A hospitalized patient with a C7 cord injury asks, "Why can't I feel my legs anymore?" Which is the most appropriate action by the nurse?
1. Remind the patient of her injury and try to comfort her.
2. Call the health care provider and get an order for radiologic evaluation.
3. Prepare the patient for surgery, as her condition is worsening.
4. Explain to the patient that this could be a common, temporary problem.
4
Rationale 1: This action will be necessary but is not the most complete strategy.
Rationale 2: There is no indication that a radiologic evaluation is necessary.
Rationale 3: Surgery is not indicated at this point, as loss of sensation below the injury may occur.
Rationale 4: Spinal shock is a condition that affects almost half the people with acute spinal injury. It is characterized by a temporary loss of reflex function below the level of injury and includes the following symptomatology: flaccid paralysis of skeletal muscles, loss of sensation below the injury, and possibly bowel and bladder dysfunction and loss of ability to perspire below the injury level.
You might also like to view...
Which type of nursing diagnosis describes human responses to a health condition or life process that many develop in a vulnerable population?
1. risk diagnosis 2. wellness diagnosis 3. illness continuum 4. all of the above
A nurse is supervising an unlicensed assistive personnel (UAP). The nurse appropriately intervenes when observing the UAP
1. Allowing a patient to wear underwear. 2. Assisting a patient in putting on pajamas. 3. Using a blanket to cover a patient during a bath. 4. Promoting dependence in activities of daily living.
The educator is reviewing the physiology of the renal system with a nurse. Which statement made by the nurse indicates further teaching is required?
A. "The kidneys stimulate white blood cell production." B. "The kidneys help regulate blood pressure." C. "The kidneys regulate the acid-base balance of body fluids." D. "The kidneys produce the active form of vitamin D."
Feelings of grief and loneliness are common among elderly residents
Indicate whether the statement is true or false.