A nurse is caring for a client who is postoperative following a laminectomy with spinal fusion. Which of the following actions should the nurse take?
A.
Position the client in a high-Fowler’s position if clear drainage is noted on the dressing
B.
Monitor sensory perception of the lower extremities.
C.
Assist the client into a knee-chest position to manage postoperative discomfort.
D.
Maintain strict bed rest for the first 48 hr postoperative
The correct answer and Explanation is :
The correct answer is B. Monitor sensory perception of the lower extremities.
Explanation:
After a laminectomy with spinal fusion, monitoring sensory perception of the lower extremities is crucial for several reasons. This surgery involves removing a portion of the vertebrae (laminectomy) and fusing adjacent vertebrae to stabilize the spine. Given the proximity to the spinal cord and nerves, there is a risk of neurological complications. Assessing sensory perception helps in detecting any potential nerve damage or spinal cord issues early.
- Neurological Monitoring: Following spinal surgery, monitoring sensory and motor functions is essential. This includes checking for sensations such as light touch, pain, temperature, and proprioception in the lower extremities. Changes in sensory perception can indicate complications like nerve damage or worsening conditions that might require immediate intervention.
- Early Detection of Complications: Changes in sensory perception may signal issues such as hematoma formation, infection, or pressure on the spinal cord. Early detection of these problems can lead to timely treatment and improve the overall recovery outcome.
- Postoperative Care: Maintaining strict bed rest, while important in the initial recovery phase, should be balanced with appropriate activity and movement to prevent complications such as pressure ulcers, deep vein thrombosis, and muscle atrophy. Monitoring sensory perception is a proactive approach to identifying complications rather than reactive.
The other options provided are less appropriate in this context:
- A. Positioning the client in a high-Fowler’s position: This is not recommended immediately after spinal surgery as it could place undue stress on the surgical site. The positioning should generally be more neutral and aligned to avoid compromising the surgical area.
- C. Knee-chest position: This position is not suitable for postoperative spinal fusion patients. It can put excessive pressure on the spine and potentially disrupt the surgical site.
- D. Strict bed rest for 48 hours: While bed rest is important, strict bed rest for an extended period can lead to complications like deep vein thrombosis and pressure ulcers. Movement and repositioning are generally encouraged as per the healthcare provider’s instructions.
Therefore, monitoring sensory perception (B) is a critical action to ensure early identification and management of any potential complications after spinal surgery.