Adult II Exam 3 Case Studies

Glasgow Coma Scale
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Mannitol (Osmitrol)expands plasma and increases cerebral blood flow while osmotic diuresis decreases ICPSpinal cord injury interventions-X-rays of the spine -Spinal CT scan and/or MRI -Administration of atropine -Administration of vasopressors such as dopamine -Insertion of NG tube to suction -Insertion of an indwelling catheter -Initiate 2nd IV site w/ large-bore catheter -Administer oxygen -Cardiac monitoringSpinal shock-decreased reflexes below the level of the injury -loss of sensation -flaccid paralysis -lasts for days to monthsNeurogenic shock-hypotension -warm -dry skin -bradycardia (due to loss of function of part of sympathetic nervous system)Necrotic destruction of the spinal cord-hemorrhage -vasospasm -norepinephrine, serotonin, and dopamine -edema -hypoxiaC8 injuryloss of grip strengthNeurogenic shock: Kinetic treatment bed-inspect skin over all areas at least q2h -assess the patient's ability to count to 10 aloud without taking a breath -notify the physician if PaO2 is less than 60 mm Hg and if PaCO2 is greater than 45 mm Hg -Use compression gradient stockings or pneumatic compression devices on calves -auscultate bowel sounds at least q4h and monitor for abdominal distention -maintain accurate intake and output records -provide stimulation of vision, smell, and hearing to compensate for sensory deprivationCervical laminectomy complications-UTI -pneumonia -DVT -pressure ulcers -paralytic ileusAutonomic dysreflexiasympathetic nervous system response to sensory stimulation resulting in marked hypertension (symptoms include headache and blurred vision)Autonomic dysreflexia interventions-take blood pressure and pulse -elevate head of bed -check the bladder for distention -catheterize the bladder