a case study on a patient with spinal fracture with complete nursing and medical interventions.

1. SPINAL CORD
INJURY
Presented by
saba yasin

2. Objectives
 By the end of the presentation students will be able to
 Define spinal injury.
 Discuss significance of the case study.
 Explain the pathophysiology of the disease.
 Discuss the sign and symptoms of the disease.
 Explain the causes and complications and diagnostic tests.

3. Conti……
 Explain the treatment and surgical procedure
 Discuss the pharmacological drugs
 Discuss the tests and lab reports
 Integrate researches with case study
 Discuss nursing care plan and patient teaching

4. Significance
 I chose this topic because it is very interesting case for me
 It is also included in over AHN syllabus.

5. Scenario
 Demographic data :
 A 50 years old male admitted to D3W1.
 Past medical history :
 Rhinoplasty 20 year back.
 Family history
 HTN
 Diabetes

6.  Present complain :
 He came hospital after motor vehicle accident .
 Medical diagnose:
 C5-C6 compression

7. Patient’s data
 Vital signs :
 BP:> 140/100mmHg
 TEMP:> 37 C
 PULSE:> 65 B/M
 RESP:> 20B/P
 GCS:> 15/15
 Pain :> 2/10

8. Spinal cord injury
 Spinal cord injury refers to any injury to the spinal cord that is caused by trauma
instead of disease.

9. Physiology

11. Causes
 Falls .
 Sports related injury.
 Motor vehicle crash.
 Violence related injury.

12. Sign and symptoms
 Depending on where spinal cord and nerve roots are damaged , the symptoms can
vary widely from pain to paralysis to incontinence.

13. Contin…..
1. Pain
 Maximum at time of trauma and surgery , but during my visit it was at 2(0-10) on pain
scale
2.Breathing problem
 Assessment :patient using his accessory muscles
 O2 saturation is 92%at rest and 86% at activity.
3.Little control on bowel and bladder
 Folley’s catheter was attached.
4.Paraplegic
 no sensation of both legs

15. Diagnostic test
 Physical assessment
 Neurological assessment
 CT scan
 Shows compression at the level of C5-C6.
 MRI

16. Chem 7

17. CBC

18. Surgical management
 Spinal traction
 Laminectomy

19. Complication
 CSF leakage.
 Infection .
 Quadriplegia .

20. Pharmacological management
 Alpha choline
 Decadrone
 Inj omnet
 Inj biocobal
 Atem saline nebs
 Tab florinif
 inj falgan
 Tromal
 Syp duphalac

21. Drug card

22. NCP
 Assessment :
 Neurological assessment
 Muscle strength grade
 Weaker grasping.
 Difficulty in writing.
 Overall right side weakness.
site Total grade Client’s grade
arms 5 4
legs 5 +1

23. Conti….
 Respiratory assessment.
 Vital signs.
 Skin assessment.

24. Altered breathing pattern , ineffective airway clearance r/t
diaphragm insult s/c cervical fracture
 Assessment
 Asses for cough , breathing pattern , use of accessory muscle.
 Monitor the O2 saturation and respiration rate.
 Nursing management
 Assist patient with O2 therapy.
 Perform suctioning if required.
 Nebulize the patient to humidify the secretions.
 Perform chest physiotherapy.

25. Impaired physical mobility r/t paraplegia s/c cervical fracture
 Assessment
 Asses the patient skin , both extremities , color , pulses for circulation.
 Asses the patient’s skin foe any breakdown and for muscle strength.
 Nursing management
 Position the client every 2 hourly.
 Avoid the patient’s foot drop.
 Avoid contracture and muscle atrophy.
 Perform passive ROM.

26. Imbalance nutrition less than body requirement r/t increase
metabolic demand s/c spinal trauma
 Assessment
 Monitor I/O and weight.
 Nursing management
 Encourage to eat soft diet.
 Give time to eat.

27. Impaired urinary elimination r/t decreased innervation of
bladder
 Assessment
 Monitor I/O and voiding pattern.
 Nursing management
 Intermittent catheterization.

28. Disturbed body image r/t paralysis and loss of control on body
function
 Nursing management
 Asses patient’s grieving status.
 Provide support to family and patient.

29. Interrupted family process r/t changes in roles with in family
because of neurological status.
 Nursing management
 Explain about the problem and possible prognosis.
 Involve the patient’s family in patient’s care.

30. CIM

31. Teaching
 Therapeutic exercise
 Isotonic (ROM)
1. Teach patient about the importance of ROM that it minimize muscle atrophy and
disuse syndrome.
2. Ask the patient to perform following ROM to increase muscle strength
a. move his weak arm with the help of strong arm.
b. Open or close bottle cap.
3.Teach the family member to perform passive ROM of legs to minimize the muscle
atrophy.

32.  Isometric exercise
 Teach patient to grip the pen , or finger.
 Therapeutic positioning
 Teach the patient to change the position for every 2-4 hours like side line ,supine
and sitting.
 Teach patient about the use of positioning aids like trochanter role.

33. TILT BED PHYSIOYHERAPY

34. Physical therapy

35. RESEARCH
ACCORDING TO THE SPINAL CURE CENTRE OF AURSTALIA
STATICS

36.  More than one injury of this type occurs every day in Australia
 Over 15,000 Australians live with a spinal cord injury
 The most likely age to have a spinal cord injury is just 19 years
 83% of sufferers are male.

37. Research 2
Journal of Nervous and Mental Disease 41: 141–147. by Allen A 1914
 Experiment performed on rats
 Forces of 2.3, 16.9 or 53.0 gms were applied at C7–T1 until decompression was
performed after 15, 60, 120, or 240 minutes of compression. Functional recovery
was assessed weekly for 8 weeks using the inclined plane technique.

38. IN THE CASE OF EMERGENCY

40. SUMMERIZATION

41. References
 Sandler A N, Tator C H 1976 Review of the effect of spinal cord trauma on the
vessels and blood flow in the spinal cord. Journal of Neurosurgery 45: 638–646
 Dohrmann J G, Wagner C F, Bucy C P 1972 Transitory traumatic paraplegia: electron
microscopy of early alterations in myelinated nerve fibres. Journal of Neurosurgery
 Burner&sudharth .medical and surgical nursing 7th edition.

42. THANK YOU