What is one indication for early surgical therapy of the patient with a spinal cord injury?
There is incomplete cord lesion involvement
The ligaments that support the spine are torn
A high cervical injury causes loss of respiratory function
Evidence of continued compression of the cord is apparent
The Correct Answer is D
Early surgical intervention is indicated when there is continued compression of the spinal cord, which can worsen neurological deficits. Prompt decompression helps prevent permanent damage, reduce inflammation, and improve the potential for neurological recovery. Timing of surgery is critical to minimize secondary injury and optimize functional outcomes.
Rationale for correct answer:
4. Evidence of continued compression of the cord is apparent. Ongoing compression can exacerbate ischemia and necrosis of spinal tissue. Surgical decompression relieves pressure on the cord, limiting further neurologic compromise and improving recovery potential. Early identification and intervention are essential in preventing irreversible deficits.
Rationale for incorrect answers:
1. There is incomplete cord lesion involvement. While incomplete lesions have better prognosis, this alone does not mandate immediate surgery.
2. The ligaments that support the spine are torn. Ligament injury may require stabilization but is not the primary indicator for urgent decompression.
3. A high cervical injury causes loss of respiratory function. Respiratory compromise is managed supportively; surgical intervention is not indicated solely for loss of function unless compression is present.
Take-home points:
- Continued cord compression is a key indication for early spinal surgery.
- Early decompression reduces secondary injury and improves neurological outcomes.
- Not all spinal injuries require immediate surgery; assessment of compression and stability guides intervention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
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 D
Explanation
A C4 spinal cord injury can result in paralysis of the diaphragm and intercostal muscles, which significantly compromises respiratory function. The greatest risk is respiratory compromise, which can lead to hypoventilation, hypoxia, and potential respiratory failure. Maintaining airway patency and monitoring respiratory status are top priorities in acute care.
Rationale for correct answer:
4. Respiratory compromise. C4 injuries impair diaphragmatic and accessory muscle function, making the patient highly dependent on ventilatory support. Early recognition of respiratory difficulty and timely interventions are critical to prevent life-threatening complications.
Rationale for incorrect answers:
1. Neurogenic shock. While possible in high-level SCI, neurogenic shock typically occurs acutely and is managed; it is not as immediately life-threatening as respiratory compromise in C4 injuries.
2. Paralytic ileus. Paralytic ileus is more common in thoracic and lumbar injuries; it is secondary in priority to airway and breathing concerns.
3. Stress ulcer. Stress ulcers are a potential complication but develop later and are not an immediate threat to life compared with respiratory failure.
Take-home points:
- C4 SCI patients are at highest risk for respiratory compromise due to diaphragmatic paralysis.
- Continuous monitoring of oxygenation, ventilation, and airway is essential.
- Early intervention with mechanical ventilation or suctioning may be required to maintain life-sustaining respiration.
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