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?
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