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NPRO 2000 Case Study Spinal Cord Injury

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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. Provider Orders:  I ...

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. Provider Orders:  Insert Foley catheter  ECG monitoring  Immobilize the cervical spine  Oxygen at 4L/min via nasal cannula  Initiate two large-bore IVs  Neurologic assessment every hour  Apply warming blankets as needed 1. Describe a plan for implementing these orders. The initial interventions in this situation would be to maintain the patient’s airway, give oxygen through the nasal cannula, and immobilize the cervical spine to prevent its further damage. After the patient is immobilized, I would perform a neuro assessment. The next steps would be to start IVs, place ECG monitoring, insert foley catheter, and apply a warming blanket as needed. 2. What other interventions might be done by the ED nurse? Other interventions would be:  Assess for ABCs to ensure that there are sufficient oxygenation and perfusion to organs  Assess for pain  Assess for paralytic ileus by listening to bowel sounds and palpating the abdomen for distension  Assess for symptoms of VTE due to high risk for VTE after spinal cord injury  Get labs such as CBC, lactate, and BMP  Get ready for CT scan 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?  Promote airway clearance and improve breathing  Immobilize the cervical spine with the head and neck maintained in a neutral position to prevent further injury  Maintain urinary elimination  Decrease pain  Monitor for signs and symptoms of autonomic dysreflexia  Monitor for signs and symptoms of shock  Provide all needed information for triage at the hospital 4. The provider orders the following for T.W.: IV methylprednisolone (Solu-Medrol), bolus of 30 mg/kg over 15 minutes, followed by a maintenance infusion of 5.4 mg/kg body weight/hr. This study source was downloaded by 100000849512884 from CourseHero.com on 07-16-2022 03:42:26 GMT -05:00 https://www.

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