NPRO 2100
Case Study
Spinal Cord Injury
Case Scenario
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.
- To implement this order the first thing to consider is immobilization of the patient. this is
because in emergency situation, someone with suspected spinal cord injury needs to be
immobilized to prevent further damage to the spinal code. that is when planning care, the
priority intervention, the nurse should take is to prevent further damage to the spinal cord by
minimizing movement of the client until the spinal cord is stabilize.
ATI Nursing. (2016). Spinal Cord Injuries. In RN Adult Medical Surgical Nursing(10th
ed., p. 94). Assessment Technology Institute, LLC.
(Hinkle & Cheever, 2017, p. 2050)
- the most common complication of acute spinal cord injury is is
respiratory impairment and the first intervention in an emergent
situation is typically maintaining the patient’s airway. in order to
maintain a high partial pressure of arterial oxygen (PaO2),Oxygen is
given. This is because hypoxemia can create or worsen a neurologic
deficit of the spinal cord. (Hinkle & cheever, 10/2017, p. 2051).
- ECG monitoring is important, when caring for someone with spinal cord injury,
hypoxia and hypotension should be avoided because it can lead to neurogenic
shock, bradycardia and asystole. Maine, Mary. (2019). Management of patients
with neurological trauma. [Powerpoint slides 14]. Retrieved
fromhttps://minneapolis.learn.minnstate.edu/d2l/le/content/
- initiate two large -bore IVs, during acute phase IV access is established for the the
administration of medication (Hinkle, 10/2017, p. 2051)
, - Neurologic assessment every hour. the patient is monitored closely for changes in
motor or sensory function and symptoms of progressive neurologic damage. These
findings are recorded on a flow sheet so that changes in the baseline
neurologic status can be monitored closely and accurately. Any
decrease in neurologic function is reported immediately (Hinkle,
10/2017,p.2054).
Maine, Mary. (2019). Management of patients with neurological trauma.
[Powerpoint slides 14]. Retrieved
fromhttps://minneapolis.learn.minnstate.edu/d2l/le/content/
- insert foley catherter,bladder is atonic and can become overdistended in spinal shock.
The bladder may become hyperirritable with reflex emptying after spinal shock subsides,
so this may require indwelling catheter. Maine, Mary. (2019). Management of patients
with neurological trauma. [Powerpoint slides 14]. Retrieved
fromhttps://minneapolis.learn.minnstate.edu/d2l/le/content/
- Warming blanket: Thermoregulation is impaired with SCI because peripheral
temperature sensations cannot reach the hypothalamus. The ability to sweat or
shiver to control temperature is impaired below the level of injury.
Maine, Mary. (2019). Management of patients with neurological trauma.
[Powerpoint slides]. Retrieved
fromhttps://minneapolis.learn.minnstate.edu/d2l/le/content/
Source: prioritization
2. What other interventions might be done by the ED nurse?
To avoid further injury, the ED nurse might promote adequate breathing and airway clearance to
avoid impending respiratory failure. Clearing bronchial and pharyngeal secretions can prevent
retention of secretions and atelectasis. Also,preventing injury due to sensory and perception
alterations, that is the nurse should stimulate the senses of the client through touch, aromas,
conversation or music. The patient should be assessed for symptoms of VTE, patients are at high risk
for VTE after spinal cord injury. (Hinkle, 10/2017, p. 2048)
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?
To ensure this goal is met, the nurse should know that improper handling of the client can cause
further damage and loss of neurologic function. The nurse should know that, at the scene of the
injury, the patient must be immobilized on a spinal board, with the head and neck maintained in a
neutral, position to prevent an incomplete injury from becoming complete. cervical immobilizing
device is applied, if possible, at least four people should slide the patient carefully onto a board for
transfer to the hospital. Head blocks should also be considered, as they will further limit any neck
movement. Patient is then transfer to the trauma centre in the first 24 hours after injury. in the x-ray
Case Study
Spinal Cord Injury
Case Scenario
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.
- To implement this order the first thing to consider is immobilization of the patient. this is
because in emergency situation, someone with suspected spinal cord injury needs to be
immobilized to prevent further damage to the spinal code. that is when planning care, the
priority intervention, the nurse should take is to prevent further damage to the spinal cord by
minimizing movement of the client until the spinal cord is stabilize.
ATI Nursing. (2016). Spinal Cord Injuries. In RN Adult Medical Surgical Nursing(10th
ed., p. 94). Assessment Technology Institute, LLC.
(Hinkle & Cheever, 2017, p. 2050)
- the most common complication of acute spinal cord injury is is
respiratory impairment and the first intervention in an emergent
situation is typically maintaining the patient’s airway. in order to
maintain a high partial pressure of arterial oxygen (PaO2),Oxygen is
given. This is because hypoxemia can create or worsen a neurologic
deficit of the spinal cord. (Hinkle & cheever, 10/2017, p. 2051).
- ECG monitoring is important, when caring for someone with spinal cord injury,
hypoxia and hypotension should be avoided because it can lead to neurogenic
shock, bradycardia and asystole. Maine, Mary. (2019). Management of patients
with neurological trauma. [Powerpoint slides 14]. Retrieved
fromhttps://minneapolis.learn.minnstate.edu/d2l/le/content/
- initiate two large -bore IVs, during acute phase IV access is established for the the
administration of medication (Hinkle, 10/2017, p. 2051)
, - Neurologic assessment every hour. the patient is monitored closely for changes in
motor or sensory function and symptoms of progressive neurologic damage. These
findings are recorded on a flow sheet so that changes in the baseline
neurologic status can be monitored closely and accurately. Any
decrease in neurologic function is reported immediately (Hinkle,
10/2017,p.2054).
Maine, Mary. (2019). Management of patients with neurological trauma.
[Powerpoint slides 14]. Retrieved
fromhttps://minneapolis.learn.minnstate.edu/d2l/le/content/
- insert foley catherter,bladder is atonic and can become overdistended in spinal shock.
The bladder may become hyperirritable with reflex emptying after spinal shock subsides,
so this may require indwelling catheter. Maine, Mary. (2019). Management of patients
with neurological trauma. [Powerpoint slides 14]. Retrieved
fromhttps://minneapolis.learn.minnstate.edu/d2l/le/content/
- Warming blanket: Thermoregulation is impaired with SCI because peripheral
temperature sensations cannot reach the hypothalamus. The ability to sweat or
shiver to control temperature is impaired below the level of injury.
Maine, Mary. (2019). Management of patients with neurological trauma.
[Powerpoint slides]. Retrieved
fromhttps://minneapolis.learn.minnstate.edu/d2l/le/content/
Source: prioritization
2. What other interventions might be done by the ED nurse?
To avoid further injury, the ED nurse might promote adequate breathing and airway clearance to
avoid impending respiratory failure. Clearing bronchial and pharyngeal secretions can prevent
retention of secretions and atelectasis. Also,preventing injury due to sensory and perception
alterations, that is the nurse should stimulate the senses of the client through touch, aromas,
conversation or music. The patient should be assessed for symptoms of VTE, patients are at high risk
for VTE after spinal cord injury. (Hinkle, 10/2017, p. 2048)
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?
To ensure this goal is met, the nurse should know that improper handling of the client can cause
further damage and loss of neurologic function. The nurse should know that, at the scene of the
injury, the patient must be immobilized on a spinal board, with the head and neck maintained in a
neutral, position to prevent an incomplete injury from becoming complete. cervical immobilizing
device is applied, if possible, at least four people should slide the patient carefully onto a board for
transfer to the hospital. Head blocks should also be considered, as they will further limit any neck
movement. Patient is then transfer to the trauma centre in the first 24 hours after injury. in the x-ray
