Max, a 19-year-old male, suspected of spinal injury followin

Max, a 19-year-old male, suspected of spinal injury following a… Max, a 19-year-old male, suspected of spinal injury following a gunshot wound 1 hour ago. The gunshot injury occurred during a hunting accident when his best friend’s gun accidentally discharged. His injury is at the T5 level. AssessmentPatient is screaming out in pain and crying uncontrollably, states “I can’t feel my legs”. NKA, Height: 6 ft, Weight: 100 kg, IV: 20-gauge LFAVitals:• BP 160/100, HR 144, R 32 and labored• O2 Saturation: 88% on 15L NRB• EKG: Sinus Tachycardia with PVCsUpon arrival to the ER, Max was immediately intubated• Vent Settings: AC 12, VT 500, FiO2 80%, O2 Saturation 100%Current medications:• 0.9 NS running wide open• Propofol @ 50mcg/kg/min 1. What is clinically significant in the patient’s initial SBAR and why?  2. How should the nurse expect other body systems to be compromised given Max’s level of injury?  What orders would the RN suggest to the HCP and why? 3. What is the difference between and initial and secondary injury?  What interventions can be used to prevent a secondary injury?  2 Days LaterMax is weaned from the ventilator and extubated, he has progressed well and is now on 2L NC.Assessment:• A/O x3, patient is calm but he still states “I can’t feel my legs”• Decreased reflexes, loss of sensation, flaccid paralysis below level of injury• Gunshot wound to the mid back dressing changes BID• Foley in place, Urinary Output 50 ml/hrVitals:• Weight 95 kg• BP 110/33, HR 98, R 20 • O2 Saturation 95% on 2L NC• EKG: Normal Sinus Rhythm Current Medications:• 0.9%NS @ 50ml/hr• IV Antibiotics• Hydromorphone IVP PRN 4. What teaching would you provide to Max and his family about his progress?  Referring back to most recent assessment what referrals can you suggest for this patient at this time and why? 5. Describe the difference between spinal shock and neurogenic shock? 6. What is autonomic dysreflexia and why is this a concern for Max?  7. List interventions the nurse should use to prevent autonomic dysreflexia? 8. If Max develops autonomic dysreflexia what changes in his assessment would the RN anticipate seeing? What interventions should the RN use to manage this change in condition? 9. When managing a patient with a SCI, what is the significance of the level of injury when providing and planning care? 10.  Briefly explain the clinical significance of T5 SCI injury and how would other body systems be compromised with this level of injury? 11. After completing this case study, the 3 things I have learned are? 12. After completing this case study, I have identified 3 areas for improvement?  Health Science Science Nursing

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