A child is admitted to the orthopaedic unit after spinal cord instrumentation for the treatment of scoliosis. Which assessment is most important in the immediate postoperative periods?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

The highest priority after spinal surgery is assessing neurovascular status to detect potential spinal cord injury or compression from postoperative edema, hematoma, or hardware displacement.
A complete neurovascular assessment includes checking circulation (capillary refill, color, temperature), motion (movement of all extremities), and sensation (touch, numbness, tingling).
This comprehensive approach is crucial because sensory changes (like numbness) can be an early warning sign before motor deficits (like paralysis) occur.
Early detection of any neurovascular compromise is critical for immediate surgical intervention to prevent permanent neurological damage.

Option A: Pain is an expected postoperative symptom and its management is important for comfort, but it is not the highest priority. A neurological deficit is a much more severe and urgent complication.
Option B: This is an incomplete assessment. It only evaluates motor function in the lower extremities and neglects sensory function and circulation, which are also critical indicators of spinal cord integrity.
Option C: This describes a nursing intervention, not a patient assessment. Logrolling is the proper technique for repositioning the patient to protect the spine, not a method to evaluate their condition.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Postoperative priority assessment following spinal instrumentation for scoliosis in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Nurses must perform and document neurovascular checks frequently (e.g., every 1-2 hours) in the immediate postoperative phase after spinal surgery, as per hospital protocol.
Any new or worsening deficit in sensation or motion is a critical finding that must be reported to the surgeon immediately, as it may indicate a surgical emergency requiring prompt intervention.
What if? If the child reports new numbness in their toes and has a slower capillary refill in one foot, the nurse's priority action is to notify the surgical team immediately, not just document the finding or administer pain medication.

How to Approach the Question

First, identify the core of the question: it's asking for the HIGHEST priority assessment after a major spinal surgery.
Recall the major risks associated with spinal surgery. The most severe and time-sensitive complication is damage to the spinal cord, which can lead to paralysis.
Evaluate each option based on its ability to detect this critical complication.
Option A (Pain) relates to comfort. Option B (Flexing feet) is only a partial neurological check. Option C (Logroll) is a nursing action, not a patient assessment.
Recognize that Option D (Capillary refill, sensation, and motion in all extremities) is the most comprehensive choice, covering all aspects of a neurovascular assessment (Circulation, Motion, Sensation).
Therefore, select the most thorough option that directly addresses the most critical potential complication.

Concept Tested & Keywords

Concept Tested: Postoperative priority assessment following spinal instrumentation for scoliosis.
Stem keywords: spinal cord instrumentation, scoliosis, immediate postoperative, assessment
Lead-in keywords: most important
Clinical cues: The procedure involves the spinal cord, which elevates the risk of neurological injury.
Negative lead-in flag: false

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E6 Nursing Brunner Adult Health 3SA Vol 2 Part 2 pp. 101-103, 100-102

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 118-120

Practise the full DHS Staff Nurse - 2018 (Shift-2nd)

Attempt every question from this paper in a timed mock, then review the full solution for each one.