Introduction We agreed to choose Spinal Cord Injury and Herniated Nucleus Pulposus as our case study to be presented in this

case presentation. We chose this as our subject because as we having duty at orthopedic ward and during this time there are people suffering from this disease, so we need to be equipped, equipped with the knowledge and skills that could truly help us, and patients in the ward. A spinal cord injury (SCI) refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence. Spinal cord injuries are most often traumatic, caused by lateral bending, dislocation, rotation, axial loading, and hyper flexion or hyperextension of the cord or cauda equina. Motor vehicle accidents are the most common cause of SCIs, while other causes include falls, work-related accidents, sports injuries, and penetrations such as stab or gunshot wounds. The prevalence of spinal cord injury is not well known in many large countries. A herniated nucleus pulposus is a slipped disk along the spinal cord. The condition occurs when all or part of the soft center of a spinal disk is forced through a weakened part of the disk. Most herniation takes place in the lower back (lumbar area) of the spine. Lumbar disk herniation occurs 15 times more often than cervical (neck) disk herniation, and it is one of the most common causes of lower back pain. The cervical disks are affected 8% of the time and the upper-to-mid-back (thoracic) disks only 1 - 2% of the time. Nerve roots (large nerves that branch out from the spinal cord) may become compressed resulting in neurological symptoms, such as sensory or motor changes. Disk herniation occurs more frequently in middle aged and older men, especially those involved in strenuous physical activity. Other risk factors include any congenital conditions that affect the size of the lumbar spinal canal.

Objectives: Formulate and apply nursing care plans utilizing the nursing process. To learn new clinical skills as well as sharpen our current clinical skills required in the management of the patient.

Theoretical Framework: Hildegard Peplau's model Peplau's model has proved of great use to later nurse theorists and clinicians in developing more sophisticated and therapeutic nursing interventions Peplau's Seven Nursing Roles Peplau's Seven Nursing Roles illustrate the dynamic character roles typical to clinical nursing. 1. Stranger role: Receives the client the same way one meets a stranger in other life situations; provides an accepting climate that builds trust. 2. Resource role: Answers questions, interprets clinical treatment data, and gives information. 3. Teaching role: Gives instructions and provides training; involves analysis and synthesis of the learner's experience. 4. Counseling role: Helps client understand and integrate the meaning of current life circumstances; provides guidance and encouragement to make changes. 5. Surrogate role: Helps client clarify domains of dependence, interdependence, and independence and acts on clients behalf as advocate. 6. Active leadership: Helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way. 7. Technical expert role: Provides physical care by displaying clinical skills; Operates equipment Peplau's Developmental Stages of the Nurse-Client Relationship 1. Orientation Phase 2. Working Phase -Identification Phase -Exploitation Phase 3. Termination / Resolution Phase