Spinal Cord Injury Case Study: Emergency Management and Treatment, Exams of Health sciences

Download Spinal Cord Injury Case Study: Emergency Management and Treatment and more Exams Health sciences in PDF only on Docsity! Spinal Cord Injury Case Study Latest Update Assured Success : 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 : Chart View Physician’s Orders · Insert Foley catheter · ECG monitoring · Immobilize the cervical spine · Oxygen at 4 L per nasal cannula · Initiate two large bore IVs · Neurologic assessment every hour · Apply warming blankets as needed 1. Describe a plan for implementing these physician's orders. • To implement this order I would first start by first immobilizing the cervical spine. This is considered an emergency and is critical because improper movement can cause further damage and loss of the neurological function. Next I would make sure the patient has his O2 to help facilitate his breathing, I would make sure the patient is connected to the ECG monitor next I would start the IV to have access to administer medications easily being that the patient it immobilized. After that I would complete my neurological assessment by assessing the patients motor and sensory function, testing the patient ability to squeeze my hands, move fingers and toes and monitor for signs of autonomic dysreflexia. Next I would insert foley catheter, bladder is atonic and can become over distended in spinal shock. The bladder may become hyperirritable with reflex emptying after spinal shock subsides, so this may require indwelling catheter. Lastly, I would pg. 1 apply the warming blanket as needed to promote thermoregulation which can be impaired by the spinal injury. 2. What other interventions might be done by the ED nurse? • The ED nurse should continuously monitor the patient’s respiratory status which is the first priority. Involuntary respirations can be affected due to a lesion. The nurse should provide oxygen and suction as needed, and assist with coughing by applying abdominal pressure when he patient is attempting to cough. 3. Awareness of the prehospital management of an SCI is critical to each patient's ultimate neurologic outcome. What actions will the nurse take to ensure this goal is met? • To ensure the goal is met the nurse should know how to properly handle a patient with a spinal cord injury. The nurse should be aware that improper handling of the patient can cause further damage and loss of neurologic function. The nurse should know that, at the scene of the injury, the patient must be immobilized on a spinal board, with the head and neck maintained in a neutral, position to prevent an incomplete injury from becoming complete. 4. The physician orders the following for T.W.: IV methylprednisolone (Solu-Medrol), pg. 2 Teaching would include the importance of drinking around 2.5 L of fluid a day to promote an • effective urine flow out of the bladder. It is also important for the nurse to teach good hygiene to promote infection or bacteria and maintain skin integrity. The nurse would also teach the client the signs of a bladder or urinary tract infection, such as fever, fatigue, and urine that is .foul-smelling, cloudy, or contains blood and he should notify the provider if so T.W. is taking vitamin C 2 g orally four times daily. What is the purpose of this and what .8 ?other nursing actions should accompany vitamin C therapy • Vitamin C is an essential nutrient involved in the repair of tissue and the enzymatic production of certain neurotransmitters. It also makes the urine more acidic to help prevent UTI’s. • The nurse should check allergies before giving the medication, make sure the patient understands the importance of taking the medications as prescribed. What outcome parameters would you use to determine whether your efforts in regards .9 ?to promoting urinary excretion have been effective • A nurse could use a bladder scanner to determine the residual level of urine in the bladder after the client has emptied their bladder. Outcome parameters that may be used to determine if urinary elimination is effective include if the client has adequately participated in a bladder training program. The nurse could check the foley to ensure the patient is voiding an adequate amount of urine. The large bowel musculature has its own neural center that can directly respond to .10 distention caused by fecal material. This is what allows most SCI patients to regain bowel pg. 5 ?.control. What dietary instructions are important for T.W • Dietary instructions to promote bowel elimination includes intake of high fiber foods such as vegetables, fruits and brans and daily fluid intake of 2-3L unless contraindicated to prevent hard stools from forming and stimulate peristalsis to avoid constipations. T.W. should also be taught bowel training techniques. What would this teaching ?include .11 • Maintaining a bowel pattern prevents constipation and bowel incontinence. Patient should also be informed that the time after breakfast is usually ideal for bowel movement since the natural gastro colic and duodenocolic reflexes are stimulated within about 30 minutes after meals. If further inventions are needed, use of suppositories, stool softeners, laxatives, dietary changes can be taught to patient along w/ bowel training to assist with defecation. ?What medications can assist with a bowel program .12 Stool softness and bulk forming laxatives can assist the patient in preventing constipation. • .Decussate sodium or polycarbophil prevent constipation and keep the stool soft .Describe digital stimulation .13 Digital stimulation is completed by massaging the anal sphincter with a gloved and lubricated finger. Inserting 1 finger about 2.5 cm into the rectum and moving in a circular and side to side motion. This process is done on a schedule in order to condition the anal sphincter and will depend on the individual. It can be done every 48 hours or after meals and accommodated to pg. 6 fit the needs of the individual living at home. T.W. asks you whether he'll ever be able to have sex again. What do you tell him, and ?what are some possible referrals .14 I wonder explain that since he has no movement in his lower extremities he may be less able • to have reflexogenic erections, I would refer him to s SCI support group that can aid in .emotionally adapting to changes in the body image and role You request a consultation with a registered dietitian because you realize that T.W. has .special dietary needs. Describe an optimal diet for T.W .15 The diet should include foods that are high in protein, vitamins and calories in order to • prevent muscle wasting and to maintain skin integrity. The patient should also be encouraged to drink adequate amount of fluids to maintain well-functioning kidneys and to prevent constipation and UTIs. The dietician should choose whole grains, vegetables, fruits and proteins such as eggs, legumes, lean meats and low/non-fat dairy products to ensure that the patient is getting all the nutrients. Patient’s diet should also include foods high in fiber to prevent bowel problems. Limiting salt intake is also important since it can increase blood .pressure and cause water retention which can lead to bloating and edema Case Study Progress T.W. turns on his call light and asks for medication for headache. As pg. 7