SCENARIO OVERVIEW:
David Montanari (pronouns: he/him/his) is a patient who suffered a T4-T5 burst fracture and
right scapula fracture as a result of a motorcycle accident on Sunday. He underwent spinal fusion
on Sunday evening and has had an uneventful recovery period. David has no sensation or
movement below the nipple line and is bed bound. He is frustrated and anxious about his
condition and is refusing postoperative interventions, including pain medication and
use of the incentive spirometer. The scenario takes place Wednesday at 08:00 during the
morning nursing assessment. During this scenario, students will have the opportunity to assess
and manage care for a patient with postoperative atelectasis following spinal surgery.
1. Identify three (3) priority nursing interventions to prevent pulmonary complications in post-
operative patients. Include the desired outcomes of each priority nursing intervention.
1. Incentive Spirometry
Intervention: Encourage and assist the patient using the incentive spirometer every 1–2
hours while awake.
Desired Outcome: Improved lung expansion, Prevention or resolution of atelectasis,
Improved oxygenation and breath sounds
2. Pain Management
Intervention: Administer prescribed pain medications and educate the patient on how
pain control supports deep breathing and coughing.
Desired Outcome: Patient reports tolerable pain levels, Improved ability to take deep breaths,
cough, and participate in respiratory exercises.
3. Positioning and Repositioning
Intervention: Reposition the patient at least every 2 hours and elevate the head of the bed
as allowed by spinal precautions.
Desired Outcome: Improved ventilation and lung expansion, Reduced risk of atelectasis
and pneumonia
2. When caring for a spinal cord injury patient, what cues would indicate the patient is having
difficulty coping?
• Refusal of postoperative interventions, such as pain medication and use of the
incentive spirometer, indicating possible emotional distress, loss of control, or denial
• Verbal expressions of frustration and anxiety about his condition and prognosis
• Flat affect, irritability, or withdrawal during the nursing assessment
• Lack of engagement in care or rehabilitation activities, despite education on their
importance
• Statements expressing hopelessness or fear related to paralysis or loss of independence
David Montanari (pronouns: he/him/his) is a patient who suffered a T4-T5 burst fracture and
right scapula fracture as a result of a motorcycle accident on Sunday. He underwent spinal fusion
on Sunday evening and has had an uneventful recovery period. David has no sensation or
movement below the nipple line and is bed bound. He is frustrated and anxious about his
condition and is refusing postoperative interventions, including pain medication and
use of the incentive spirometer. The scenario takes place Wednesday at 08:00 during the
morning nursing assessment. During this scenario, students will have the opportunity to assess
and manage care for a patient with postoperative atelectasis following spinal surgery.
1. Identify three (3) priority nursing interventions to prevent pulmonary complications in post-
operative patients. Include the desired outcomes of each priority nursing intervention.
1. Incentive Spirometry
Intervention: Encourage and assist the patient using the incentive spirometer every 1–2
hours while awake.
Desired Outcome: Improved lung expansion, Prevention or resolution of atelectasis,
Improved oxygenation and breath sounds
2. Pain Management
Intervention: Administer prescribed pain medications and educate the patient on how
pain control supports deep breathing and coughing.
Desired Outcome: Patient reports tolerable pain levels, Improved ability to take deep breaths,
cough, and participate in respiratory exercises.
3. Positioning and Repositioning
Intervention: Reposition the patient at least every 2 hours and elevate the head of the bed
as allowed by spinal precautions.
Desired Outcome: Improved ventilation and lung expansion, Reduced risk of atelectasis
and pneumonia
2. When caring for a spinal cord injury patient, what cues would indicate the patient is having
difficulty coping?
• Refusal of postoperative interventions, such as pain medication and use of the
incentive spirometer, indicating possible emotional distress, loss of control, or denial
• Verbal expressions of frustration and anxiety about his condition and prognosis
• Flat affect, irritability, or withdrawal during the nursing assessment
• Lack of engagement in care or rehabilitation activities, despite education on their
importance
• Statements expressing hopelessness or fear related to paralysis or loss of independence
