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.
1. Describe a plan for implementing these physician's orders.
First, I would apply o...
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.
1. 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.
2. 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
3. Which assessment should you complete first?
a. Assessing ability to move the extremities
b. Determining pupil response to light
c. Auscultating breath sounds
d. Testing the peripheral reflexes
4. 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)
This study source was downloaded by 100000830772748 from CourseHero.com on 07-16-2022 10:34:30 GMT -05:00
1
, 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)
5. 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)
a. How many milligrams of methylprednisolone (Solu-Medrol) will T.W. receive
with the bolus?
2400
b. How many milligrams per hour will T.W. receive with the maintenance
infusion?
9600
c. What effect will this medication have on T.W.?
This steroid is given to help decrease inflammation
Case Study Progression
Although T.W.'s injury is at a level where independent respiratory function is expected, he
experiences low oxygen saturation levels and is placed on a mechanical ventilator. The physician
states that this is because of spinal shock.
7. How would you explain spinal shock to T.W.'s family and why T.W. requires
mechanical ventilation at this time?
Spinal shock is a complete but temporary ( if corrected in time) loss of
all muscle tone and normal reflex activity below the level of injury.
This study source was downloaded by 100000830772748 from CourseHero.com on 07-16-2022 10:34:30 GMT -05:00
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