Generic Name: Etoricoxib Brand Name: Arcoxia Classification: Analgesic/NSAID Mode of Action: Inhibits prostaglandin synthesis by decreasing enzyme

needed for biosynthesis; Analgesic and inflammatory Indication: Treatment of the S/S of osteoarthritis and rheumatoid arthritis. Relief of acute pain. Contraindication: Hypersensitivity or Active peptic ulceration Side effect: nausea and vomiting Adverse effect: Immune system disorder, cardiac disorder, renal and urinary disorders. NURSING RESPONSIBILITIES: 1. Administer with foods to prevent GI upset. 2. Use cautiously in patients with renal/liver dysfunction 3. Observe client for bleeding gums, petechiae, ecchymoses, or black stools.

Definition of Herniated disk: A herniated (slipped) disk occurs when all or part of a spinal disk is forced through a weakened part of the disk. This places pressure on nearby nerves. Herniated nucleus pulposus (slipped disk) Causes, incidence, and risk factors: The bones (vertebrae) of the spinal column run down the back, connecting the skull to the pelvis. These bones protect nerves that come out of the brain and travel down your back, forming the spinal cord. Nerve roots are large nerves that branch out from the spinal cord and leave your spinal column between each vertebrae.
y

The spinal vertebrae are separated by disks filled with a soft, gelatinous substance. These disks cushion the spinal column and space between your vertebrae. These disks may herniate (move out of place) or rupture from trauma orstrain. When this happens, the spinal nerves may become compressed, resulting in pain, numbness, or weakness.

The lower back (lumbar area) of the spine is the most common area for a slipped disk. The cervical (neck) disks are affected 8% of the time. The upper-to-mid-back (thoracic) disks are rarely involved.

Radiculopathy refers to any disease that affects the spinal nerve roots. A herniated disk is one cause of radiculopathy (sciatica).

Disk herniation occurs more frequently in middle-aged and older men, especially those involved in strenuous physical activity. Other risk factors include any conditions present at birth (congenital) that affect the size of the lumbar spinal canal. - HERNIATED DISC -

Definition A herniated disc is a fragment of the disc nucleus which is pushed out of the outer disc margin, into the spinal canal through a tear or "rupture." In the herniated disc's new position, it presses on spinal nerves, producing pain down the accompanying leg. This produces a sharp, severe pain down the entire leg and into the foot. The spinal canal has limited space which is inadequate for the spinal nerve and the displaced herniated disc fragment. The compression and subsequent inflammation is directly responsible for the pain one feels down the leg, termed "sciatica." The direct compression of the nerve may produce weakness in the leg or foot in a specific patter, depending upon which spinal nerve is compressed.

A herniated disc is a definite displaced fragment of nucleus pushed out through a tear in the outer layer of the disc (annulus). For a disc to become herniated, it typically is in an early stage of degeneration.

In this situation there is a portion of the annulus that has isolated itself from the rest of the disc and all or part of its displaced will out into the canal. This situation is the one that responds best surgery. It may not respond to conservative therapy, including manipulation and even chemonucleolysis.

Typical Pain and Findings Typically, a herniated disc is preceded by an episode of low back pain or a long history of intermittent episodes of low back pain. However, when the nucleus actually herniates out through the annulus and compresses the spinal nerve, then the pain typically changes from back pain to sciatica. Sciatica is sharp pain which radiates from the low back area down through the leg, into the foot in a characteristic pattern, depending upon the spinal nerve affected. This pain often is described as sharp, electric shock-like, sever with standing, walking or sitting. The pain is frequently relieved by lying down or utilizing a lumbar support chair or insert. There also may be resulting leg muscle weakness from a compromise of the spinal nerve affected. Most commonly, the back pain has resolved by the time sciatica develops, or

there is minimal back pain compared to the severe leg pain. The location of the leg pain is usually so specific that the doctor can indentify the disc level which is herniated. In addition to leg muscle weakness, there may also be knee or ankle reflex loss.
THE SPINE The back is highly complex, and pain may result from damage or injury to any of its various bones, nerves, muscles, ligaments, and other structures. Still, despite sophisticated techniques, which provide detailed anatomical images of the spine and other tissues, the cause of most cases of back pain remains unknown. Vertebrae. The spine is a column of small bones, or vertebrae, that support the entire upper body. The column is grouped into three sections:

y y y

The cervical (C) vertebrae are the seven spinal bones that support the neck. The thoracic (T) vertebrae are the twelve spinal bones that connect to the rib cage. The lumbar (L) vertebrae are the five lowest and largest bones of the spinal column. Most of the body's weight and stress falls on the lumbar vertebrae. Below the lumbar region is the sacrum, a shield-shaped bony structure that connects with the pelvis at the sacroiliac joints. At the end of the sacrum are two to four tiny, partially fused vertebrae known as the coccyx, or "tail bone."

Each vertebra is designated by using a letter and number, allowing the doctor to determine where it is in the spine.

y o o o y

The letter reflects the spinal region where the vertebra is located: C=cervical (neck region) T= thoracic (chest, or middle back, region) L=lumbar (lower back) The number signifies the vertebra's place within that spinal region. The numbers start with 1 at the top of a region and count up as the vertebrae descend within the region. For example, C4 is the fourth bone down in the cervical region, and T8 is the eighth thoracic vertebrae. The Disks. Vertebrae in the spinal column are separated from each other by small cushions of cartilage known as intervertebral disks. The disks have no blood supply of their own. They rely on nearby blood vessels to keep them nourished.

Click the icon to see an image of an intervertebral disk.

Each disk is 80% water and contains two structures.

y y

Inside each disk is a jelly-like substance called the nucleus pulposus. The nucleus pulposus is surrounded by a tough, fibrous ring called the annulus. Processes. Each vertebra in the spine has a number of bony projections called processes. The spinous and transverse processes attach to the muscles in the back and act like little levers, allowing the spine to twist or bend. The particular processes form the joints between the vertebrae themselves, meeting together and interlocking at the zygapophysial joints (more commonly known as facet, or z-joints). Spinal Canal. Each vertebra and its processes surround and protect an arch-shaped central opening. These arches, aligned to run down the spine, form the spinal canal, which encloses the spinal cord.

Spinal Cord. The spinal cord is the central trunk of nerves that connects the brain with the rest of the body. Each nerve root passes from the spinal column to other parts of the body through small openings, bounded on one side by the disk and on the other by the facets. When the spinal cord reaches the lumbar region, it splits into four bundled strands of nerve roots called the cauda equina(meaning horsetail in Latin).