A patient with suspected spinal cord and head injuries is brought into the emergency department on a backboard after a car accident. The Glasgow Coma Scale score is 15; vital signs are blood pressure 130/82 mm Hg, pulse 102 beats/min, respirations 20 breaths/min, and temperature 98°F (36.6°C). What is the most important nursing intervention during initial care of the patient?

Question

Quizplus · Accepted Answer

In a patient with suspected spinal cord injury and head injury, it is crucial to avoid any unnecessary movement of the patient. This is to prevent any further damage to the spinal cord or brain. Therefore, the most important nursing intervention during initial care of the patient is to avoid moving the patient. Checking the extremities for range of motion or turning the patient to the side to avoid aspiration may be appropriate interventions but only after it has been determined that it is safe to do so. Keeping the head of the bed elevated 30 degrees may also be important for certain patients, but in this case, it is not the most important intervention.

A Patient with Suspected Spinal Cord and Head Injuries Is