Laminectomy program maps a path for patient

A clinical pathway for laminectomy patients developed at Mercy Fairfield (OH) Hospital includes a patient education handout about the program, which is summarized as follows:

Phase I — Preoperative: Pre-op testing to be completed includes lab work and possibly an EKG and X-rays. Pre-op assessment will include a history of your current problems or pain you are having and any other illnesses you may have. We will ask about other surgeries you have had in the past. We also will want to know what kind of medication allergies you might have and what kind of reaction you had to those medications. An anesthesiologist and a nurse will ask these questions. Your pre-op instructions will be given by the pre-op assessment nurse, and will include the following:

• pre-op scrub technique for your shower time prior to coming into the hospital;

• pre-op pain evaluation, and how your body responds to pain medications;

• post-op Incentive Spirometry use and reason for the Incentive Spirometry, deep breathing, etc.;

• recognition of problems which may interfere with the healing process;

• positions which may increase your level of comfort post-op and any restrictions you may have in exercise or movement.

Phase II — Postoperative: The following signs will be evaluated frequently after your surgery: vital signs (heart rate, temperature, and blood pressure); your ability to feel (sensation) and move; and circulation (blood flow) to the lower legs. We may be measuring oxygen saturation with a clip on your finger. Your level of pain (if present) will also be checked often. You may need to ask the nurse for your pain medication when you feel uncomfortable. If you are not comfortable after the pain medication has had a chance to work, please tell your nurse.

Your dressing will be checked frequently. It is important to keep it clean and dry. Your position in bed or in the chair is also important. Your caregiver will have some suggestions to help you with your discomfort and to position you for the best effect.

Walking is important and leads to a successful recovery. You will be encouraged to be up and about as soon as possible. Questions should be directed to your health care team members (nurse) and your physician.

Phase III — Discharge: On this day your discharge plans should be complete. Plans for your post-op office visit will be discussed. You will need to call the doctor’s office to make that appointment when you go home. Any post-op testing to be completed will also be set up.

Instructions on how to care for your dressing will have been completed. Any limitations to your activity should be stated in your [patient] booklet. Any questions you may have should be answered by your health care team. Signs and symptoms for any problems post-op will be covered with your nurse before going home. Your instructions should include:

• shower instructions;

• exercise plans: walking, etc;

• control of pain at home;

• positioning and restrictions for activity.