NAME: ____________________________DATE: ________________Score:____________

WEEK 9: Case Scenario (FALL 2015) SCI (Adam)
Adam, a 22-year-old college student, was rock climbing when he fell 30 feet to the ground.  EMS found him in the supine position and he was unable to move any of his extremities.  He complained that he could not feel his arms and legs. 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 at the scene of the injury revealed a blood pressure of 111/65, heart rate of 86 beats per minute, respirations of 18 per minute.  A cervical collar was applied and he was placed on a back board, and transported by helicopter to the hospital with a suspected spinal cord injury (SCI).
Upon examination in the emergency department, his stretch reflexes in the upper and lower extremities were absent.  He said everything felt numb from his nipple line across and down his entire body.   He had some sensation in his arms, but could not localize touch.  He was able to raise his shoulders and tighten his biceps slightly in each arm.  He could not raise either arm against gravity. His lower extremities were flaccid and he was unable to move them. Vital signs were taken again and were as follows: blood pressure 94 / 56, heart rate 59, respiratory shallow 18/min. His oral temperature was 102.2 degrees F, and O2 sat of 93% on room air.   His color was dusky and his skin was warm and dry to the touch.
X-rays taken upon arrival revealed a fractured vertebra at C5. A chest X-ray showed a decreased lung expansion.  Blood tests were normal, with the exception of acidosis (blood pH 7.25). The neurosurgeon inserted tongs into his skull above the ears to hold his neck in a safe position.  Allen was transferred to intensive care and his condition was stabilized.
Content: Wagner and Hardin-Pierce (2014) Chapters: 18 and 19
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1.    Adam is suspected of having neurogenic shock. Explain the pathophysiology of neurogenic shock and how neurogenic shock is different from hypovolemic shock.  Which vital sign(s) correlate with this diagnosis? (1.25 point)

2.    Explain in detail what the rationale is for Adam having a fever and dry skin upon admission to the hospital. (0.5 points)

3.    Explain the use of skull tongs in the SCI patient. (0.5 points)
4.    What pulmonary complications are prevalent in the SCI patient?  Does Adam have any signs of pulmonary complications and if so, what are they? (1 point)

5.    Explain how to conduct a sensory assessment on Adam. (1 point)

6.    Explain the complication of thromboembolism in the SCI patient.  What clinical practice is recommended to reduce the risk of a DVT? (1.5 points)

7.    Adam is prescribed Lovenox 0.5mg/kg subcutaneous injection every 12 hours.  Explain the action, uses, major adverse effects, and nursing implications of Lovenox. (1 point)

8.     24 hours after Adam is hospitalized his manual blood pressure is 210/99 and the nurse is suspecting autonomic dysreflexia.  What is autonomic dysreflexia and what can trigger autonomic dysreflexia in the SCI patient? (1.25 points)

Reference