Neurological Disorders Q 141

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Nurse Amber is caring for a client who underwent a lumbar laminectomy two (2) days ago. Which of the following findings should the nurse consider abnormal?

  

     A. More back pain than the first postoperative day.

     B. Paresthesia in the dermatomes near the wounds.

     C. Urine retention or incontinence.

     D. Temperature of 99.2° F (37.3° C).

    

    

Correct Answer: C. Urine retention or incontinence.

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Urine retention or incontinence may indicate cauda equina syndrome, which requires immediate surgery. Cauda equina syndrome (CES) results from compression and disruption of the function of these nerves and can be inclusive of the conus medullaris or distal to it, and most often occurs when damage occurs to the L3-L5 nerve roots.

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Option A: An increase in pain on the second postoperative day is common because the long-acting local anesthetic, which may have been injected during surgery, will wear off. The role of the nurse in the postoperative period should include finite management of intravenous fluids, foley catheter care until ambulating, administering antibiotics, pain control, wound/dressing care, encouraging patient ambulation, and advance diet when appropriate.

Option B: While paresthesia is common after surgery, progressive weakness or paralysis may indicate spinal nerve compression. Related-technique complications are associated with the underlying structures covered by the laminae, being the dural sac tear and nerve roots injury the most common. These complications occur more often in elderly patients due to the fragility of the dural sac. Also, the severity of compression could be a factor that increases the rate of a dural tear; the most common risk factor for dural tear is the reoperation due to the presence of scar tissue.

Option D: A mild fever is also common after surgery but is considered significant only if it reaches 101° F (38.3° C). Postoperative wound infection and wound dehiscence are other complications to consider, the presence of wound erythema, increased pain, or swelling may raise the suspicion of wound infection.

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