2804NRS Case Study: Spinal Cord Compression and Nursing Care

This case study assignment analyzes a patient with a spinal cord compression resulting from a fracture at the T5-T6 level. It explores the patient's risk factors, including age and gender, and details the subsequent pathophysiological changes, such as ischemia, hypoxia, and edema. The assignment emphasizes the importance of nursing interventions, including managing hypertension, pain, and respiratory distress, as well as providing cardiovascular and bowel care. It also highlights the critical aspects of spinal care, such as bracing and monitoring for sensorimotor deficits. The study references relevant literature to support the nursing interventions and diagnostic investigations, such as X-rays and CT scans. Overall, the assignment demonstrates the student's understanding of clinical reasoning and the application of evidence-based practices in nursing care for patients with spinal cord injuries.

Running head: NURSING
NURSING
Name of Student
Name of University
Author note

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Patient risk factors
Aetiology
Impaired blood circulation
Ischemia – due to vasoconstriction
Hypoxia – due to ischemic changes
Demyelination
Hypertension
No
sensation in
umbilicus
Hyperreflexia
Upper back pain –
tenderness of T5-
T6
Pins and needles
sensation in both
limbs
Oedema – due to immune system cellular infiltration
Axonal damage
Gliosis
Necrosis
Release of chemokines and cytokines
No bowel
movement
Autonomic dysreflexia
Nursing interventions
X-ray
AGE GENDER
FALL FRACTURE Spinal cord
compression
Prostaglandin release
Pain management
Respiratory care
Cardiovascular care
Bowel care
Spinal care
Normalize blood pressure
Pathophysiology
CT scan
Investigations

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Response to question 1
The risk factors in the patient include age and gender. As she is an elderly woman of
65 years old, she is more at the risk of developing pressure problems, sympathetic
disturbances and she is more prone to the fall risks as well. Being female, she has reached
menopause that increases the chances of osteoporosis even more that lead to more chances of
developing fractures after fall injuries or other form of physical traumas.
Response to question 2
The subject had a fracture at the T5-T6 level that resulted in a spinal cord injury.
Following the spinal cord injury there are a series of pathophysiological changes that follows.
It is to be critically noted that the primary trauma causes primary injury that in turn leads to
the secondary injury. The primary trauma causes axon shearing and the Wallerian
degeneration. The primary changes in the primary trauma include passage of blood from the
raptured vessels to the subdural, extradural and subarachnoid space, cell necrosis and
apoptosis, release of prostaglandins, arachadonic acid and alarmin which causes the
secondary damage. Impaired blood circulation leads to ischemia, hypoxia and extravasation
of the leukocytes are the secondary changes. Edema formation, demyelination, axonal
damage and gliosis follow. The release of prostaglandins caused pain in the patient.
Hypertension and Hyperreflexia is caused by autonomic dysreflexia which is asymptom after
spinal cord injury. Sensory deficits and numbness in the patient were caused by neurological
disruption at the spinal cord level.

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Response to question 3
Firstly Hypertension is huge problem in the patient and this can led to various
complications and threats such as cerebrovascular accidents (CVA) – the hypotension
management should be started by the attending nurse. The right pharmacological
management by administering the antihypertensives is important. Proper positioning of the
patients by keeping the head level above the body is important. Stabilization of blood
pressure is a very critical nursing intervention.
Secondly, pain management is vital. The pharmacological management by the
administration of analgesics in conjunction with proper positioning of the patient is
important. In collaboration with a physical therapist, exercise therapy and electrotherapeutic
modalities can be used by nurse in order to manage the pain presentation properly. Using
visual imagery, guided imagery, progressive muscle relaxation exercises and massage therapy
– the pain relief can be bought.
Thirdly, respiratory care is critical for the patient. In cases of any respiratory distress
arising from autonomic dysreflexia, breathing exercises can be started immediately by the
nurse and overall relaxation should be promoted to normalize the cardiorespiratory rhythm.
In cases of severity and considering the age of the patient to be elderly –ventilation and
oxygen therapy should be started by the nurse in emergency situations (Barclay et al. 2019).
The respiratory rate should be continuously monitored by the nurse and the oxygen saturation
should be closely observed.
Fourthly, cardiovascular care is a very important nursing intervention as the subject
has autonomic dysreflexia due to spinal shock, following the spinal cord injury. Monitoring
of the vital signs such as heart rate, respiratory rate regularly, maintaining hydration (to
balance sweating and maintain body temperature) are important aspect of nursing care. In

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case the bradycardia is not managed, the nurse can use cardiac pacing. Warming the subject
with warm clothes if there is temperature dysregulation leading to hypothermia – is
important, as a nursing intervention (Wicks & McDonald 2018).
Fifthly, bowel care is importantly as the subject is a reported case of bowel
dysfunction. Maintaining fluid intake would metabolically promote bowel movement.
Performing abdominal and gluteal exercises in the patient will promote peristalsis and help in
bowel movement (Squair et al. 2017). Proper positioning of the patient, balancing the proper
nutritional intake in collaboration with a nutritionist will help the care process properly. The
urine flow and the urine frequency should also be checked in order to understand if there is a
dysfunction with the bladder as well. Any signs of incontinence, bowel or bladder should be
immediately checked by the nurse.
Spinal care is the most critical aspect of this planned nursing care as the subject has
suffered from a spinal cord injury. Bracing the spine properly to prevent any further
movement that might cause dislocation and aggravation of the symptoms – is a crucial
nursing intervention (McGrath et al. 2019). Using the right and the appropriate orthotic
devices, in collaboration with the physical therapist, to prevent any further movement to the
spine and to maintain the stability of the vertebral column in the immobilization phase is a
critical nursing intervention. Bracing would also protect the spine from further injury.
Checking for the sensorimotor deficits is important and any pressure to the neurovascular
structure should be released.
For assessing the bony impingements better and to understand the body structures, X-
ray would be an important investigation and for studying the integrity plus condition of soft
tissue, which in this case is spinal cord, MRI and CT-scan would be requested.

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References
Barclay, L., Lalor, A., Migliorini, C., & Robins, L. (2019). A comparative examination of
models of service delivery intended to support community integration in the
immediate period following inpatient rehabilitation for spinal cord injury. Spinal
Cord, 1-9. https://doi.org/10.1038/s41393-019-0394-x
McGrath, R., Hall, O., Peterson, M., DeVivo, M., Heinemann, A., & Kalpakjian, C. (2019).
The association between the etiology of a spinal cord injury and time to mortality in
the United States: A 44-year investigation. The journal of spinal cord medicine, 42(4),
444-452. https://doi.org/10.1080/10790268.2018.1505311
Morgan, S. (2020). Recognition and management of autonomic dysreflexia in patients with a
spinal cord injury. Emergency Nurse, 28(1). https://journals.rcni.com/emergency-
nurse/evidence-and-practice/recognition-and-management-of-autonomic-dysreflexia-
in-patients-with-a-spinal-cord-injury-en.2019.e1978/abs
Squair, J. W., West, C. R., Popok, D., Assinck, P., Liu, J., Tetzlaff, W., & Krassioukov, A. V.
(2017). High thoracic contusion model for the investigation of cardiovascular function
after spinal cord injury. Journal of neurotrauma, 34(3), 671-684.
https://doi.org/10.1089/neu.2016.4518
Wicks, K., & McDonald, T. T. (2018). Catheter-associated problems among people with
spinal cord injury or multiple sclerosis: A narrative review. Journal of the
Australasian Rehabilitation Nurses Association, 21(3), 15.
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