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Teri Holwerda, MSN, RN, ONC, APRN-BC
Advanced Practice Nurse, Spine and Neuroscience Board certified as an Orthopaedic Nurse, Teri Holwerda, MSN, RN, ONC, APRN-BC is an Advanced Practice Nurse at Spine and Neurosciences at Saint Mary's Health Center in Grand Rapids, MI. Teri independently manages spine patients in an outpatient clinic setting and assists in the post-operative management of patients undergoing spine surgery at Saint Mary's. In addition, Teri is Chair of the Spine Task Force, a multidisciplinary group that tracks and manages data on hospitalized spine patients. Teri is a graduate of the Blodgett School of Nursing, Mercy College of Detroit School of Nursing, and the Kirkhof School of Nursing at Grand Valley State University in Allendale, MI. She has served as clinical adjunct faculty for the Kirkhof School of Nursing and is a manuscript reviewer for Orthopaedic Nursing. Teri is a member and former president of the National Association of Orthopaedic Nurses' Lake Michigan Chapter. Other association memberships include North American Spine Society, National Association of Clinical Nurse Specialists, Phi Kappa Phi, and Sigma Theta Tau. SpineUniverse articles from Teri Holwerda, MSN, RN, ONC, APRN-BC Acute Adult Spine: Introduction and Scope of the Problem It is essential that nurses caring for a growing population of spine patients be knowledgeable about spinal conditions, surgical procedures, expected outcomes, complications and the unique needs of the spine patient. Arthrodesis (Fusion), Instrumentation and Bone Grafts Painful disc degeneration is a controversial indication for lumbar arthrodesis. The goal of arthrodesis for painful disc degeneration is to eliminate motion across the painful disc thereby eradicating the pain generator. Author Commentary and References (1-50) Author's comments and article references (1-50) to Acute Adult Spine by Teri Holwerda, MSN, RN, ONC, APRN-BC. Behavioral Issues in Spine Care Workers compensation status has been shown to affect outcomes in patients with spinal conditions. The results of a large prospective study of return-to-work rates among patients with spinal fracture are examined. Complications of Spinal Surgery Includes the most common complications after spinal surgery with corrresponding nursing interventions. Degenerative Changes and Spinal Disorders Degenerative changes can contribute to spinal stenosis, a narrowing of the space available for the spinal cord or nerve roots. Degenerative Spinal Disorders Trauma or cumulative wear and tear from age can result in disc herniations, a condition in which the annulus ruptures allowing disc material to escape. Fractures and Spinal Stability The determination of spinal stability is of paramount concern when planning the appropriate treatment for spinal fractures. Functional Outcomes and Economic Issues Patients undergoing lumbar fusion procedures and spinal trauma patients may require intensive inpatient rehabilitation after discharge from the hospital. Non-Operative Treatments, Discectomy and Spinal Decompression The goals of spine surgery include preserving or restoring neurologic function, stabilizing unstable spinal segments, improving functional status, and relieving pain. Patient Care Assessment Initial assessment of the patient with spinal conditions includes a detailed history of patient's chief complaint, symptom history and visual pain diagram. Post-Operative Bracing and Halo Vest Immobilization After spinal fusion, bracing may aid in immobilization in the early stages of fusion healing. However, due to advances in internal fixation techniques, not every patient will require postoperative bracing. Post-Operative Pain Management Adequate post-operative pain management is essential in facilitating a patient's recovery from spine surgery. Pre-Operative Assessment, Diagnostic Tests and Patient Education While most spine surgeons have standard pre-operative evaluation preferences, the ideal pre-operative testing and evaluation process is guided by the patient's history, physical examination, and type of procedure to be performed. Radiographs, CT Scans, Myelography, MRI, Bone Scan, Electrodiagnostic Tests and Discography Plain radiographs of the spine can identify deformity, most fractures, destructive lesions, spondylolisthesis, and spondolytic changes but are less sensitive for soft tissues. References (121-186) References (121-186) to Acute Adult Spine by Teri Holwerda, MSN, RN, ONC, APRN-BC . References (51-120) References (51-120) to Acute Adult Spine by Teri Holwerda, MSN, RN, ONC, APRN-BC . Spinal Anatomy Biomechanically, 80% of weight bearing occurs through the disc and vertebral bodies with 20% of weight bearing occurring through the facet joints. Spinal Fractures: References References to the article "Spinal Fractures: The Three-Column Concept" by Teri L. Holwerda, MSN, RN, ONC, APRN-BC. Spinal Fractures: Stability and Treatment Options Fractures that leave the spine unstable often include neurologic problems such as paralysis, loss of sensations, and bowel and bladder difficulties. Spinal Fractures: The Three-Column Concept Accurate classification of a spinal fracture is a very important factor in determining the appropriate treatment plan. Spinal Trauma and Fractures Accurate vertebral fracture classification is a key factor in determining the appropriate treatment for spinal fractures. Spine Patient Care Guidelines Pre-operative teaching recommendations for spinal surgery patients include information on the surgical procedure, length of hospital stay, preparation, intra-operative events, and post-operative care. Spondylolysis, Spondylolisthesis, Rheumatoid Arthritis, Ankylosing Spondylitis and Osteoporosis Repeated stress and loading in the form of vigorous sports may lead to mechanical failure in the spine and cause stress fracture. Subject Index: Acute Adult Spine An index page listing the individual sections of the article Acute Adult Spine by Teri Holwerda, MSN, RN, ONC, APRN-BC. Trends in Spine Care A summation of the current treatment trends in spine care including artificial discs, BMP, nucleoplasty, kyphoplasty, and minimally invasive surgery techniques.
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