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IV fluids. While IV fluids are used for hydration, they do not address gastric decompression or relieve ileus. They may be given alongside NG suction but are not the priority intervention.

Tube feedings. Enteral feeding is contraindicated in paralytic ileus, as the GI tract cannot process nutrients until bowel function returns. Starting tube feedings would increase risk of aspiration and worsening distention.

Parenteral nutrition. Total parenteral nutrition (TPN) may be considered only if the paralytic ileus is prolonged, but it is not the initial management. Early care focuses on gastric decompression.

Intermittent catheterization. This method is preferred once the acute phase resolves and reflex bladder activity returns, but it is not used initially because the bladder cannot contract. Early use would risk overdistention and damage.

Insertion of a suprapubic catheter. This is a more invasive procedure, typically considered for long-term bladder management when intermittent catheterization is not feasible. It is not indicated during the acute phase.

Use of incontinent pads to protect the skin. Pads may protect skin from moisture if incontinence occurs, but they do not address the problem of retention during spinal shock. Reliance on pads could lead to serious complications such as bladder rupture.

“It is really still too soon to know if you will have a return of function.” While factually correct, this response dismisses the patient’s hope and may create unnecessary discouragement. It lacks therapeutic value.

“That’s wonderful. We will start exercising your legs more frequently now.” This assumes that the movement is functional recovery and could lead to false reassurance. Rehabilitation intensity should be guided by professional evaluation, not solely the patient’s report.

“I’m sorry but the movement is only a reflex and does not indicate normal function.” This is overly dismissive and may harm the patient’s motivation. While reflexes can return after spinal shock, assuming this without assessment is not appropriate.

Hygiene care for an indwelling urinary catheter. While infection prevention is important, indwelling catheters are avoided for long-term use due to the high risk of urinary tract infections and complications such as urethral damage.

To empty the bladder with manual pelvic pressure in coordination with reflex voiding patterns. Although this may be used in some cases, it is less reliable than intermittent catheterization and may not ensure complete bladder emptying, leading to urinary stasis and complications.

That a urinary diversion, such as an ileal conduit, is the easiest way to handle urinary elimination. Urinary diversion is a surgical option reserved for patients who cannot manage bladder function with less invasive strategies. It is not a first-line intervention.

Assist the patient to move through all stages of the mourning process to acceptance. While nurses support patients through grief, they cannot control or force progression through stages. Each patient experiences grief uniquely and may not follow a predictable path.

Let the patient know that anger directed at the staff or the family is not a positive coping mechanism. Although anger may be difficult to manage, it is a normal part of the grieving process. The nurse should acknowledge and redirect it constructively rather than labeling it as negative.

Facilitate the grieving process so that it is completed by the time the patient is discharged from rehabilitation. Grieving is not expected to be complete within a rehabilitation timeframe. Expecting closure by discharge is unrealistic and may increase frustration or guilt.