الفهرس 
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Abstract
Lumbar disc disease (LDD) is one of the most common spinal disorders worldwide.
It contributes significantly to health care costs and work disability. Lumbar disc herniation exists on a continuum of degenerative spinal processes that frequently affect the spine in young and middle-aged patients, these include intervertebral disc degeneration and lumbar spondylosis. The incidence of asymptomatic lumbar disc herniation, within certain populations has been estimated to be greater than 50 %. The highest prevalence is among people aged 30 to 50 years, with a male to female ratio of 2:1. In people aged 25 to 55 years, about 95% of herniated discs occur in the lower lumbar spine (L4/5 and L5/S1 level); disc herniation above this level is more common in people aged over 55 years.
The management of lumbar disc prolapse includes conservative and operative
treatment. The majority of herniated discs will heal themselves within 6-8 weeks and do not require surgery. The non-surgical or conservative management includes; analgesics, anti-inflammatory drugs, oral or locally injected steroids, weight loss, smoking cessation, muscle relaxation, chiropractic therapy, acupuncture, and /or patient education on body mechanics, physiotherapy, and heat therapy. Once non-surgical methods have failed, operative management is the treatment of choice. The most common surgeries are laminectomy, and discectomy.
The nursing care of LDP surgery patients includes nursing assessment,
interventions, and monitoring. Preoperative nursing management include certain activities, assessing and correcting physiological and psychological problems, that may
increase surgical risk, describing the surgical procedure to the patient and family,informed consent obtained by surgeon, describing the postoperative and long term expected outcomes, arranging for required preoperative testing, advising patients to
discontinue medications such as herbal products, NSAIDs, anticoagulants, aspirin, warfarin, encouraging patients to anticipate, and arrange for preoperative and postoperative care, instructing and demonstrating exercises that will benefit the patient
postoperatively, and planning for discharge and any projected changes in lifestyle following the surgery The aim of this study was to determine the effect of implementing a protocol of
nursing care on postoperative expected outcomes for patients undergoing intervertebral lumbar disc herniation surgeries.
Materials and method:-
Materials:
The study was carried out at the Neurosurgery Department of Alexandria Main University Hospital. Subjects of this study were a convenient sample of 50 adult patients undergoing lumbar disc herniation surgery. They were assigned to 2 equal groups, control group(I) :who were subjected to routine hospital care , and a study group(II):was exposed to a proposed protocol of nursing care , (25 patients in each). Two tools were used to determine the effect of implementing a protocol of nursing care on postoperative expected outcomes for patients undergoing intervertebral lumbar disc herniation surgeries. Tool I: lumbar disc prolapse patient’s assessment. This tool
included seven parts: part I: related to bio-socio-demographic and clinical data, Part II:
related to knowledge about the lumbar disc surgery, meaning of lumbar disc prolapse,aggravating factors, postoperative complains, intervention and discharge precautions, part
III: lower limb neurological assessment. Part IV: pre and postoperative disc surgery patient’s problems/ complaints, partV: postoperative disc surgery studied patient’s compliance with protocol of nursing care, part VI: postoperative disc surgery patient’s
satisfaction with the provided nursing care, and partVII: postoperative disc surgery patient’s expected outcomes. Tool II: lumbar disc prolapse patient pain assessment structured interview. This tool included two parts: Part I: pain intensity assessment using
numerical rating scale, and Part II: low back pain evaluation structured interview schedule: which was derived from (JOABPEQ) and (ODI).
Method:
Adult patients who fulfilled study subject inclusion criteria were assigned
sequentially and equally into two groups 25 patients each, immediately on admission. Bio-socio-demographic and clinical data were obtained from all patients participating in both groups on the first day of admission. Patients in the control group I was only exposed to routine hospital care as carried out by ward medical and nursing staff. A proposed protocol of nursing care was carried out by the researcher at the study setting to each patient and caregiver in the study group II and reinforce it on the first, 2nd, and 3rd
postoperative day, using verbal instructions and colored booklets.
The illustrated colored booklet was distributed to each patient as a reference. Patients of the study group were asked to bring one of the family members to attend the teaching. Patients in the experimental group were managed and followed before surgery. Preoperative measures included; neurological assessment, preoperative preparations.
Postoperative care until discharge included; receiving patients from the operating department, transferring patients to the ward bed, checking vital signs every half an hour in the first 2 hours and then every 8 hours, administering the prescribed medication
including analgesics, watching the wound site for any signs of bleeding or CSF leakage, keeping patients NPO until complete recovery from anesthesia or peristalsis movement return to normal and then shifting to fluid diet, then soft diet and gradual return to
regular diet, reinforcing the instructions given in the preoperative period, as a breathing exercise and leg exercise, assisting with out of bed activities. Patients were followed on
the first, 2nd, 3rd , and 15th postoperative days, to ensure that patients would follow the
instructions appropriately.