Question

Spinal Cord Injury Case Study             Name: ____________________________

10 points total (1 point per answer, 0.25 points per reference for each question)

Patient Profile:

M.P, a 19-year-old African American male, has a spinal cord injury following a gunshot wound 2 weeks ago. The gunshot injury occurred during a hunting accident when his best friend’s gun accidently discharged. His injury is at the T5 level. The goal is to prepare him for transfer to a rehabilitation unit in the next few days.

Subjective Data

• Has just completed his first year of college as an engineering student
• States he is depressed and “he cannot get used to the idea of not walking again”

Objective Data

Physical Examination

• Supine blood pressure 120/68, sitting blood pressure 114/62, pulse 68, temperature 99.8° F, respirations 16
• Slight edema bilateral lower extremities – ace wraps wrapped around lower extremities
• Abdominal binder in place
• Urinary catheter intact and draining dark yellow urine
• Last bowel movement 2 days ago; it was hard, small and brown
• Full head, neck, shoulder and upper extremity movement with normal muscle strength and sensation
• Complete paralysis of lower body and legs with no sensation present
• Full passive range of motion without crepitation in the bilateral lower extremities

Diagnostic Studies

• Spinal series x-rays: Complete transection at T5
• MRI: Confirmed transection and revealed no clots or masses present

• Laboratory results:
  • White blood cells: 9500/µL
  • Hemoglobin: 16 g/dL
  • Hematocrit: 45%

Discussion Questions

1. Based on the assessment data, what are the nursing priorities for M.P.at this time?

2. What actions do you need to take based on these priorities?

3. What is the rationale for the lower extremity elastic compression stockings and abdominal binder?

Case Study Progress

M.P. did not have any signs of autonomic dysreflexia. He had a large bowel movement after receiving a PRN suppository. Antibiotic therapy was initiated after results of a urinalysis with culture and sensitivity indicated a urinary tract infection. After 3 days of medication and fluid therapy, he is being transferred to the rehabilitation unit.

4.    What are M. P.’s priority nursing diagnoses while in rehabilitation?

5.   Because of the complexity of M.P.’s care, you are coordinating care among many members of the health care team. Who might be participating in M.P.’s rehabilitation?

6. List three potential adverse conditions to continue to monitor M.P. for throughout his stay.

7. Rehabilitation care includes initiating a bowel-retraining program. Outline the components of a program for M.P.

8. List three physical rehabilitation goals (obtainable goals) that M.P. can achieve.

Answer 1

1. Priorities would be

To prevent further injury to other spinal cord vertebrea.

Orthostatic hypotension is 2nd priority

Bowel & bladder movement.

Joint contractures and muscle spasm.

Strengthening of upper extremities to maximum.

2. Action to be taken;

Medications that reduce pain, muscle spasticity to be given

Medications to control the bowel and bladder movement to be given

Immobilization

Surgery to remove the gun shots

to reduce inflammation etc

3. Abdominal binders are used to aid respiratory function in SCI patients. It restores abdominal pressure, improve breathing capacity and reduce postural hypotension in SCI patients.

Ace wraps are used to improve postural hypotension. Post to SCI there are changes happening in CVS. Heart rate is lower, blood pressure is lower. The blood flow in legs are slowed down since there is no movement from legs.

Compression stclockings to be worn as there is edema in legs due to less blood pumping back from legs to heart.

4. Priorities during rehabilitation;

to enable the patient to meet daily needs

To provide emotional support

to inprove physical mental and emotional functioning.

The following can be done

Spasticity management

Wheel chair clinic

Neurigenic bladder and bowel movement

Locomotor training

Sexual function management etc