Neurological Disorders Q 86

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The nurse is caring for a client who suffered a spinal cord injury 48 hours ago. The nurse monitors for GI complications by assessing for:

  

     A. A flattened abdomen.

     B. Hematest positive nasogastric tube drainage.

     C. Hyperactive bowel sounds.

     D. A history of diarrhea.

    

    

Correct Answer: B. Hematest positive nasogastric tube drainage.

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Development of a stress ulcer can be detected by hematest positive NG tube aspirate or stool. Gastrointestinal dysfunction including constipation, straining, diarrhea, distention, abdominal pain, incontinence, rectal bleeding, hemorrhoids, and autonomic dysreflexia during bowel movements occur in 27% to 62% of individuals with a spinal cord injury. During the acute stage of spinal cord injury there is an increased risk of gastrointestinal complications within the first few days post injury, including gastrointestinal hemorrhage, perforation, and paralytic ileus, while neurogenic bowel, affecting almost half of those with a spinal cord injury (46.9%) is a major problem long term both in terms of physical and psychological well being.

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Option A: The paralysis does not need to be complete to cause ileus, but the intestinal muscles must be so inactive that it prevents the passage of food, and leads to a functional blockage of the intestine, which causes abdominal distension. A distended abdomen increases the work of breathing but also may cause vomiting, which increases the risk for aspiration pneumonia and further respiratory complications. Individuals with a paralytic ileus are typically managed Nil by Mouth (NPO) with nasogastric suction to regularly aspirate the stomach contents.

Option C: After spinal cord injury, the client can develop paralytic ileus, which is characterized by the absence of bowel sounds and abdominal distention. Paralytic Ileus, often associated with spinal shock post an acute spinal cord injury, is an obstruction of the intestine secondary to paralysis of the intestinal muscles with no evidence of mechanical obstruction, which like spinal shock can last from a few days to a few weeks.

Option D: A history of diarrhea is irrelevant. Lower Motor Neuron (LMN) Bowel Syndrome, occurring in a spinal cord injury at the injury at the conus medullaris or cauda equina results in an areflexic bowel, characterised by loss of spinal cord-mediated peristalsis and slow stool propulsion with an atonic external anal sphincter. Typically associated with constipation and a significant risk of incontinence due to flaccid paralysis of the external anal sphincter and reduced motor control of levator ani.

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