Question

The patient is a 23-year old man who sustained a C-7 fracture during a skiing accident. He is being transferred from the medical-surgical unit to the inpatient rehabilitation unit. He has family in the area and they have been supportive throughout his stay. His mother, in particular, has spent many hours at the bedside and expresses a willingness to take him home and continue his care once his hospital and rehab treatment are completed. The patient has lost approximately 18 lbs. during his hospital stay and demonstrates a weak non-productive cough. He had been actively participating with physical therapy and occupational therapy, but he is currently discouraged and withdrawn.

1. What deficits would be expected in a patient with a C7 fracture?
2. What are the major complications of prolonged immobility and what are the nursing interventions that could be used to prevent each?
3. Why is this patient at risk for pneumonia and what are the nursing interventions that could be used to help prevent this complication?
4. Describe the essential elements of a bladder retraining program?
5. What nursing interventions would assist the patient with SCI with psychosocial adaptation?

Answer 1

1)Cervical vertebra commonly called as neck bones. It is of 7 vertebral bones. Cervical vertebra plays an important role in holding or connecting skull with the neck. Cervical vertebra in level 7 nerves controls arm extension and finger extension. Any injury to the C7 level will leads to inability to move arms and fingers still patient can carry out activity of daily living but need assistance to carry on complex task. Autonomic dysreflexia caused by injury to spinal cord injury at or above T6 level.

2) Major complications of prolonged immobility are break down of intact skin, decubitus ulcers, venous stasis resulting in Deep vein thrombosis, Muscle weakness, softening of bones leads to osteoporosis, excess pooling of secretions leads to pneumonia, atelectasis.

Nursing interventions focussed on :

1) Maintaining skin integrity by following measures: periodical skin care by applying moisturizer, emollient. Providing with crease / wrinkle free bed as constant pressure results in friction and shearing. Changing position of patient every second hourly. Providing pillows or soft cushions over bony prominences back of head, ears, shoulders, elbows, wrist, thigh, knees and ankles will prevent decubitus ulcer.

2) Deep vein thrombosis occurs on prolonged venous stasis on hamstring muscles. Nurses identify positive Homan's sign to elicit pain on calf muscles.This can be prevented by applying compressive bandages and elevating legs 45 degree, exercise regularly.

3) Prolonged immobility results in pooling of excess secretions in lungs . Nursing interventions of chest physiotherapy, postural drainage, oral suctioning if patient is unable to bring out the secretions. Hand hygiene before handling patients can prevent transmission of infection from one patient to other.