Spinal stenosis is characterized by spinal canal narrowing, which can compress the spinal cord and nerve roots, causing pain, numbness, and mobility issues. This nursing diagnosis focuses on managing symptoms, preventing complications, and improving patient quality of life.
Causes (Related to)
Spinal stenosis can develop through various mechanisms, with several contributing factors:
- Degenerative changes due to aging
- Herniated discs
- Osteoarthritis of the spine
- Chronic health conditions such as:
- Osteoporosis
- Rheumatoid arthritis
- Paget’s disease
- Spinal tumors
- Risk factors include:
- Advanced age (typically over 50)
- Previous spine trauma
- Occupational stress on the spine
- Genetic predisposition
Signs and Symptoms (As evidenced by)
Spinal stenosis presents with characteristic signs and symptoms that nurses must recognize for proper assessment and intervention.
Subjective: (Patient reports)
- Progressive back pain
- Numbness or tingling in extremities
- Leg weakness
- Decreased walking tolerance
- Balance problems
- Pain relief when bending forward
- Difficulty with stairs
- Bladder or bowel changes
Objective: (Nurse assesses)
- Altered gait pattern
- Decreased range of motion
- Positive straight leg raise test
- Decreased sensation in extremities
- Muscle weakness
- Diminished reflexes
- Poor balance
- Postural changes
Expected Outcomes
The following outcomes indicate successful management of spinal stenosis:
- The patient will report decreased pain levels
- The patient will demonstrate improved mobility
- The patient will maintain optimal posture
- The patient will perform ADLs independently
- The patient will demonstrate proper body mechanics
- The patient will avoid falls
- The patient will maintain bladder/bowel continence
Nursing Assessment
Pain Assessment
- Evaluate pain characteristics
- Document pain triggers
- Assess pain relief measures
- Monitor pain medication effectiveness
- Note the impact on daily activities
Neurological Status
- Assess muscle strength
- Check sensory function
- Monitor reflexes
- Evaluate gait pattern
- Document balance issues
Functional Ability
- Assess ADL independence
- Evaluate mobility status
- Check transfer ability
- Monitor activity tolerance
- Document assistive device use
Complications Risk
- Screen for fall risk
- Monitor bladder/bowel function
- Check skin integrity
- Assess nutritional status
- Document sleep patterns
Support System
- Evaluate home environment
- Assess caregiver availability
- Check social support
- Review financial resources
- Document educational needs
Nursing Care Plans
Nursing Care Plan 1: Chronic Pain
Nursing Diagnosis Statement:
Chronic Pain related to nerve root compression as evidenced by reported back pain rated 7/10 and decreased mobility.
Related Factors:
- Spinal nerve compression
- Inflammatory process
- Muscle tension
- Activity limitations
Nursing Interventions and Rationales:
- Assess pain characteristics regularly
Rationale: Enables appropriate pain management planning - Administer prescribed medications
Rationale: Provides pain relief and improves function - Teach positioning techniques
Rationale: Reduces nerve compression and discomfort
Desired Outcomes:
- The patient will report pain level ≤4/10
- The patient will demonstrate effective pain management techniques
- The patient will maintain the optimal activity level
Nursing Care Plan 2: Impaired Physical Mobility
Nursing Diagnosis Statement:
Impaired Physical Mobility related to neurological impairment as evidenced by difficulty walking and decreased range of motion.
Related Factors:
- Spinal cord compression
- Muscle weakness
- Pain with movement
- Fear of falling
Nursing Interventions and Rationales:
- Implement a progressive mobility program
Rationale: Maintains function and prevents deconditioning - Teach proper use of assistive devices
Rationale: Ensures safe mobility and prevents falls - Encourage regular exercise within limits
Rationale: Maintains strength and flexibility
Desired Outcomes:
- The patient will demonstrate safe mobility techniques
- The patient will maintain optimal independence in ADLs
- The patient will use assistive devices correctly
Nursing Care Plan 3: Risk for Falls
Nursing Diagnosis Statement:
Risk for Falls related to impaired balance and altered gait as evidenced by unsteady walking pattern.
Related Factors:
- Muscle weakness
- Balance impairment
- Sensory deficits
- Environmental hazards
Nursing Interventions and Rationales:
- Implement fall precautions
Rationale: Prevents injury and maintains safety - Assess the environment for hazards
Rationale: Reduces fall risk factors - Teach safety awareness
Rationale: Promotes patient participation in fall prevention
Desired Outcomes:
- The patient will remain free from falls
- The patient will demonstrate safety awareness
- The patient will maintain a safe environment
Nursing Care Plan 4: Self-Care Deficit
Nursing Diagnosis Statement:
Self-Care Deficit related to mobility limitations as evidenced by difficulty completing ADLs independently.
Related Factors:
- Physical limitations
- Pain with movement
- Fatigue
- Decreased strength
Nursing Interventions and Rationales:
- Assist with ADLs as needed
Rationale: Maintains dignity while ensuring needs are met - Teach energy conservation techniques
Rationale: Maximizes independence and function - Provide adaptive equipment
Rationale: Facilitates independent self-care
Desired Outcomes:
- The patient will demonstrate increased independence in ADLs
- The patient will use adaptive equipment effectively
- The patient will maintain optimal self-care ability
Nursing Care Plan 5: Knowledge Deficit
Nursing Diagnosis Statement:
Knowledge Deficit related to unfamiliarity with condition management as evidenced by questions about activity limitations and treatment options.
Related Factors:
- Lack of exposure to information
- Misinterpretation of information
- Complex medical terminology
- Anxiety about condition
Nursing Interventions and Rationales:
- Provide condition-specific education
Rationale: Improves understanding and compliance - Teach self-management strategies
Rationale: Promotes independence in condition management - Demonstrate exercises and techniques
Rationale: Ensures proper performance of recommended activities
Desired Outcomes:
- The patient will verbalize understanding of the condition
- The patient will demonstrate proper management techniques
- The patient will identify when to seek medical attention
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Kwon JW, Moon SH, Park SY, Park SJ, Park SR, Suk KS, Kim HS, Lee BH. Lumbar Spinal Stenosis: Review Update 2022. Asian Spine J. 2022 Oct;16(5):789-798. doi: 10.31616/asj.2022.0366. Epub 2022 Oct 21. PMID: 36266248; PMCID: PMC9633250.
- Lee BH, Moon SH, Suk KS, Kim HS, Yang JH, Lee HM. Lumbar Spinal Stenosis: Pathophysiology and Treatment Principle: A Narrative Review. Asian Spine J. 2020 Oct;14(5):682-693. doi: 10.31616/asj.2020.0472. Epub 2020 Oct 14. PMID: 33108834; PMCID: PMC7595829.
- Liang J, Wang L, Song J, Zhao Y, Zhang K, Zhang X, Hu C, Tian D. The impact of nursing interventions on the rehabilitation outcome of patients after lumbar spine surgery. BMC Musculoskelet Disord. 2024 May 4;25(1):354. doi: 10.1186/s12891-024-07419-9. PMID: 38704573; PMCID: PMC11069211.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
