Which assessment findings are consistent with spinal cord compression in a patient with metastatic cancer? Select all that apply.
Loss of bowel control
Sharp thoracic back pain
Inability to move arms
Progressive muscle weakness in legs
Paresthesia in lower extremities
Correct Answer : A,B,D,E
A. Loss of bowel control: Loss of bowel or bladder control is a late sign of spinal cord compression. Compression of sacral nerve roots impairs autonomic function, making this a critical symptom to assess and report immediately.
B. Sharp thoracic back pain: Localized, severe, or sharp back pain, especially in the thoracic region, is often the earliest symptom of spinal cord compression. It may worsen with movement or coughing and signals pressure on vertebral or spinal structures.
C. Inability to move arms: Arm paralysis occurs only if cervical spinal cord levels are affected. In metastatic cancer, compression is most commonly thoracic or lumbar, so upper extremity motor loss is less typical and not a consistent finding unless the lesion is cervical.
D. Progressive muscle weakness in legs: Weakness in the lower extremities is a hallmark early manifestation of thoracic or lumbar spinal cord compression. It typically progresses gradually, reflecting motor pathway involvement.
E. Paresthesia in lower extremities: Sensory changes, such as numbness, tingling, or burning sensations in the legs, occur as the spinal cord or nerve roots are compressed. Early recognition helps prevent permanent neurologic deficits.
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Related Questions
Correct Answer is C
Explanation
A. Obtain 24-hour dietary intake: While monitoring dietary intake is important for long-term management of diabetes insipidus, it does not address the acute and potentially life-threatening fluid and electrolyte imbalance caused by excessive water loss. This is not the immediate priority.
B. Administer corticosteroids: Corticosteroids may be used in cases of secondary DI due to adrenal insufficiency, but they are not first-line therapy for the majority of DI patients. Immediate management focuses on correcting dehydration and hypernatremia rather than starting steroids.
C. Administer IV fluids: Patients with DI excrete large volumes of dilute urine, leading to dehydration and hypernatremia. Rapid IV fluid replacement is critical to restore circulating volume, correct electrolyte imbalances, and prevent hypovolemic shock. This intervention addresses the most urgent physiologic threat.
D. Obtain blood cultures: Blood cultures are indicated if infection is suspected but are not part of the immediate management of DI. Delaying fluid resuscitation to obtain cultures could worsen dehydration and hemodynamic instability.
Correct Answer is D
Explanation
A. Decrease in cardiac output: A Swan-Ganz (pulmonary artery) catheter rarely causes an immediate decrease in cardiac output unless complications like arrhythmias or pulmonary artery rupture occur. Monitoring hemodynamics helps detect changes, but this is not the most common risk during insertion or removal.
B. Damage to the mitral valve: The catheter passes through the right atrium and right ventricle into the pulmonary artery, so the mitral valve is not in the pathway. Injury to the mitral valve is unlikely, making this a low-risk complication.
C. Myocardial infarction: Myocardial infarction is not a typical complication of Swan-Ganz catheterization unless coronary perfusion is severely compromised by another underlying condition. It is not directly caused by the catheter itself.
D. Ventricular dysrhythmias: As the catheter passes through the right ventricle, it can mechanically irritate the ventricular myocardium, leading to premature ventricular contractions, ventricular tachycardia, or other dysrhythmias. This is the most common and expected complication during insertion and removal, requiring continuous ECG monitoring.
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