An adolescent has just returned from surgery after spinal fusion surgery. Which of the following assessments would be priority at this time?

1. Increased intracranial pressure
2. Seizure activity
3. Impaired pupillary response during neurological checks
4. Impaired color, sensitivity, and movement to lower extremities


4
Rationale:
1. Increased intracranial pressure is not a great risk following spinal fusion surgery. Impaired color, sensitivity, and movement to the lower extremities are greater risks.
2. Seizure activity is not typically seen following spinal fusion. There is a risk for impaired color, sensitivity, and movement to the lower extremities.
3. Pupillary response is not affected after spinal fusion surgery. There is a risk for impaired color, sensitivity, and movement to the lower extremities.
4. When the spinal column is manipulated, there is a risk for impaired color, sensitivity, and movement to lower extremities. The other signs are neurological impairment, and are not high-risk with spinal surgery.

Nursing

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