Which one of the following statements by a patient with backache should alert the nurse?

JIPMER Nursing Officer-2017

Medical & Surgical Nursing

Medium

Appeared in: JIPMER Nursing Officer-2017

Explanation

Perineal anaesthesia, also known as saddle anaesthesia, is a loss of sensation in the perineum, buttocks, and inner thighs.
This symptom is a classic and critical sign of Cauda Equina Syndrome, a neurological emergency caused by severe compression of the nerve roots at the end of the spinal cord.
Immediate medical evaluation and intervention, often surgical, are required to prevent permanent consequences like paralysis and loss of bowel/bladder control.
Unlike other common back pain symptoms, perineal anaesthesia signals a severe, central neurological compromise that must be addressed urgently.

Option A: Pain on movement is a very common and expected symptom of mechanical back pain (e.g., muscle strain). It does not, by itself, indicate a neurological emergency.
Option B: Pain radiating down the leg (sciatica) indicates nerve root irritation, commonly from a herniated disc. While it requires management, it is not an acute emergency unless accompanied by other red flags like motor weakness or bladder/bowel dysfunction.
Option D: Loss of pain sensation in the feet is a significant neurological sign (peripheral neuropathy or radiculopathy) that needs investigation. However, it does not carry the same immediate urgency as perineal anaesthesia, which points specifically to compression of the sacral nerve roots controlling bowel and bladder function.

Clinical Relevance

Nursing practice connection: Use the key finding related to Identification of red flag symptoms in a patient with backache, specifically signs of Cauda Equina Syndrome to guide bedside assessment, documentation, and the next nursing action.
A nurse's ability to recognize red flag symptoms for back pain is crucial for timely escalation and prevention of devastating, permanent neurological damage.
Failure to identify and act on signs of Cauda Equina Syndrome can lead to irreversible paralysis, incontinence, and sexual dysfunction for the patient.
What if? If a patient reported pain radiating down the leg AND new-onset urinary retention, the nurse should be just as alerted. The combination of sciatica with bladder dysfunction is also a major red flag for Cauda Equina Syndrome, requiring immediate escalation.

How to Approach the Question

First, understand the question is asking for the most alarming symptom that should 'alert' the nurse, implying a potential emergency.
Evaluate each option's clinical significance. Differentiate between common, expected symptoms and 'red flag' symptoms.
Recognize that 'Pain on movement' is a general symptom of most back injuries.
Identify 'Pain radiating the leg' (sciatica) as nerve irritation, which is serious but not typically an immediate surgical emergency on its own.
Recall that neurological deficits involving the perineal area (saddle region), bowel, or bladder are critical signs of severe spinal cord or nerve root compression.
Conclude that 'Perineal anaesthesia' is the most critical finding as it is a hallmark of Cauda Equina Syndrome, a surgical emergency.

Concept Tested & Keywords

Concept Tested: Identification of red flag symptoms in a patient with backache, specifically signs of Cauda Equina Syndrome.
Stem keywords: backache, alert, nurse, patient statement
Lead-in keywords: Which one
Negative lead-in flag: false

Qy2AO95HBdcGz3qWE-30oO

E6 Medicine Macleod Clinical Examination 15e p. 304-306