Lewis, et al: Medical-Surgical Nursing: Assessment and Management of
Clinical Problems, 6th Edition
Case Study Questions
Chapter 59: NURSING MANAGEMENT: Peripheral Nerve and Spinal
Cord Problems
Spinal Cord Injury
Patient Profile
Samuel D., a 25-year-old-man, is admitted to the emergency department with the
diagnosis of a cervical spinal cord injury. Samuel was swimming at a neighbor’s
backyard pool. He dove into the shallow end, striking his head on the bottom of the pool.
His friends noticed that he did not resurface. They rescued him and brought him to the
side of the pool. They maintained neck immobilization until the rescue crews arrived.
Subjective Data
 Is awake and alert
 Has complaints of neck pain
 Is anxious and asking why he cannot move his legs
 Is asking to see his family
Objective Data
Physical Examination
 Weak biceps movement
 No triceps movement
 Gross elbow movement present
 Decreased sensation from the shoulders down
 No bladder or bowel control
 BP 90/56; pulse: 56; respirations: 32 and labored
Diagnostic Studies
 X-rays revealed C5 fracture dislocation
Collaborative Care
 Placed in tongs and traction in the emergency department
 Started on methylprednisolone in the emergency department
 Admitted to ICU
Critical Thinking Questions
1. What nursing activities would be a priority on Samuel D.’s arrival in the ICU?
2. What physiologic problems are causing Samuel D. to have hypotension and
bradycardia?
3. What would the first line of treatment be for Samuel D.’s hypotension and
bradycardia?
4. What signs and symptoms would indicate respiratory distress and what physiologic
problem would cause respiratory distress in Samuel D.’s injury state?
5. What can the nurse do to decrease Samuel D.’s anxiety?
6. Based on the assessment data provided, write one or more nursing diagnoses. Are
there any collaborative problems?