Spinal Cord Injury Case Study

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.

• 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.

• 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

• Which assessment should you complete first?
• Assessing ability to move the extremities
• Determining pupil response to light
• Auscultating breath sounds
• Testing the peripheral reflexes 1 / 2

• 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) 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)

• 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)

• How many milligrams of methylprednisolone (Solu-Medrol) will

T.W. receive with the bolus?2400

• How many milligrams per hour will T.W. receive with the

maintenance infusion?9600

• What effect will this medication have on T.W.?
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