A. Definition
Sensori is painful and emotional experience that is not enjoyable as a result of damage to the network and the actual potential. Definition of nursing is painful, painful for any of the body of the individual / mengalaminya someone who, whenever there is a person you say it (2). Regulations in primary care for patients with pain is that all pain is real, although it is not known. Therefore, the presence of pain is based only on patient reports.
Low Back Pain (LBP) or the bottom of the back pain is a painful sensation that is felt in the discus intervertebralis generally lumbal down, L4-L5 and L5-S1 (2.4).
B. Etiology
Most back pain is caused by under one of the many problems muskuloskeletal (eg regangan lumbosakral acute, ligamen lumbosakral instability and muscle weakness, osteoartritis spine, spinal stenosis, a problem intervertebralis discus, leg length inequality). Other causes include Obesity, kidney disturbances, problems pelvis, retroperitoneal tumor, aneurisma abdominal and psychosomatic problems. Most back pain due to interference by muskuloskeletal akan diperberat activity, whereas pain due to other circumstances is not affected by the activity (2,4).
C. Patofisiology
Specific structure in the nervous system involved in the stimulus became painful sensation. System involved in pain transmission and perception is called the system nosiseptif. Sensitivity of the system components nosiseptif can be influenced by a number of factors and vary among individuals. Not all those who terpajan to the same stimulus intensity experienced the same pain. Sensation is very painful for someone may not feel close to others (1,3).
Reseptor pain (nosiseptor) is the free end of the nerve in the skin berespons only on a strong stimulus, which is potentially harmful, which are the stimuli can be chemical, mechanical, thermal. Reseptor pain is a multi-way jaras complex. Nerve fiber is very close to the fork originally on the skin and sends branches to the local blood vessel. Mast cells, folikel hair and sweat gland. Stimuli fiber histamin this result in release from mast cells and cause vasodilatasi. Fiber kutaneus located more towards the central branch of the further and related to the chain simpatis paravertebra nervous system and internal organs with a larger. A number of substances that can increase the transmission or perception of pain include histamin, bradikinin, asetilkolin and substance P. Prostaglandin where substances that can increase the effect of that cause pain bradikinin. Other substances in the body that functions as a inhibitor of pain transmission is endorfin and enkefalin found in the concentration of a strong central nervous system (1,3).
Kornu dorsalis of the medulla spinalis is a sensori process, which can be painful to be consciously, in neuron system assenden must be enabled. Activation occurs as a result of input from the painful reseptor located in the skin and internal organs. The process occurs because of a painful interaction between pain stimulus and pain sensation (1,3).
In the painful sensation Patofisiologi back down in this case kolumna vertebralis can be considered as an elastic rod is composed of many units on the vertebrae and the discus intervertebrae tied to one another by complex faset joints, muscles and ligamen various paravertebralis. Back the unique construction allows flexibility while on the other can still memberikanperlindungan the sum of the maximum-sum spine. Spinal curvature akan absorb shock when the vertical run or jump. Torso help stabilize the spine. Abdominal musculature and have very important Toraks activities lift the burden. When not in use will never weaken the structure of this support. Obesity, the postures, the problem of structure and support peregangan excessive spine can result in back pain (2,4).
Discus intervertebralis akan changing nature of the increasing old age. In the young people, especially structured discus fibrokartilago up with gelatinus matrix. In the elderly will become a solid and fibrokartilago ramble. Discus intervertebra degeneration is a common cause of back pain. Discus lumbal down, L4-L5 and L5-S6, suffer the most stress and weight change terberat degeneration. Projection discus or damaged joints can lead to emphasis on the nerve roots exit kanalis spinalis, causing pain that spreads along the nerve (2,4).
D. Clinical manifestations
Patients usually engeluh painful punngung acute and chronic back pain and weakness. During the initial interview locations painful knowledge, and are penjalarannya along the nerve fiber (sciatica), I also evaluated the way patients, spinal mobility, reflex, leg length, strength and motorist perception sensoris with the degree of inconvenience dialaminya. Rise straight leg in a show cause painful irritation nerve fiber.
Physical examination can find the spasme muscle paravertebralis (increased bone postural muscle tonus back over), along with loss of flexion lordotik lumbal normal and that there may be deformitas spine. When the patient is examined in telungkup, akan paraspinal muscle relaxation and deformitas caused by spasme akan disappeared.
Sometimes basic organic back pain can not be found. Worries and stress can raise spasme and muscle aches. Pain down the back can be anifestasi depression or mental conflict or reaction to a stressor environment and life. When we examine patients with painful punngung down, nurses need to review the family relationship, a variable environment and work situation (2,4).
E. Diagnostic Evaluation
Diagnostic procedures should be performed on patients who mendertita sore back down. X-rays showed the vertebra may fraktur, dislocation, infection, scoliosis or osteoartritis. Computed Tomografi (CT) is useful to know that underlie the disease, such as the network software lesi hidden around the kolumna vertebralis and discus intervertebralis problem. USG can help diagnose kanalis constringency spinalis. MRI allows visualization nature and location of spinal pathology (2).
F. Implementations
Most back pain can be lost and will recover in 6 weeks with tirah lie, stress reduction and relaxation. Patients must stay at a bed with mattress and solid membal not for 2 to 3 days. Position the patient so that made FLEKSI lumbal greater that can reduce the pressure on the nerve fiber lumbal. The head of the bed elevated 30 degrees and slightly bend patients lie lututnya or italics with lutu and ditekuk pelvis and leg and a pillow placed under the head. Prone position because it will aggravate avoided lordosis. Sometimes patients need to be treated for the handling of "active conservative" and physiotherapy. Traksi pelvic intermiten with 7 to 13 kg load traksi. Traksi allows the addition FLEKSI lumbal and muscle relaxation is.
Physiotherapy should be given to reduce pain and muscle spasme. Therapy may include cooling (with ice missal), heating infra red rays, compress and humid summer, swimming and turbulent traksi. Circulation disturbances, disruption and trauma palpability is contra indications hot compress. Turbulent dikontraindikasikan therapy pool for patients with problems due to the inability kardiovaskuler tolerate vasodilatasi perifer massif that arise. Ultra will cause waves that heat can increase the inconvenience caused swelling in the acute stages.
Drugs may be needed to deal with acute pain. Analgetik drug used to cut off the circle aches, muscle relaksan tranquilizer and used to make relaks the patient and the spasme muscle, which can reduce the pain. Antiinflamasi drugs, such as aspirin and antiinflamasi nonsteroid drugs (NSAID), is useful for reducing pain. Kortikosteroid short-term response inflamasi can reduce and prevent the emergence neurofibrosis that occur due to interference iskemia (2,4).
G. Anamnesis
Patients pungung pain led to the inconvenience (missal location, weight, duration, nature, spread and leg weakness associated). Explanation of how the pain relief with a certain action or activity where the muscles are weak over-used and how patients cope. Information on work and recreational activities can help identify areas for health education.
During this interview, the nurse can make observations of the patient postures, the position deviation and how the road. On physical examination, examined spinal curvature, Krista iliakan and kesimetrisan shoulder. Paraspinal muscle dipalpasi and note the existence of pain and spasme press. Patients reviewed the Obesity can be caused due to back pain below (2).
H. Nursing Diagnosis (2)
1.Nyeri b.d problem muskuloskeletal
2.Kerusakan bd painful physical mobility, spasme muscle, and less kelenturan
Bd 3.Kurang knowledge engineering mechanics to protect the body back
4.Perubahan performance of the role of mobility and interference bd painful chronicles
5.Gangguan nutrition: more than the needs of the body b. d Obesity
I. Intervention and Implementation (2)
Pain reduction
To reduce the pain nurse can recommend tirah recline position and conversion, which is determined to improve FLEKSI lumbal. Taught patients to control and adjust the pain through the respiratory diaphragm and relaxation can help reduce muscle tension that contribute to the pain back down. Distract attention from the patient's pain with other activities missal to read books, watch TV and the imagination (imagine excitement with the focus on it).
Massage with a soft network software is very useful to reduce spasme muscles, improve blood circulation and reduce pain and reduce pembendungan. When nurses are given the medicine must examine the response of each patient on medication.
recovery physical mobility
Physical mobility of monitored through continuous. How nurses assess patients' movement and standing. So back pain is reduced, self-care activities may be done with a minimal regangan on the structure of the injury. Changes in position should be done slowly and dibatu if necessary. Movement and play should be avoided sway. Patients are encouraged to take turns aktifiats lie, sit and walk in a long time. Nurses need to encourage patients to comply with the appropriate training program is set, a practice that is not effective.
increase the appropriate body mechanics
Patients should be taught how to sit, stand, stretch and lift items correctly.
health educations
Patients should be taught how to sit, stand, stretch and lift items correctly
role performance recover
Responsibilities related to the role may have changed since the occurrence of pain down the back. Once the sore healed, the patient can return to the responsibility of the role again. However, when these activities affect the occurrence of painful pungung down again, may be difficult to return to the responsibility of the bear without the risk of a painful chronicle pungggung down with a disability and depression caused.
changes nutrition and a decrease in body weight
BB through a decrease in how meals adjustment kekambuhan can prevent back pain, with nutrition through a rational plan that includes changes in eating kebaisaaan to maintain the desired BB.
J. Evaluation (2)
quieting pain
Resting comfortably
Comfortable with the position change
Avoiding drug dependency
return of physical mobility
Return to activity gradually
Avoiding positions that cause the muscles that cause inconvenience
Plan rest recline all day
showing body mechanics of the spine
Repairs postures
Changing the position itself to minimize back stress
Demonstrate the use of good body mechanics
Participating in the exercise
back to the responsibilities associated with the role
Using the techniques have problems to adapt to the stressful situation
Shows the reduced dependence to another person for self-care
Back to work when the back pain was healed
Back to the lifestyle of full and productive
desired body weight
Identify the need for a decrease in BB
Participate in the development plan reduction BB
Reduction program with a loyal BB
References:
1.Brunner & Suddarth, Change Language Monica Esther, SKP; Book Ajar medical Surgical Nursing, 8 Edition, Volume 1, EGC, Jakarta, 2002
2.Brunner & Suddarth, Change Language Monica Esther, SKP; Book Ajar medical Surgical Nursing, 8 Edition, Volume 3, EGC, Jakarta, 2002
3.Ruth F. Craven, EdD, RN, Fundamentals Of Nursing, Edition II, Lippincot, Philadelphia, 2000
4.Wim de Jong, Buku Ajar Surgical Sciences, Revised Edition, Printed I, EGC, Jakarta, 1997
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