WEEK 8: Case Scenario (SPRING 2015), Mrs. Dell
Mrs. Dell is a 44-year-old female that was injured in a head on motor vehicle crash and is unable to move or feel her extremities at the scene. EMS places a neck collar and uses a backboard to move her from the scene to the emergency department of the hospital. Cervical spine x-rays and CT scan revealed an unstable spinal injury and fracture at the level C4-C5. Gardner-Wells tongs are inserted and traction is applied. She is admitted to ICU.
Blood Pressure Temperature Pulse SpO2 Respirations
Left Arm 98.8 F
Apically 100% 22/min
Past Medical History: Diabetes Type II for 10 years and HTN
Past Surgical History: None
Current Medications: Glyburide and Lopressor
Mrs. Dell develops respiratory distress, is intubated, and placed on a mechanical ventilator. The nurses are performing serial neurological exams on an hourly basis.
Content: Wagner and Hardin-Pierce (2014): Chapters 18 and 19
1. Based on Mrs. Dell?s presentation, what mechanism of injury did she sustain at the scene of the accident that is likely to be associated with her SCI? Is the spinal cord injury considered unstable? Explain your answer. (0.75 point)
2. Discuss the rationale behind these two interventions for Mrs. Dell: Intubation and Gardner-Wells tongs with specifications regarding traction. (1.25 points)
3. The physician orders an anti-inflammatory for Mrs. Dell. Name the likely anti-inflammatory, its action and uses, major adverse effects, and nursing implications for the drug. (0.5 point)
4. Identify and explain the series of three events (pathophysiologic processes) within the spinal cord that occur within the first 24 hours post injury and contribute to secondary spinal cord injuries.(1.25 point)
5. The nurses are performing serial neurological exams on an hourly basis. Discuss what motor and sensory assessments should be included in these neurological exams for a patient with spinal cord injury. (1 point)
Scenario continued: The next day, the neurosurgeon tells Mrs. Dell and her family that she presently has spinal shock and the exact extent of the injuries cannot be known until the condition resolves.
6. Explain the concept of spinal shock. (0.5 point)
Scenario continued: Spinal shock resolves. An MRI is done to assess vascular supply and a somatosensory-evoked potentials (SEP) test is done. SEP results indicate that SEPs are present during the test. Mrs. Dell has an incomplete spinal cord injury (SCI).
7. In detail, explain the differences between a complete and incomplete spinal cord injury. (1.25 point)
8. With a spinal cord injury at or above the T6 level, Mrs. Dell could experience autonomic dysreflexia. Explain this condition including pathophysiology, symptoms, common causes, and nursing priorities. (1.5 points)