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Spinal Cord Injury Case Study (60 min)

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Mr. White is a 17 year old male who was injured in a snowboarding accident 3 weeks ago. He sustained a vertebral fracture and complete spinal cord injury at T7. His fracture has been stabilized with rods and screws.  The plan is for him to be discharged home in 3 days with home health and family care.

Critical Thinking Check
Bloom's Taxonomy: Comprehension

Considering the level of the spinal cord injury, do you anticipate any concern for respiratory weakness?

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Critical Thinking Check
Bloom's Taxonomy: Application

What are the possible complications of a spinal cord injury?

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The CNA reports to you that the bath has been completed, there was no BM or incontinence of urine. However, Mr. White’s blood pressure has risen to 189/100 with a heart rate of 56. You immediately go to the room to check on Mr. White.

Critical Thinking Check
Bloom's Taxonomy: Analysis

What could be going on with Mr. White?

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Critical Thinking Check
Bloom's Taxonomy: Application

What things should you assess in order to determine the problem?

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You note that Mr. White is warm to touch, his temp is 103.6°F. You palpate his abdomen, which is soft and nondistended throughout. His bladder is also nondistended. He tells you he’s starting to feel very anxious  You ask the CNA to help you turn Mr. White and you find a washcloth had been left under his back.

Critical Thinking Check
Bloom's Taxonomy: Analysis

What is going on with Mr. White, physiologically?

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Critical Thinking Check
Bloom's Taxonomy: Analysis

What medications might be ordered for Mr. White? What other nursing interventions should you include?

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Together with the CNA, you remove the cloth, straighten Mr. White’s sheets, and make him comfortable. You provide a cool cloth for his forehead, and place a small ice pack under each armpit. You administer Nitroglycerin 0.4 mg SL as ordered. In 5 minutes you recheck and his BP has come down to 142/90, and his HR is 70. He reports his anxiety is decreasing and his temperature has come down to 100.6°F.

Critical Thinking Check
Bloom's Taxonomy: Analysis

What would you discuss with the CNA to prevent this from recurring in the future?

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Critical Thinking Check
Bloom's Taxonomy: Application

What education will be required for Mr. White and his family on discharge to prevent complications?

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