.
          2. For cervical laminectomy: head of bed elevated, neck immobilized with collar or sandbags.
       6. Encourage deep breathing to prevent respiratory complications.
       7. Prevent strain or fleon at surgical site: log-rolling with spinal fusion.
       8. Some surgical interventions that require small incisions (microsurgery) have no specific postoperative positions.
    3. Goal: promote comfort.
       1. Administer analgesics if sciatic-type pain continues after lumbar surgery (arm pain after cervical surgery), due to edema from trauma of surgery.
    4. Goal: prepare for early discharge.
       1. Patients having microsurgery for repair of herniated disk will usually be discharged from the hospital 1 day postoperative; teaching regarding allowed and restricted activities must be done early.
    5. Goal: health teaching.
       1. How to turn and move from side to side in one motion, sit up, and get out of bed without twisting spine; to get out of bed: raise head of bed while in side-lying position, then put feet over edge of bed, and stand.
       2. Proper positioning and ambulation techniques.
       3. Correct posture, body mechanics, activities to prevent further injury; increase activities according to toleranc
       4. Physiotherapy; encourage compliance for full rehabilitation.
    3. Evaluation/outcome criteria:
       1. No respiratory, bowel, or bladder complications note
          1. Lung sounds clear.
          2. Bowel sounds present; able to pass gas and feces.
          3. Urinary output adequate.
       2. Regains mobility.
       3. Comfort level increases: reports leg and back pain decrease
       4. Demonstrates protective positioning and ambulation techniques.