Question of The Day

The emergency department nurse receives report on 4 clients. Which client should the nurse assess first?

1.
Client with acute cholecystitis who reports right shoulder pain
2.
Client with gastroparesis who reports persistent nausea and vomiting
3.
Client with intractable lower back pain who reports new urinary incontinence
4.
Client with Ménière disease who reports increasing tinnitus

Post your answer in the comment section.

CORRECT ANSWER (3)

Cauda equina syndrome is a disorder that results from injury to the lumbosacral nerve roots (L4-L5) causing motor and sensory deficits. The main symptoms are severe lower back pain, inability to walk, saddle anesthesia (ie, motor weakness/loss of sensation to inner thighs and buttocks), and bowel and bladder incontinence (late sign). Cauda equina syndrome is a medical emergency. Treatment requires urgent reduction of pressure on the spinal nerves to prevent permanent damage. This client displays characteristic late signs of cauda equine syndrome (ie, incontinence); therefore, the nurse should assess this client first.

(Option 1) Clients with acute cholecystitis may experience referred pain to the right shoulder due to irritation of the diaphragm from the inflamed gallbladder. Although the client’s pain should be addressed, this client is not the priority.

(Option 2) Clients with gastroparesis have delayed gastric emptying and often report persistent nausea and vomiting. Treatment includes antiemetics, but this client is not the priority.

(Option 4) Ménière disease is an inner ear disorder. Expected symptoms include episodic vertigo, tinnitus, and muffled hearing. Treatment during an acute attack includes antihistamines, anticholinergics, and benzodiazepines. As long as the client is safe from falling, treatment is not emergent.

Educational objective:
Signs and symptoms of cauda equina syndrome (eg, acute spinal/back pain, inability to walk, saddle anesthesia, bowel/bladder incontinence) require emergency attention to prevent permanent damage.