Question

PART 1 MEDICAL SURGER FASE STUDY PROGRESS als of the fracture is confirm CASE STUDY SICUT.W. s taken to s SICU and 5 days in the neurot med and Twistered to voery 48 hours after the accident to in the neurology unit and now is in the extremities. Shortly after the trade, ou walk into the room, you immedia onal days in Sic t he ve paralysis of his lower dication for headache. A he is profusely sweating t complication do you suspect T.W.is, suspect T.W.is experiencing and why? 9. What complicat what further assessment data do you need to colle 10. What further asses 6 Neurologic Disorders What could happen if autonomic dysreflexia (AD) is left untreated 12. What interventions do you need to perform for T.W.? 13. After your prompt intervention, T.W's AD resolves and you need to document what happened. Write an example of a documentation entry describing this event on care includes teaching T.W. how to manage his continuous urinary 14. Part of rehabilitation care includes teaching 1.W. drainage system (UDS). What would this teaching inciu

Answer 1

Spinal stabilisation

Spinal stabilisation is a surgical procedure to stabilize the spine and to restore the integrity of vertebral column to prevent further injuries to spinal cord and other nerves.

9. Complication : Autonomic Dysreflexia

Autonomic Dysreflexia is one of the major complication of Spinal cord injury and surgeries related to spine. It is an Autonomic nervous system condition characterised by sudden onset of high blood pressure and it usually found in the patients with spinal cord injury especially injury at or above T6 level( 6th thoracic vertebrae).

Autonomic Dysreflexia in spinal cord injury patients may happen due to various reasons such as bowel or bladder distention, urinary infection or pain. Due to any of these afferent stimuli( pain, bladder distention) sympathetic preganglionic neurons get activated. This activation results in high blood pressure due to vasoconstriction below the level of Spinal injury. This inturn results in the activation of Parasympayhetic system for vasodialation. but the the will be unable to transmit the Parasympayhetic signal below the injury, resulting in vasodialation above the affected part. As a result patient may suffer with headache, flushing of the face, profuse sweating, nasal stiffness etc.

10. Assessment

* Monitor vital signs

* Assess for the signs and symptoms of Autonomic Dysreflexia

* Assess for the cause/ locate the cause( triggers / noxious stimuli below the injury such as bowel or bladder distention, blocked catheter.

* Assess the severity of head ache

* Check the patency of urinary catheter

* Check the motor function and reflexes

11. If Autonomic Dysreflexia left untreated, the condition may become lethal. It may leads to cerebral or myocardial infarction, seizures , cerebral haemorrhage and death.

12. Interventions

* provide a sitting position to the patient/ elevate the head end of the bed to 90 degree.

* loosen tight clothings, abdominal binders, if there.

* Check and remove the cause or noxious stimuli ( bowel or bladder distention, stimulations or pressure on the skin , pain on abdomen, blocked catheters)

* Catheterize the patients ( if the patient is not in catheter)

* If any Bed sore present, anesthetize the are with topical spray.

* Administer anti hypertensive drugs according to the physician's order.

14. Patient teaching

* Instruct the patient drink plenty amount of fluids ( if it is not contraindicated)

* Ensure that catheter is in position , if any pain or discomfort related to position or feeling of displaced catheter, inform the care givers or nurses

* The drainage bag should be attached with the bed frame and to be kept below the bladder level. The drainage bag should never touch on the floor.

* When ever the drainage bag fills ( above 400 ml)empty it to prevent tension on catheter