Spinal Cord Injury Scenario


Read over the spinal cord injury scenario below and then use your PDA to find information about this condition so you can provide appropriate nursing care.

Spinal Cord Injury Scenario:

Joe Thompson is a 34 year old male with a spinal cord injury (SCI) that occurred 1 year ago in a waterskiing accident. The CSI is at the T-8 level. He was in the hospital for 2 months and then was transferred to a skilled nurisng facility for rehabilitation. He is currently depressed and has not wanted to get out of bed or participate in physical and occupational therapy for the last 2 weeks. He has a Stage I pressure ulcer on his right hip.

Health history: Healthy prior to accident.

Healthcare Provider's Orders:

Warfarin 7.5 mg PO every evening
Acetaminophen 650 mg PO every 4-6 hours prn mild pain
Regular diet
Physical and Occupatonal therapy for activities of daily living and job preparaton
Anti-embolism hose

In preparing for clinical, you are aware that a person with SCI at the T-8 would have some specific limitations in functionality. 

  • What potentially life-threatening complication is associated with acute SCI at the T-8 and above?  Go to RnDisease. Type in spinal and select Spinal cord injury. Select spinal cord injury again and then go to Planning and Implementation (Pl).  Scroll down to Independent and read over the information.
    • What are the precipating factors associated with this potentially life-threatening complication? Click on the link within the above paragraph.
    • What are the clinical manifestations associated with this potentially life-threatening complication? Click on the link within the above paragraph.
  • Go to  RnDisease and look for pressure ulcers/sore and answer the following questions. Make sure you are in the Main Index. Type in pressure and select Pressure ulcer. 
    • What are common sites for pressure ulcers to develop? Read the Introduction (I).
    • What are the different stages of pressure ulcers? How many stages are there?  What are the symptoms of each stage? Scroll down in the Introduction and click on Table 4 - Staging of Pressure Ulcers.
    • What symptoms would you expect in a stage I pressure ulcer? 
    • What is the primary nursing diagnosis related to pressure ulcers? Select Primary Nursing Diagnosis (PR).
    • What are two methods to prevent pressure ulcers from developing? Select Planning and Implementation (PI). Scroll down to Independent.
  • You are aware that spinal cord injury patients have impaired mobility. Look under RnDisease. Type deep and select Deep vein thrombosis. 
    • What is DVT? Click on Introduction (I). 
    • What are the causes of DVT? Click on Causes (CA).
    • How can DVT be prevented? Click on Planning and Implementation (Pl).
    • What are you doing for your patient to prevent DVT?
  • Now, look under RnDisease. Go to DRG Index and look for 271 under Medical: Skin Ulcers. What is the Mean Length of Stay (LOS) for this category if the patient were in an acute care setting?
  • What can you do to help your patient cope with his current situation?  Go to RnDxInt and select Nursing Diagnosis with the arrow at the top. Then type coping. Select Coping, Ineffective. Then select Actions Interventions (A). Read over the 5 Nursing Priorities.
  • Now, go to DrugGuide and look up Warfarin and identify the following: First go to Main Index or Generic Index. Type in and select Warfarin.
    • Why is this a high alert medication? Click on Implementation (Im).
    • Why would the patient be given this drug following spinal cord injury? Then select Indications (I).
    • What is the brand name for Warfarin? Click on the top arrow and then on US Brand Names.
    • What is the normal dose of Warfarin? Select Route/Dosage (Do).
    • Is your patient's dosage within the normal range?
    • Which laboratory test is used to monitor Warfarin? Select Route/Dosage (Do).
  • Now, go to DrugGuide and look up Acetamnophen and identify the following: First go to Main Index or Generic Index. Type in and select Acetaminophen. 
    • Why would the patient be given this drug following spinal cord injury? Then select Indications (I).
    • What is a common brand name for Acetaminophen? Click on the top arrow and then on US Brand Names.
    • What is the normal dose of Acetaminophen? Select Route/Dosage (Do).
    • Is your patient's dosage within the normal range?
    • What organ can be affected in overdose situations of Acetaminophen? Select Pharmacokinetics (Pk).