Spinal Cord Injury Case Study
: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
:Chart View
Physician’s Orders
· Insert Foley catheter
· ECG monitoring
· Immobilize the cervical spine
· Oxygen at 4 L 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.
• To implement this order I would first start by first immobilizing the cervical spine. This
is considered an emergency and is critical because improper movement can cause further
damage and loss of the neurological function. Next I would make sure the patient has his
O2 to help facilitate his breathing, I would make sure the patient is connected to the ECG
monitor next I would start the IV to have access to administer medications easily being
that the patient it immobilized. After that I would complete my neurological assessment
by assessing the patients motor and sensory function, testing the patient ability to squeeze
my hands, move fingers and toes and monitor for signs of autonomic dysreflexia. Next I
would insert foley catheter, bladder is atonic and can become over distended in spinal
shock. The bladder may become hyperirritable with reflex emptying after spinal shock
subsides, so this may require indwelling catheter. Lastly, I would apply the warming
blanket as needed to promote thermoregulation which can be impaired by the spinal
injury.
2. What other interventions might be done by the ED nurse?
• The ED nurse should continuously monitor the patients respiratory status which is the
first priority. Involuntary respirations can be affected due to a lesion. The nurse should
provide oxygen and suction as needed, and assist with coughing by applying abdominal
pressure when he patient is attempting to cough.
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 the goal is met the nurse should know how to properly handle a patient with a
spinal cord injury. The nurse should be aware that improper handling of the patient 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.
4. The physician orders the following for T.W.: IV methylprednisolone (Solu-Medrol),
Page 1|7
, bolus of 30 mg/kg over 15 minutes, followed by a maintenance infusion of 5.4
mg/kg body weight/hr. 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.?
• 2.2 pound = 1kg
• 176 pounds = x
• = 80kg
• 80 kg× 30 mg/kg = 2400mg
• The maintenance infusion will then be = 5.4 mg/kg× 80 kg
• = 432mg/hr
• Methylprednisolone is a glucocorticoid and it aids in decreasing edema of the spinal cord
which can cause spinal cord compression and areas of ischemia.
Case Study Progress
The diagnosis of the fracture is confirmed and T.W. is transferred from the ED to the SICU.
Although T.W.'s injury is at a level where independent respiratory function is expected, he
experiences low oxygen saturation levels and is placed on a mechanical ventilator. The
.physician states that this is due to spinal shock
5. How would you explain spinal shock to T.W.'s family and why T.W.
requires mechanical ventilation at this time?
• I would explain spinal shock to the patients family as the spinal cords response to the
inflammation caused by the injury. I would explain that it is a complete but temporary
loss of motor, sensory, reflex and autonomic function that usually last less than 48
hours but can continue for several weeks. I would also explain that the mechanical
ventilation provides breathing support until the lung function is restored.
6. List three critical potential infections that T.W. will be monitored for throughout
his hospitalization.
1. Respiratory Infection: due to the mechanical ventilation tube
2. Urinary Tract/ Bladder Infection: which can happen as a result of
the foley
3. Wound/ Pressure Ulcer Infection: can happen from the patient being
immobilized
Case Study Progress
T.W. was taken to surgery 48 hours after the accident for spinal stabilization. He spent 2
additional days in the SICU and 5 days in the neurology unit and now is ready to be
transferred to your rehabilitation unit. He continues to have no movement of his lower
.extremities
Rehabilitation teaching includes teaching T.W. how to manage his urinary drainage .7
?system (UDS). What would this teaching include
Page 2|7
: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
:Chart View
Physician’s Orders
· Insert Foley catheter
· ECG monitoring
· Immobilize the cervical spine
· Oxygen at 4 L 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.
• To implement this order I would first start by first immobilizing the cervical spine. This
is considered an emergency and is critical because improper movement can cause further
damage and loss of the neurological function. Next I would make sure the patient has his
O2 to help facilitate his breathing, I would make sure the patient is connected to the ECG
monitor next I would start the IV to have access to administer medications easily being
that the patient it immobilized. After that I would complete my neurological assessment
by assessing the patients motor and sensory function, testing the patient ability to squeeze
my hands, move fingers and toes and monitor for signs of autonomic dysreflexia. Next I
would insert foley catheter, bladder is atonic and can become over distended in spinal
shock. The bladder may become hyperirritable with reflex emptying after spinal shock
subsides, so this may require indwelling catheter. Lastly, I would apply the warming
blanket as needed to promote thermoregulation which can be impaired by the spinal
injury.
2. What other interventions might be done by the ED nurse?
• The ED nurse should continuously monitor the patients respiratory status which is the
first priority. Involuntary respirations can be affected due to a lesion. The nurse should
provide oxygen and suction as needed, and assist with coughing by applying abdominal
pressure when he patient is attempting to cough.
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 the goal is met the nurse should know how to properly handle a patient with a
spinal cord injury. The nurse should be aware that improper handling of the patient 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.
4. The physician orders the following for T.W.: IV methylprednisolone (Solu-Medrol),
Page 1|7
, bolus of 30 mg/kg over 15 minutes, followed by a maintenance infusion of 5.4
mg/kg body weight/hr. 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.?
• 2.2 pound = 1kg
• 176 pounds = x
• = 80kg
• 80 kg× 30 mg/kg = 2400mg
• The maintenance infusion will then be = 5.4 mg/kg× 80 kg
• = 432mg/hr
• Methylprednisolone is a glucocorticoid and it aids in decreasing edema of the spinal cord
which can cause spinal cord compression and areas of ischemia.
Case Study Progress
The diagnosis of the fracture is confirmed and T.W. is transferred from the ED to the SICU.
Although T.W.'s injury is at a level where independent respiratory function is expected, he
experiences low oxygen saturation levels and is placed on a mechanical ventilator. The
.physician states that this is due to spinal shock
5. How would you explain spinal shock to T.W.'s family and why T.W.
requires mechanical ventilation at this time?
• I would explain spinal shock to the patients family as the spinal cords response to the
inflammation caused by the injury. I would explain that it is a complete but temporary
loss of motor, sensory, reflex and autonomic function that usually last less than 48
hours but can continue for several weeks. I would also explain that the mechanical
ventilation provides breathing support until the lung function is restored.
6. List three critical potential infections that T.W. will be monitored for throughout
his hospitalization.
1. Respiratory Infection: due to the mechanical ventilation tube
2. Urinary Tract/ Bladder Infection: which can happen as a result of
the foley
3. Wound/ Pressure Ulcer Infection: can happen from the patient being
immobilized
Case Study Progress
T.W. was taken to surgery 48 hours after the accident for spinal stabilization. He spent 2
additional days in the SICU and 5 days in the neurology unit and now is ready to be
transferred to your rehabilitation unit. He continues to have no movement of his lower
.extremities
Rehabilitation teaching includes teaching T.W. how to manage his urinary drainage .7
?system (UDS). What would this teaching include
Page 2|7
