Spinal Cord Injury: Emergency Department Care and Medications for T.W., Exams of Nursing

Download Spinal Cord Injury: Emergency Department Care and Medications for T.W. and more Exams Nursing in PDF only on Docsity! Spinal Cord Injury Case Study Latest Update Success Assured :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 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 patients 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 P a g e 1 | 8 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), P a g e 2 | 8 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 you walk into the room, you immediately note that T.W.'s face is flushed. You suspect that T.W. might be experiencing .(autonomic dysreflexia (AD ?What further assessment data do you need to collect .16 The patient may experience a sudden sever headache, severe hypertension and bradycardia, • .sweating, nausea, nasal stiffness and goose bumps ?What is AD, and what are its potential causes .17 AD is a neurological emergency, it is commonly caused by visceral distention from a • .distended bladder or impacted rectum. It can cause a hypertensive stroke ?What interventions do you need to perform for a patient with AD .18 Nursing interventions include: raising the head of the bed and contacting the provider, loosen • tight clothing, check for bladder distention, administer a antihypertensive medication, if foley .is in place check for any kinks, document the occurrence, treatment and response ?AD is a medical emergency. What could happen if it is left untreated .19 If left untreated it can cause hypertensive shock • P a g e 5 | 8 Consider a hierarchy of rehabilitation needs for patients such as T.W. Number the following .20 .options from highest (1) to lowest (8) priority as they apply to T.W P a g e 6 | 8 a. Community integration b. Gainful employment c. Accomplishment of self-care and ADL d. Self-actualization e. Stabilization of the physiologic systems and early psychological support f. Adjustment to living at home g. Participation of physical therapy, occupational therapy, and social worker; use of assistive devices; bowel and bladder training h. Independence Stabilization of the physiologic systems and early psychological support .1 Adjustment to living at home .2 Independence .3 Accomplishment of self-care and ADLs .4 Gainful employment .5 Self-actualization .6 Participation of physical therapy, occupational therapy, and social worker; use of .7 assistive devices; bowel and bladder training Community integration .8 P a g e 7 | 8