T.W. is a 22-year-old man who fell 50 feet from a chairlift while skiing and landed on hard-packed snow. He was found to have a T10-11 fracture with paraplegia. He was initially admitted to the SICU and placed on high-dose steriods for 24 hours. He was taken to surgery 48 hours postaccident for spinal stabilization. He spent 2 additional days in the SICU, 5 days on the neuro unit, and now is ready to be transferred to your rehab unit. He continues to have no movement of his lower extremities.
1. The goal of treatment in the acute phase of spinal cord injury (SCI) is to help T.W. survive the injury and maintain physiologic stability through the period of spinal shock. Once the acute phase is over, T.W. moves into the postacute and early rehab phases. What are the treatment goals for T.W. in these phases?
2. Considering a hierarchy of rehabilitative needs for patients like T.W., number the following from highest (1) to lowest (5) priority.
_____Community integration and employment
_____Accomplishment of self-care and ADLs
_____Self-actualization
_____Stabilization of the physiologic systems
_____Adjustment to living at home
3. T.W. receives high-dose steroid therapy every 24 hours; then he is placed on a smaller maintenance dose. What effect will steroids have on T.W.?
4. List three critical potential infections that T.W. should be monitored for throughout his hospitalization.
A person with an SCI at the T2-12 level should be independent in a wheelchair and able to manage ADLs, including bowel and bladder care.
5. T.W. is taking vitamin C 250 mg PO bid. What is the purpose of this?
You request a consultation with an RD because you realize that T.W. neeeds proteins for healing; however, too much can stress his kidneys. The RD will adjust his diet to ensure adequate amount of protein, carbohydrates, calcium, magnesium, and zinc.
6. Rehabilitation teaching includes teaching T.W. how to manage his urinary drainage system. What would this teaching include?
7. What is the usual amount of time for the return of reflex function of the bladder?
8. The large musculature has its own neural center that can directly respond to distention caused by fecal material. This is what allows most SCI patients to regain bowel control. What dietary instructions are important for T.W.?
9. T.W. should also be taught bowel training techniques. What would this teaching include?
10. What medications can assist with a bowel program?
11. Describe digital stimulation.
12. T.W. asks you whether hell ever be able to have sex again. What do you tell him, and what are some possible referrals?
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