This Study Resource Was: Spinal Cord Injury Case Study

Spinal Cord Injury Case Study
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 was found to have a T10-11 fracture with paraplegia. He was
initially admitted to the surgical intensive care unit (SICU) from the emergency
department (ED) and placed on high-dose steroids for 24 hours. He was taken to
surgery 48 hours after the accident for spinal stabilization. He spent 2
additional days in the SICU and 5 days on the neurologic unit, and now is ready to
be transferred to your rehab unit. He continues to have no movement of his lower
extremities.
1. Awareness of the pre-hospital management of a spinal cord injury (SCI)

is critical to each patient’s ultimate neurologic outcome. What actions
m
should the nurse take to ensure this goal is met?
er as
The nurse needs to take a thorough history of the accident and all connected events
co
until the arrival of the EMT or other medical responders. The nurse also needs to
eH w
make sure that the first responder's information is correct and incorporated into the
patient chart.
o.
rs e
2. On arrival to the ED, what are the main interventions done by the ED
ou urc
nurse?
The ED nurse will need to:
 Assess ABCs
o
 Immobilize the spine

aC s
 Make a thorough neurological assessment

vi y re
 Have suction available

 Inset two large bore IVs
 Insert NG and Foley
 Keep patient warm
ed d
 Continue to reassess ABCs and neurological status

ar stu
3. T.W. receives high-dose steroid therapy in the ED; then he is placed on a

sh is
continuous infusion. What effect will steroids have on T.W., and what is
Th
the usual method of steroid administration?

Steroids will decrease inflammation by suppressing the immune system. Steroids
can put him more at risk for nosocomial infections and can cause euphoria and
depression. The best outcome occurs when it is given within 3 hours. The usual
method for administration is a bolus of 30 mg/kg over 15 minutes, then a
maintenance infusion of 5.4 mg/kg/hr.
4. List three critical potential infections that T.W. should be monitored for throughout
his hospitalization.
 Pulmonary infection
 UTI
 Wound infection
https://www.coursehero.com/file/23129530/Spinal-Cord-CASE-STUDY/
5. Explain the difference between spinal shock and neurogenic shock.
Spinal shock is immediately after the injury and may last a few days to weeks. It is
accompanied by the loss of motor, sensory, and reflex functions below the level of
injury reflexes surrounding the injured site return last.
Neurogenic shock is a form of distributive shock and is associated with and SCI at
level T6 and above. S&S will include: decreased preload, decreased cardiac filling,
decreased stoke volume, hypotension, and bradycardia.
6. T.W. is taking vitamin C 1 to 2g qid. What is the purpose of this?

The purpose is to acidify the urine to prevent UTIs.
7. Rehabilitation teaching includes teaching T.W. how to manage his
urinary drainage system. What would this teaching include?
Some patients can be taught to catheterize themselves 3-4 times a day and not
m
wear a continuous drainage system. They should know to:
er as
 Cleanse the area before catheterization
co
 Use clean technique
eH w
 Maintain patency of UDS
o.
 Irrigate UDS using sterile technique
rs e
 Change urinary catheter at regular intervals
ou urc
 Position to promote drainage
 Empty UDS at regular periods
 Check the length of the bag straps
o
 Skin care
 Clean leg bag daily
aC s
 Monitor for bladder distention

vi y re
8. When can the bladder training program be started?

When spinal shock resolves, within 4-6 weeks.
ed d
9. The large bowel musculature has its own neural center that can directly
ar stu
respond to distention caused by fecal material. This is what allows most

SCI patients to regain bowel control. What dietary instructions are
important for T.W.?
sh is
Increase fluids, fiber, roughage, and warm fluids can stimulate the gastrocolic reflex
which increases peristalsis and contractions of the GI tract.
Th
10. T.W. should also be taught bowel training techniques. What would this
teaching include?
 Identify foods high in bulk
 Understand adequate fluid intake
 Obtain adequate exercise
 Have a consistent time for defecation
 Ensure privacy
 Administer suppository when needed
 Perform digital stimulation when needed
11. What medications can assist with a bowel program?
Stool softeners, bulk producers, lubricants, mild cathartics, suppositories
12. Describe digital stimulation.

Digital stimulation is used to elicit reflex elimination to evacuate the lower bowel. A
gloved lubricated finger is inserted into the rectum 1/2 to 1 inch and pointed
posteriorly. The finger is then gently rotated in a circular motion for 30 seconds or
longer. It can be repeated every 20 minutes.
13. 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?
 Sexual function is controlled by spinal levels S2-4
 Many techniques are available to increase erections such as drugs, vacuum
pumps, cock rings, and penile prosthesis
m
er as
co
eH w
o.
rs e
ou urc
o
aC s
vi y re
ed d
ar stu
sh is
Th
Powered by TCPDF (www.tcpdf.org)

This Study Resource Was: Spinal Cord Injury Case Study

Uploaded by

Copyright:

Available Formats

This Study Resource Was: Spinal Cord Injury Case Study

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

This Study Resource Was: Spinal Cord Injury Case Study

Uploaded by

Copyright:

Available Formats

Spinal Cord Injury Case Study

1. Awareness of the pre-hospital management of a spinal cord injury (SCI)

 Immobilize the spine

 Make a thorough neurological assessment

 Have suction available

 Continue to reassess ABCs and neurological status

3. T.W. receives high-dose steroid therapy in the ED; then he is placed on a

the usual method of steroid administration?

6. T.W. is taking vitamin C 1 to 2g qid. What is the purpose of this?

 Monitor for bladder distention

8. When can the bladder training program be started?

respond to distention caused by fecal material. This is what allows most

11. What medications can assist with a bowel program?

12. Describe digital stimulation.

Powered by TCPDF (www.tcpdf.org)

You might also like