Case Study 70 Spinal Cord Injury

T.W. is a 22-year-old man who fell 50 feet from a chairlift while skiing and landed on hardpacked 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 4L 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.

Immobilize the patient’s spine and place them on 4 L nasal cannula. Next place two large bore

IV’s for easy access. Connect patient up to ECG monitoring and insert a Foley catheter. Apply a

warming blanket and complete first neurological assessment.

2. What are the nursing priorities at this time?

The immediate nursing priorities are to maintain the integrity of the patient’s spine and to

provide continuous oxygen to his body.

3. Which assessment would 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?

There would likely be wounds that need to be irrigated and bandaged. The nurse will need to do

assess all of the patient’s cranial nerves and peripheral senses.

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?

The nurse should obtain a detailed history of the accident and what happened afterwards to the

patient. The nurse will gather information from the first responders and contact the family for

further information.

6. The physician orders the following for T.W.: Intravenous (IV) methylprednisolone (SoluMedrol), 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. How many milligrams of methylprednisolone

(Solu-Medrol) will T.W. receive with the bolus? How many milligrams per hour will T.W.

receive with the maintenance infusion? What effect will this medication have on T.W.?

Powered by qwivy(www.qwivy.org)

 1 / 1