What lab data and procedures would you order for a laminectomy?

[onlyj]

im a first level nursing student and im doing a care plan for a patient who had a laminectomy (L4-L5). her only concern is ambulation because she needs assistance. she has pain, level 8, but she doesn't want to take any pain meds because they make her feel worse. what are the lab data and procedures needed for someone who had a laminectomy? i have so far xray, myelogram, ct scan, and mri. i asked the nurse if i can see the recent lab values and she said there was none. so the patient doesn't need labs? how about for pt/inr? i thought people who had laminectomies had to be careful of clots?

[tamadrummer]

If your care plans are anything like ours, you use every lab in the chart. (Obviously the most current cbc,BMP/CMP, and any other UA, BNP......)

We also use every single diagnostic, ultra sound, x-ray, CT, ECG, you name it we use it.

Some of our care plans can have as many as 30 pages or more.

[classicdame, MSN, EdD]

Before any surgery the anesthesia dept will want AT MINIMUM an H&H & basic metabolic panel. Their standards require more depending age of the pt and co-morbidities, if any. Not only do you not want them to clot after the surgery you do not want them to bleed to death during the surgery. Knowing glucose levels and other chemistries is necessary to alert MD for potential issues during and after surgery.

[Qbert]

So is this for your care plan? or nursing diagnosis?

[onlyj]

care plan

[tamadrummer]

One other note, each time we are in clinicals, the care plan expectations change. Each clinical instructor has a different expectation.

[athflying]

One other note, each time we are in clinicals, the care plan expectations change. Each clinical instructor has a different expectation.

Hahaha....welcome to nursing school. Well in reality life, think of your nursing instructor as your manager. Every manager and/or hospital you work for all will have different expectations. They are all living under someone elses expectations that eventually trickle down to nursing.

[canesdukegirl, BSN, RN]

Definitely an H&H, T&S, and depending on pt hx, Chem 10 and UA. Sometimes our surgeons will order a PT/PTT/INR, but not always. This is always done pre-op so that we have some baseline values.

The thing that we worry about during surgery (well, ONE of the things) is excessive bleeding. Spines and bones can bleed like stink, and without a baseline H&H, we have no idea how badly the pt is dropping...for example, if we have a 25 year old male with a baseline HCT of 42, and he has an EBL of 400 at the end of surgery, it isn't a big fat hairy deal. His HCT will likely drop to about 38, but will rebound quickly simply because of his age. On the other hand, if we have an 86 year old lady with a baseline HCT of 32 and had the same EBL, we would be worried and would likely proceed with a transfusion.

It also depends on the KIND of laminectomy that was done. Is it just a decompression? Or is it a decompression with fusion?

Regarding your care plan, pain meds are a must in order for your pt to ambulate adequately. You can always give her a choice of what she would like for pain meds. Administer that 30 minutes prior to activity. She needs assistance with ambulation, of course. She should also have compression stockings on (TEDS or SCDS) while in bed.

Kudos to you for asking about this. I hope that you will be able to come up with a great care plan for your laminectomy pt!

[Mommy TeleRN, RN]

Those back surgery patients usually have a ton of pain! I've only ever seen one that wasn't in bad pain. She was the exception! Often you will have to help them turn because they won't do it independantly, so you have potential for impaired skin integrity (in addition to their incision), potential for infection, and altered elimination due to narcotic usage and decreased mobility.

As far as labs, a CBC for sure as others mentioned to assess for bleeding but also to monitor white count. Although in my personal experience, neurosurgeons tend not to order very many labs or diagnostic testing.