A patient with a recent spinal cord injury is at risk for complications to the gastrointestinal system. Which nursing intervention is primarily directed at minimizing this risk?
1. Insertion of a nasogastric tube
2. Regular assessment of the patient's bowel sounds
3. Administration of a lansoprazole (Prevacid)
4. Elevating the end of the bed to 35 degrees
1
Rationale 1: The gastrointestinal effects of spinal shock include gastroparesis, loss of intestinal peristalsis, and ileus. Placement of a nasogastric or oral gastric tube will be necessary in the acute phase of SCI for decompression of the stomach.
Rationale 2: Regular assessment of bowel sounds will help determine the presence or absence of peristalsis, but it is not effective in reducing risk.
Rationale 3: Prevacid is a proton pump inhibitor that is used in the treatment of GERD.
Rationale 4: Elevating the head of the bed will have little effect on the gastrointestinal system and may be contraindicated for other reasons.
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