Spinal Cord Injury Case Study Mr.

Dexter, a 19-year-old college student, was rock climbing when he fell 30 feet to the ground. Paramedics arriving at the scene found him lying in the supine position, conscious, but having a difficult time breathing. The paramedics applied a cervical collar, placed him on a backboard, immobilized his head, and transported him to the trauma center by helicopter. His pupils were equal and reactive to light. He showed no other signs of injury except for several scrapes on his arms. His vital signs revealed a blood pressure of 110 / 72, heart rate of 82 beats per minute, respirations of 18 per minute being given a 100% on a nonrebreather mask. Upon examination at the hospital, Mr. Dexter was slightly able to raise his shoulders and had minimal sensation only around his shoulders. His extremities were flaccid, despite attempts to move them. Reflexes were not intact. He was awake and able to follow commands. Vital signs were taken again at the hospital and were as follows: blood pressure 94 / 55; heart rate 64; Spo2 was 98%; RR was 12. His oral temperature was 102.2 degrees F. No sedation medication was given until a CT scan was done. The CT scan showed no head injury or bleed. X-rays taken upon arrival revealed a fractured vertebra at a particular location. A chest X-ray showed a decreased lung expansion upon inhalation. After the CT scan and x-ray, his respirations became more shallow. His color was dusky and his skin was warm and dry to the touch. All his labs were normal except for a blood gas. pH was 7.20, pCO2 was 59, HCO3 was 24, pO2 was 54. The patient was immediately intubated and the neurosurgeons immobilized his neck by inserting tongs into the skull above the ears to hold his neck in a position so that no further injury could occur. Allen was transferred to intensive care and his condition was stabilized. A physical examination four days later revealed normal vital signs and no change in his arm strength or sensation, but also marked spasms and exaggerated stretch reflexes of the lower extremities. He also had urinary incontinence which required the placement of a Foley catheter connected to a urine collection bag. 1. Why did Mr Dexter's heart rate and blood pressure fall in this time of emergency (i.e. at a time when you'd expect just the opposite homeostatic responses)? In your own words, explain the pathophysiology of what is happening to Mr. Dexter. Include signs and symptoms.

2. What interventions would need to be done for hypotension?

3. Why do you think Mr. Dexter had a fever?

4. Upon admission to the hospital, Mr. Dexter's breathing was rapid and shallow. Can you explain why?

5. Based on his blood gas, what do you think the patient has?

6. What is the primary muscle of respiration? What nerve innervates this muscle?

7. Based upon the physical exam findings, which vertebral bone do you think was fractured? Give reasons for your answer.

8. By four days after the injury, some of Allen's signs and symptoms had changed. Allen's arm muscles were still flaccid, yet his leg muscles had become spastic and exhibited exaggerated stretch reflexes. Use your knowledge of motor neural pathways to explain these findings.

9. Mr. Dexters foley becomes kinked and his blood pressure shoots up to 165/91, has a bounding headache, profuse diaphoresis, blurred headache, and a HR of 55. Explain what is happening to the patient.

10. What should the nurse do in Mr. Dexters case?

11. After a week and half in the ICU, Mr. Dexter is able breath on his own without the ventilator. Mr. Dexter is able to lift his shoulders and elbows. There is no sensation below the clavicles but there is some sensation in the thumbs and arms. What problems does the nurse need to look out for?

12. After 2 weeks in the hospital, Mr. Dexter is transferred to a rehab facility. Create a care plan including a diagnosis with r/t and AEB for physical mobility. Including one long -term goal and at least 3 interventions. Make the goal related to the patients level of injury.

13. Create a care plan for a neurogenic bowel including a diagnosis with r/t and AEB. Including one long -term goal and at least 3 interventions.

14. Create a care plan for a neurogenic bladder including a diagnosis with r/t and AEB. Including one long -term goal and at least 3 interventions.

15. Create a care plan for coping including a diagnosis with r/t and AEB. Including one long -term goal and at least 3 interventions.