Spinal Cord Compression: An Obstructive Oncologic Emergency

Maryjo Osowski, RN, MSN, AOCN

Disclosures

Topics in Advanced Practice Nursing eJournal. 2002;2(4) 

In This Article

Implications for the APN

The APN can favorably affect a patient's quality of life through timely recognition of early signs and symptoms of SCC. The current emphasis on pain control for oncology patients ought to increase awareness of the development of SCC, given that pain is usually present before the loss of sensation and motor and autonomic function begins. A thorough pain evaluation will lead, in the case of pain, to initiation of treatment to relieve the injury to neurologic tissue before irreversible damage occurs.

Advanced practice nurses also must keep the possibility of SCC in mind when teaching cancer patients about symptoms that should be reported immediately. It is particularly important for patients with lung, breast, or prostate cancer or lymphoma to promptly report back pain that is worse in the recumbent position or chronic back pain that suddenly changes. Because back pain is a common nonmalignant problem, it is not unusual for patients to ignore the pain until symptoms worsen and neurologic deterioration occurs.[8]

Once a diagnosis of SCC is made, supportive nursing measures are indicated. These measures include immobilization of the spine, control of pain, paying attention to the skin, and close monitoring of bladder and bowel function. Neurologic function and vital signs are checked as often as the patient's condition warrants. Safety concerns are paramount in this population of cancer patients, many of whom have fatigue and generalized weakness because of their underlying cancer or treatment side effects. Patients should always have assistance when walking, especially at night.

After discharge, the home care nurse can continue to monitor pain control and functional status. The home care nurse will also coordinate any rehabilitation efforts that may be indicated. A physical therapy referral may be made for range of motion exercises or an evaluation of functional capacity. The physical therapist or occupational therapist will evaluate the need for assistive devices such as a hospital bed, a wheelchair, or ramps in the home.

Hospice referral is appropriate for the patient with SCC whose cancer has progressed to end-stage disease. The members of the hospice team are experts in pain control and provision of emotional support to the patient and his or her family in the face of a steady progression of losses, ultimately leading to death.

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