Question

John Lopez, 36 years old, was a passenger in a car that was rear-ended while stopped at a red light. The vehicle that hit the car was traveling 40 mph on impact. Mr. Lopez was not wearing a seatbelt. Mr. Lopez's wife, who was driving the car and wearing a seatbelt, was not injured.

Mr. Lopez was taken to the Emergency Department (ED) of your facility where he was intubated and stabilized. Three-view spinal x-rays (anteroposterior, lateral, and odontoid views) and computed tomography (CT) scan revealed a C4-C5 spine fracture with displacement and spinal cord compression.

Skeletal traction with weights was applied with cervical tongs to reduce the fracture and realign the spine.

Answer the following questions:

1. Why do you think that Mr. Lopez was intubated and put on a ventilator?

2. What complications is Mr. Lopez at risk for in the first week after his injury? How can the nurse mitigate those risks?

3. What is autonomic dysreflexia? How can the nurse prevent it and/or treat it?

Answer 1

Mr.Lopez CT scan results shows he is having C4-C5 spine fracture and spinal cord compression. High cervical lesions between C2-C4 or cervical lesions below C5 are commonly causes the paralysis, weakness or spasticity of the muscles used for respiration. So to avoid respiratory complications the cervical injury patient must be electively intubated and put on mechanical ventilator.

The main complications of cervical spine fracture include

Loss of consciousness, swelling,paraplegia,quadriplegia, spinal or neurogenic shock,

Autonomic disreflexia is a condition occures after spinal cord injury especially above the T6 level. The patient with cervical spine or high thoracic spinal cord injury are more susceptible to get this condition. There will be pounding headache,nasal stiffness, nausea, sweating above the spinal cord injury, bradycardia with autonomic disreflexia. It may also lead to cerebral infarction, intracranial hemorrhage, seizures and even death.

Nursing interventions of autonomic disreflexia include:

Proper nursing assessment of the patient condition including sensory , motor and reflexes.

Monitor complaints of pain and if any abnormal sensation.

Immediately elevate the head to 90degree.

Keep the leg in a dependent position as possible to reduce blood pressure.

Loosen the tight clothing, abdominal binders etc.

Interventions to reduce urinary bladder distension and fecal impaction.

Monitor blood pressure every 2-3 minutes, and vital signs every five minutes.

Administer medication to lower blood pressure.

Patient or family teaching to prevent autonomic disreflexia and to prevent tissue injury.