Nursing Care for Patients with Fractures of the Thoracic and Lumbar Spine after Laminectomy in Intermediate Care (IMC) : Case study

Abstract

Spinal fractures and dislocations can cause death, disability and a need for long-term care. The patient will suffer from pain, disability or death from complications  from fractures. Intermediate care (IMC) is a development of health service in the Service Plan system that connects the hospital system at all levels from primary, secondary and tertiary care. The ultimate goals of this system includes ensuring that patient safety in intermediate care, providing physical, mental, emotional, social, and spiritual rehabilitation without any disability, patients can take care of their own life and able to live a normal life within society. This case study was challenging for ward nurses who prepared patients for discharge planning and provide the IMC service system.

Objective : To provide nursing care for patients with fractures of the thoracic and lumbar spine (T12 - L1) after laminectomy in intermediate care (IMC).

Results :  A 17 year-old female patient with an accident from a crash between her motorcycle and a pickup truck and motorbike was over on her body. She was taken to the hospital 1 hour after the incident with conscious, injuries on her body surface, face and back and felt numbness in her both legs. The Glasgow Coma Scale (GCS) was 13 (E3 V 4 M 6) with diagnosis : Fractures and Dislocations of T12-L1 with Torn Dura with Closed Fracture Lift Shaft Femur. Frist Laminectomy with Pedicular Screw Fixation T12-L2 with Poster Lateral Fusion Repaired Dura was performed on June 7, 2019. The Second operation for Open Reduction Internal Fixation with Plate and Screw Left Femur was performed on June 12, 2019 without complications after surgery. Patient was hospitalized for 48 days. The patient returned home with paraplegia (Motor Power grade 0). She was also inability to urinate and retained foley's catheters. The total Barthel ADL Index score was 5 which met criteria for IMC service. A multidisciplinary team provided care and  a rehabilitation service for up to 6 months with follow-up every 1 month. Nurses were involved in all stages of care and the discharge planning process for supporting patient self-care. The patient now being able to walk again with a knee brace support and a walker. She can also self-urinate, able to do more activities and did not return to hospitalize. In addition, patient has gained her knowledge and skills to take care of herself and performed activities in her physical rehabilitation medicine programs.