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.
1. Describe a plan for implementing these physician's orders.
• First,...
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)
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.
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