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%

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

4.The priority nursing diagnosis is to maintain intact skin because of the immobility of complete both lower limbs which poses him at very high risk for pressure sore

5.The following members may be required in the healthcare team to care the patient

• Physical therapist or physiotherapist to do passive exercise for the patient and aide in musculoskeletal function regaining
• Dietician to plan his diet to preve ng t constipation and ensure way for good bowel movements
• Nursing aides ,caregivers to help him in daily activities ,mobilization, feeding, etc.,
• Infection control nurse to prevent infection
• Occupational therapist

6.The potential adverse conditions which has to be continued to be monitored are

• Seizure
• Pulmonary edema
• Myocardial infarction
• Renal insufficiency

7.The components of program to initiate bowel retraining

• Scheduling a time to defecate daily as per the comfort zone of the patient
• Dietary modifications like providing a food fiber rich diet, increased fluid intake to prevent constipation
• Simple passive exercise to stimulate by enhancing circulation
• Administration of medication as per order to relieve constipation

8.The physical rehabilitation goals are

• To ensure movement of the lower limb and initiate mobilization
• To prevent any injury
• To reduce pain while mobilization