Case Study
Spinal Cord Injury
Patient Profile: Acute Phase Sal Diaz, a 24-year-old man, is admied to the emergency department with the diagnosis of a cervical SCI. Mr. Diaz was swimming at a neighbour's backyard pool. He dove into the shallow end, striking his head on the boom of the pool. His friends noticed that he did not resurface. They rescued him and brought him to the side of the pool. They maintained neck immobilization until the rescue crews arrived.
Subjective Data
• Is awake and alert
• Has complaints of neck pain
• Is anxious and asking why he cannot move his legs and has weak arms
• Is asking to see his family
Objective Data
Physical Examination
• Weak biceps movement bilaterally
• No triceps movement bilaterally
• Gross elbow movement present bilaterally
• No movement bilaterally in lower extremities
• Decreased sensation from the shoulders down
• Loss of anal sphincter contraction
• BP: 85/50 mm Hg; pulse: 56; respirations: 32 and laboured
Diagnostic Studies
• CT of cervical spine shows subluxation and compression fracture at C5–6
• MRI of cervical spine shows a severe spinal cord compression at C5–6
Collaborative Care
• Intubated in the emergency department
• Started on mechanical ventilation
• Placed in halo traction on arrival in the ICU
• Further went on to have surgical decompression and stabilization
Discussion Questions: Acute Phase
1. Priority decision: What nursing activities would be a priority on Mr. Diaz's arrival in the ICU?
2. What physiological problems are causing Mr. Diaz to have hypotension and bradycardia?
3. What would the first line of treatment be for Mr. Diaz's hypotension and bradycardia?
4. What signs and symptoms would indicate respiratory distress, and what physiological problem would cause respiratory distress in Mr. Diaz's injury state?
5. What can the nurse do to decrease Mr. Diaz's anxiety?
6. Priority decision: Based on the assessment data provided, what are the priority nursing diagnoses or problem statements? Are there any collaborative problems?
Patient Profile: Rehabilitation Phase
One month after the injury, Mr. Diaz is at a local inpatient SCI rehabilitation facility. He has since been extubated and uses a wheelchair to mobilize. He eats three meals a day with assistance and is on a strict bowel and bladder program.
Subjective Data
• Awake and alert but anxious
• Complaining of severe headache, blurred vision, and nausea
Objective Data
Physical Examination
• Flushed and diaphoretic above the level of injury
• No bowel movement for 2 days
• BP: 180/90 mm Hg; pulse: 32 beats/min; respirations: 30 breaths/min and laboured
Discussion Questions: Rehabilitation Phase
1. Priority decision: What initial priority nursing interventions would be appropriate?
2. What physiological problem is causing Mr. Diaz's hypertension and bradycardia?
3. Once the physician has been notified, what other interventions would be appropriate?
4. Priority decision: Based on the assessment data provided, what are the priority nursing diagnoses?
5. Evidence-informed practice: Mr. Diaz and his family are concerned about the risk for autonomic dysreflexia. What effective strategies to prevent autonomic dysreflexia could the nurse discuss with the patient and family?