Need nursing diagnosis for rhizotomy

Trauma Columnist · Jan 22, 2012

Moved to its own thread for more answers.

KelRN215, BSN, RN · Jan 23, 2012

What are your major concerns for a post-op patient? Alteration in comfort, Risk for Infection... those fit pretty well with most post-ops.

Esme12, ASN, BSN, RN · Jan 23, 2012

Think about what type of surgery it is......A rhizotomy ( /r aɪ ˈ z ɒ t ɵ m i / ry-zot-ə-mee) is a term chiefly referring to a neurosurgical procedure that selectively severs problematic nerve roots in the spinal cord, most often to relieve the symptoms of neuromuscular conditions such as spastic diplegia and other forms of spastic cerebral palsy ^[1]. The selective dorsal rhizotomy (SDR) for spastic cerebral palsy has been the main use of rhizotomy for neurosurgeons specialising in spastic CP since the 1980s; in this surgery, the spasticity-causing nerves are isolated and then targeted and destroyed. The sensory nerve roots, where spasticity is located, are first separated from the motor ones, and the nerve fibres to be cut are then identified via electromyographic stimulation. The ones producing spasticity are then selectively lesioned with tiny electrical pulses. Rhizotomy - Wikipedia, the free encyclopedia

What can happen when you mess with nerves? What part of the spine is affected and which body function is controlled by these nerves. It is a surgical procedure right?

When you mess with nerves and the spinal cord there may be abnormal sensitivity and tingling of the skin on the feet and legs after SDR because of the nature of the nerves that have been worked on, but this usually resolves within 6 weeks. There is no way to prevent the abnormal sensitivity in the feet. Transient change in bladder control may occur, but this also resolves within a few weeks.

If a certain degree of permanent numbness remains in certain leg-muscles, such as the quadriceps, ankles, and feet, this is usually not enough to prevent feeling and sensation, sensing of changes in temperature or pressure, etc. The affected muscle-areas simply feel less than before, and the trade-off in ease of movement is said to be immensely worth this change, should it occur.

In general, there is a combined 5-10% risk of any of the following more serious risks happening as a result of SDR. Because of technological advances in both the technology used in the surgery and also in the procedure itself, there have been no major cases of SDR that have had these side-effects.

Permanent paralysis of the legs and bladder.
Permanent impotence
Sensory loss and/or numbness that is severe enough to not feel anything any more in the legs (not paralysis; movement is retained)
Wound infection and meningitis - usually controlled with antibiotics
Leakage of the spinal fluid through the wound, also repairable; the surgical team watches very closely post-surgery for this Surgical Treatment Options for Spasticity

Nursing Care Plan

Nursing Resources - Care Plans

I hope this helps