Spinal Cord Injury Case Study NUR 401

Scenario: T.W. is a 22-year-old man who fell 50 feet from a chairlift while skiing and landed on hard-packed snow. He is now at the emergency department (ED) with a suspected T5-T6 fracture with paraplegia. 1. Describe a plan for implementing these physician's orders.  First, I would apply oxygen and immobilize the cervical spine. Then, I would Perform a neuro assessment. Next, I would start IVs, place ECG monitoring, foley catheter and if needed I would apply a warming blanket. 2. What are the nursing priorities at this time?  Prevent secondary damage to the spinal cord  Manage cardiovascular and pulmonary complications  Help the patient overcome psychosocial challenges associated with severe neurological deficit 3. Which assessment should you complete first? a. Assessing ability to move the extremities b. Determining pupil response to light c. Auscultating breath sounds d. Testing the peripheral reflexes 4. What other interventions would likely be done by the ED nurse?  Assess for paralytic ileus, listen to bowel sounds, palpate for bladder/bowel distension.  Perform a detailed motor and sensory examination (neuro assessment) 1 This study source was downloaded by from CourseH on :34:30 GMT -05:00  Assess for pain  Assessment of ABCs to ensure that optimal oxygenation and perfusion to all vital organs including the spinal  Prep patient for CT scan  Get IV access  Apply oxygen  Get labs ( CBC, lactate, BMP) 5. Awareness of the prehospital management of a spinal cord injury (SCI) is critical to T.W.'s ultimate neurologic outcome. What actions will the nurse take to ensure this goal is met?  Protect the c spine by immobilizing the cervical spine  Jaw thrust to open airway  Control shock from happening  Communicate needed information for triage at the hospital 6. The physician orders the following for T.W.: Intravenous (IV) methylprednisolone (Solu- Medrol), bolus of 30 mg/kg over 15 minutes, followed by a maintenance infusion of 5.4 mg/kg body weight per hour. T.W. weighs 176 pounds. (Remember, research is currently occurring regarding the effectiveness of this medication for SCI, but many neurosurgeons still order it) a. How many milligrams of methylprednisolone (Solu-Medrol) will T.W. receive with the bolus?  2400 b. How many milligrams per hour will T.W. receive with the maintenance infusion?  9600 c. What effect will this medication have on T.W.?  This steroid is given to help decrease inflammation Case Study Progression Although T.W.'s injury is at a level where independent respiratory function is expected, he experiences low oxygen saturation levels and is placed on a mechanical ventilator. The physician states that this is because of spinal shock. 7. How would you explain spinal shock to T.W.'s family and why T.W. requires mechanical ventilation at this time?  Spinal shock is a complete but temporary ( if corrected in time) loss of all muscle tone and normal reflex activity below the level of injury. 2 This study source was downloaded by from CourseH on :34:30 GMT -05:00 This can cause T.W. to experience things such as low blood pressure, weak/ reduced muscle tone, and a slow beating heart.  The reason T.W. is getting intubated is because when in shock the body is not capable of providing adequate oxygen to perfuse tissues. Intubation is going to breathe for T.W. which decreases the workload on the body and helps stop the shock from getting worse. 8. What is the pathophysiology of neurogenic shock, what are common signs/symptoms, and how is it treated?  Neurogenic shock occurs when the sympathetic nervous system loses the ability to stimulate nerve impulses.  S/s include hypotension, bradycardia, and warm/dry skin  Treatment consist of removing/treating the causes, preventing cardiovascular instability and promoting optimal tissue perfusion by giving fluids to treat hypovolemia, Vasopressors to treat low BP, and giving a beta adrenergic agent to treat bradycardia. 9. List three critical potential infections that T.W. will be monitored for throughout his hospitalization.  Ventilated acquired pneumonia, Skin infection from skin breakdown, and catheter associated urinary tract infection