spinal injury

In neurologic issues the level of consciousness should be the first to be assessed, because any change in the level of consciousness will be an eary sign of increased ICP. This is your baseline and any changes here will give you the most likelihood of instituting interventions that will make a difference.

A rise in SBP as part of Cushing's Triad would be a late sign in increased ICP. (this would be seen along with decreased DBP and bradycardia). HTN alone would not be as much of a concern. At this point, the change in this pt's level of consciousness occurred some time ago and those early signs of trouble were missed. At this point this is an emergent situation.

OK,
Here is my reply to this question:
While checking LOC and B/P are important, I would choose check their bladder.
There is a condition in Spinal pts called "Autonomic Dysreflexia"
This is characterized by severe hypertension, bradycardia, severe headache, nasal stuffiness, and flushing. The cause of this syndrome is a noxious stimulus, most commonly a distended bladder or constipation. This is a neuro emergency, and must be treated to prevent a stroke. This is why checking the I&O, and urine residuals are so very important in a spinal pt.
A spinal pt who is hypertensive is not uncommon, and should be treated, and LOC absolutely should be assessed, but having a full bladder can kill a spinal pt.
Amy

As a student I have to go with A because a change in level in consciousness could indicate neurological dysfunction and is important for a baseline assessment. BP can fluctuate for a variety of reasons and you may not have a true baseline BP for the patient anyway, so unless there is a truly significant change it isn't going to be the most accurate assessment tool inmho.

It's a very vague question, but if the patient needs CPR, I think it is better to have assessed the CABC's (LOC, airway, breathing, circulation) than the bladder or BP. I'd go with A.

I am with you Paisa and would answer b. This is not a neuro pt, this is a spinal pt. It does not say that you are doing cpr or that his has just occurred. During routine assessment of a spinal pt, BP is the most important. By the time they were having changes in LOC (from high blood pressure) it would be a late sign and they are either stroking or herniating.

Since the problem doesn't elaborate on when the spinal injury occurred, I would assume this is the first time you are seeing the patient after their injury, perhaps just after the trauma? It is appropriate to assess their ABCs. Since there is nothing in your answer choices regarding the airway or breathing, then the next thing you need to check is their circulation. A blood pressure measurement is a test to monitor the circulation status. Spinal injury patients can develop spinal neurogenic shock after the immediate trauma which has the symptoms of a low blood pressure and bradycardia. This needs to be assessed for and treated by the physicians first. (http://www.fpnotebook.com/ORT66.htm) If you check their level of consciousness and their bladder first, your patient may be dead before you get around to checking their blood pressure! A bladder can wait. And, if they are already in a diminished state of consciousness what are you going to do about it that takes priority over a crashing blood pressure and heart rate?