Examine daniels peripheral perfusion

Reference no: EM133343145

Assignment:

SCENARIO QUESTION

It is the start of your 12-hour shift. You are assigned to the following patient.

Daniel R. is a 25-year-old male injured in a diving accident 3 days ago. He dove into a sand bar at a remote river; alcohol was positive in the trauma toxicology screen, negative for other substances. He was diagnosed with a C4 burst fracture and a C4 ASIA-A injury. His initial CT of the head was negative for any bleed. He had a posterior spinal fusion from C3 to C5 on the day of injury and is immobilized in a cervical collar. He has remained in sinus rhythm. Over the last 24 hours his forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) have been steadily decreasing. Last night his SpO2 dropped to 82% and would only maintain at 90% with high concentrations of oxygen via a reservoir nasal cannula. Trauma anesthesia was called, and Daniel was endotracheally intubated with a fiber optic scope. He has remained in normal sinus rhythm overnight with pulse oximetry remaining at or above 98%. You are assigned to him and are completing your assessments, as follows:

Vital signs: Temp 99.8°F, HR 60/min, BP 100/72, with SpO2of 98%.

Pulmonary assessment: Breath sounds are diminished in the bases R > L with coarse rhonchi.

Abdominal assessment: Bowel sounds are diminished and abdomen is palpable but slightly distended.

Peripheral perfusion assessment: Lower leg pulses are strong bilaterally; no redness, warmth, or swelling noted. No compression devices are present.

Skin assessment: A purple discolored area is noted on the coccyx.

Answer the following questions:

1. Examine Daniel's peripheral perfusion and skin assessments. What orders (medical and nursing) should be considered based on these finding?

2. Based on Daniel's presentation, what mechanism of injury is likely to be associated with his SCI and what other associated injuries are likely to be present?

3. It has now been 48 hours since the injury. What are the priorities of caring for him now?

4. Describe interventions that Daniel will likely require to minimize complications of prolonged immobilization.

Clinical Update: It is now 1-month post-SCI, and he now exhibits reflex activity. He calls you to his room and is complaining of a severe headache. You note flushing and decide to take his BP. It is 180/95. Normally his BP is around 112/68. His pulse is 60. You remember that he no longer has an indwelling urinary catheter; it was removed yesterday for bladder training.

5. What is occurring and what should you do about it?

Reference no: EM133343145

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