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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 ...

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.?

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