A nurse is caring for a client who experienced a cervical spine injury 24 hr ago. Which of the following types of prescribed medications should the nurse clarify with the provider?
Glucocorticoids
Plasma expanders
H2 antagonists
Muscle relaxants
The Correct Answer is D
Muscle relaxants can have significant side effects in patients with acute cervical spinal cord injury, including respiratory depression, hypotension, and sedation. In the early post-injury phase, careful consideration is needed because these medications may exacerbate already compromised respiratory function. The nurse should clarify the order to ensure it is appropriate for the patient’s current neurological and respiratory status.
Rationale for correct answer:
4. Muscle relaxants. The client will still be in spinal shock 24 hr following the injury. The client will not
experience muscle spasms until after the spinal shock has resolved, making muscle relaxants
unnecessary at this time.
Rationale for incorrect answers:
1. Glucocorticoids. Glucocorticoids are appropriate medications to administer at this time as they are not universally contraindicated.
2. Plasma expanders. These are standard in managing hypotension or neurogenic shock and are appropriate in acute SCI care.
3. H2 antagonists. Used prophylactically to prevent stress ulcers, which are common in immobile patients, and are safe for acute SCI management.
Take-home points:
- Muscle relaxants may impair respiratory function in cervical SCI and require careful evaluation before use.
- Clarify medication orders to ensure safety and appropriateness based on the patient’s condition.
- Standard medications like plasma expanders and H2 antagonists are generally safe and part of routine acute SCI care.
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Related Questions
Correct Answer is C
Explanation
For patients with a cervical spinal cord injury who have not undergone surgical stabilization, skeletal traction with skull tongs is commonly used to maintain spinal alignment. This method provides continuous immobilization and realigns vertebrae while allowing for gradual reduction of fractures. Proper nursing care includes monitoring for traction-related complications and maintaining pin site integrity.
Rationale for correct answer:
3. Skeletal traction with skull tongs. Traction provides immobilization and stabilization of the cervical spine while preventing further injury. It allows for controlled alignment of cervical vertebrae and reduces pressure on the spinal cord. Nurses must ensure proper positioning, weight management, and regular neurovascular assessments.
Rationale for incorrect answers:
1. Kinetic beds. These beds are used mainly for spinal precautions in thoracic and lumbar injuries, not for cervical stabilization.
2. Hard cervical collar. This provides immobilization for minor or stable injuries but is insufficient for unstable cervical fractures.
4. Sternal-occipital-mandibular immobilizer brace. This brace is rarely used and does not provide the precise alignment achieved with skeletal traction in acute unstable cervical injuries.
Take-home points:
- Skeletal traction with skull tongs is standard for unstable cervical SCI without surgery.
- Continuous monitoring and pin care are essential to prevent complications.
- Traction maintains spinal alignment and minimizes further neurologic damage.
Correct Answer is A
Explanation
The highest priority in a patient with a recent T12 spinal cord injury is prevention of further spinal cord damage. At one week post-injury, the spinal cord remains vulnerable to secondary injury from movement, improper handling, or additional trauma. Protecting the spinal cord ensures that existing neurological function is preserved, which is critical for long-term outcomes.
Rationale for correct answer:
1. Prevention of further damage to the spinal cord. Maintaining spinal immobilization, careful positioning, and avoiding movements that could exacerbate injury are essential to prevent additional neurological loss. Preserving remaining function is the most critical immediate concern.
Rationale for incorrect answers:
2. Prevention of contractures of the lower extremities. This is important for long-term mobility and function but is a secondary priority compared to protecting the spinal cord.
3. Prevention of skin breakdown of areas that lack sensation. Pressure injury prevention is critical, but it is not more urgent than preventing permanent neurological damage.
4. Prevention of postural hypotension when placing the client in a wheelchair. Orthostatic hypotension precautions are necessary during rehabilitation but are not the immediate priority in the acute post-injury phase.
Take-home points:
- Immediate care after SCI focuses on protecting the spinal cord to preserve neurological function.
- Secondary concerns include contracture prevention, skin care, and hemodynamic stability.
- Early and careful handling can significantly influence long-term functional outcomes.
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