Following extensive spinal surgery, which action by the nurse would be prudent to prevent a common complication related to spinal swelling?
1. Administration of a stool softener and/or laxative with the return of bowel sounds
2. Immediate removal of a Foley in the PACU to prevent potential infections
3. Encouragement of the semi-Fowler's position for the first 24 hours
4. Forcing fluids greater than 100 mL/hour once tolerating oral fluids
Administration of a stool softener and/or laxative with the return of bowel sounds
Rationale:Swelling in the spine following extensive surgery can cause compression on the innervations of bowel and bladder functions. Prevention of constipation caused by narcotics, bed rest, anesthesia, and nerve compression will minimize the risk of straining to evacuate the bowel by prophylactically giving stool softeners and/or laxatives prior to actual need. Immediate removal of the Foley in the PACU is not recommended due to the increased risk of swelling innervations for bladder functions; but within 24 hours after surgery if the client is getting up the Foley is removed to minimize risk of infections. Intermittent catherizations are used if the client is unable to void. A semi-Fowler's position is contraindicated due to the risk of spinal fluid losses that occur in surgical repairs. A flat position is recommended to minimize the risk of spinal headaches that can occur with spinal fluid losses during surgery. In addition, a flat position is strongly recommended to minimize the bone stability or the risk of trauma to the surgical site. Often the orders are to lie in bed or be up walking and to not twist or turn to avoid mal-alignment of the surgical repair. Forcing fluids to 100 mL/hour may be contraindicated for cardiac or renal clients and will not improve the risk for constipation or bowel dysfunctions from spinal swelling.
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