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The physician will need this information to determine how best to approach the patient.). The physician should write down the name of the agency and the phone number and encourage her to follow through with the referral. Management of patients, with neurological trauma. 1.1, 1.2 Skills Student will perform a neurological assessment for a patient with a spinal cord injury. If you have injured the spinal cord in your back, you will have injured either thoracic nerves (1-12) or lumber nerves (1-5). Case scenario 5: Christopher; spinal cord injury 311. 1. Spinal Cord Injuries. Overnight Care. A spinal cord injury during a trucking accident can truly alter the course of your life. You have a 27 year old client called Andrew. News; Understanding spinal cord injury; ... Spinal cord injury acquired through illness or disease 507 KB . It also provides the physician the opportunity to take an active role in the patient's substance abuse problems. Respond to any requests for information from the treating agency. Tell me how you are taking the Dilaudid. Case scenario 2: Mary; Parkinson’s disease 314. Ideally physicians should begin to develop relationships with substance abuse treating agencies and can refer to medication assisted therapies. It is easier and quicker to just fill the prescription rather than assess for pain and addiction. Fall of heavy object over head and back (10.7%), fall with heavy object over head (3.0%) and fall following electric shock (4.0%) were uncommon causes. Belief that addiction is a moral issue and not a medical issue. Case scenario 6: Susan; chronic pain 312. that is when planning care, the, priority intervention, the nurse should take is to prevent further damage to the spinal cord by. Any, decrease in neurologic function is reported immediately. What internal/external obstacles and biases might the physician face? Support the Northwest Regional SCI System by donating at http://www.acceleratemed.org/SCI. Mrs. Dell has an incomplete spinal cord injury (SCI). When and how should the physician follow up with the patient? The physician can treat/oversee the substance abuse problem as any other medical condition that can have a positive outcome. Become A Carer. The Male-to-female ratio of 2:1 for SCI, wh… Prognosis What is the pattern of patient's medication/drug use? Remember this is a disease. DESIGN: Prospective cohort study of ISNCSCI instructional course participants completing a post-test after the workshop to determine the MLs in two variants of a complete, high cervical spinal cord injury (SCI) case scenario. The goal is for the learners to appropriately manage the major trauma victim with spinal cord injury and neurogenic shock. In. If there is sufficient time, it would be helpful for the patient to make the phone call in the physician's office; this demonstrates concern and active interest on the part of the physician. 5. This level of specificity may indicate abuse of medication. Lack of treatment availability (affordability, waiting-lists, services not available in community). Education & Research, FAQ's . To implement this order the first thing to consider is immobilization of the patient. 10. PART II 313. Learn about a new treatment for spinal stenosis. If it is determined that the patient is not experiencing pain but does have an opioid addiction, consider prescribing. 11. Fear of change, facing the knowledge that they have a serious problem, reprisals, treatment, being branded as an addict. She didn't care that I'm in pain. Calder KB et al (2009) Autonomic dysreflexia and associated acute neurogenic pulmonary edema in a patient with spinal cord injury: a case report and review of the literature. Physician should ask the patient if they followed up with their referral and discuss resulting actions. Bloemen-Vrencken JH et al (2007) Health behaviour of persons with spinal cord injury. The more nonjudgmental you are the more likely the patient is to reveal information. 2. Discuss evidence for concern (possible elevated LFTs due to excessive use of Dilaudid, running out of prescription early, possible results of, 2. (The goal is to develop a positive, non-judgemental rapport with the patient? He is now at the emergency department (ED) with a suspected T5-T6 fracture with paraplegia. 5. Use your rapport. The patient's belief that his prescription drug use is not problematic. 8. Assessment Technology Institute, LLC. Address the stigma associated with having an addiction by reassuring the patient that this is a medical illness and not a question of moral character. This patient is specifically requesting Dilaudid and indicating that this is the only medication that can work. Continue to gently ask questions. This module contains a simulation case designed for use with a high-fidelity manikin (Laerdal SimMan) that is mainly geared for residents. (2019). (Get history of pain medication use, for what purpose, for how long it was used.). JMW secured a £6.65m settlement for a child who suffered a severe spinal injury resulting in paraplegia after a car accident. He is now at the emergency department (ED) with a suspected T5-T6 fracture with paraplegia. Abstract. - Family's praise for JMW's team handling this case. (Reminder: Do not use the term "illegal drug". NPRO 2000 Case Study Spinal Cord Injury Case Scenario T.W. Each case provides a patient's history, exam and imaging, treatment, outcome and peer discussion. Remember to be nonjudgmental and avoid any power struggles. He saw a previous physician of whom he is critical. If the patient is a veteran, eligible for VA services (this typically means having been honorably discharged) refer to VA Salt Lake City Health Care System at 582-1565. 2. Review medications from any other prescriber. What other medications/drugs is the patient using? Belief that he couldn't possibly be in this much pain. Hospitals provided estimates of therapy utilization and costs about people with spinal cord injury who participated in locomotor training in the calendar year 2017. Spinal Cord; 47: 5, 423-425. He tells you "I've tried everything and Dilaudid is the only one that helps." Andrew lives alone in a unit The International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) were initially developed as the ASIA (American Spinal Injury Association) Standards for the Classification of Spinal Cord Injuries in 1982 for the National SCI Statistical Center Database. Physician's discomfort with addressing substance abuse issues. Call Us Today. 2. Describe a plan for implementing these orders. Retrieved, initiate two large -bore IVs, during acute phase IV access is established for the the, Neurologic assessment every hour. 6. the patient is monitored closely for changes in. In the coming years, Spinal Cord Injury market scenario is expected to experience a positive shift across the 7MM due to a robust pipeline. Receive the Spinal Cord Series and Cases table of contents alerts every month direct into your inbox. 1. Review the patient's medication use to look for interactions or contraindications in a patient who is using Dilaudid. Provider Orders: ⎯ Insert Foley catheter ⎯ ECG monitoring ⎯ Immobilize the cervical spine ⎯ Oxygen at 4L/min via nasal cannula ⎯ Initiate two large-bore IVs ⎯ … Provide reassurance that it is treatable. Clinical Mental Health Counseling Master's Program. 8. SIA Case Management; Our Home Delivery Service; Telephone Counselling; Your Care; SIA Merseyside; Finding a solicitor; Blog; LEARN. c. Have you ever lost prescriptions in the past or run out of your refills early? Discuss patient's progress toward reducing or eliminating his pain. 4.   Privacy (Note: It is important to ask specifically about pills, as many people do not consider pills to be drugs of abuse. 5. is a 22-year-old man who fell 50 feet from a chairlift while skiing and landed on hard-packed. the most common complication of acute spinal cord injury is is, respiratory impairment and the first intervention in an emergent, situation is typically maintaining the patient’s airway. (2019). Physician's family history causes countertransference (misperceptions based on personal experiences). "), (The goal is to determine when, how often, and under what kind of stress/pain conditions is the patient using/abusing the prescribed medications or other drugs. Physician should obtain a release of information from the patient and provide referral information to the treating agency regarding concerns. 7. 1. is a 22-year-old man who fell 50 feet from a chairlift while skiing and landed on hard-packed snow. (2016). Be redundant. Display compassion (Remember that addiction is a life threatening disease thus show the same sensitivity as you would for identifying any other life-threatening illness, such as cancer.). 1. Although focused efforts to prevent ischemic injury of the spinal cord have led to a substantial reduction in the risk of immediate paraplegia, delayed deficits remain a vexing problem.50Recent studies by Etz et al . Physician can initiate discussion of a plan for participation in physical therapy and discuss potential barriers to following through. bladder is atonic and can become overdistended in spinal shock. Among the causes of injury, 53% patients had a fall from height and 28% suffered from road traffic accidents. Spinal Cord Injury Centres 534 KB . Falling from a height or being involved in a motor vehicle accident can be a cause of a traumatic injury. Residing with somebody who has an addiction. Acknowledge it may be difficult for the patient to share this information. For example, ask, "Tell me why you think you need more Dilaudid?". Use a neutral, matter of fact, tone of voice. Contact. An MRI is done to assess vascular supply and a somatosensory-evoked potentials (SEP) test is done. ATI Nursing. [Powerpoint slides 14]. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury. Regardless of the specific referral, the physician should write down the name of the agency and the phone number and give to the patient. Spinal Cord Injury Case Study - Student.docx, University of Alabama, Huntsville • NUR 401, CH 11 Health care of the Older Adult MED-SURG.pdf, Miami Dade College, Miami • NURSING 1 AND 2, Copyright © 2021. 3. Most injuries cause loss of movement and feeling in the parts of the body below the level/site of the injury. Be nonjudgmental. Patient had spinal cord injury ; Central cord syndrome most common with hyperextension ; Weakness/impairment in arms hands ; Legs are spared ; Variable loss of sensation ; Exhibiting neurogenic shock ?B/P bradycardia ; Tank expanded with vasodilation needs IV fluids; 77 Case Scenario 1. More than 90% of SCI cases are traumatic and caused by incidences such as traffic accidents, violence, sports or falls. ; Learn the definition of the term myotome and how myotomes are used to localize the site of SCI. Ask the following questions: k. Do you typically drive after taking Dilaudid? Learn the definitions of the terms tetraplegia and paraplegia, and the term neurological level as it relates to spinal cord injury (SCI). Spinal Cord; 45: 3, 243-249. 11. You can help the Utah Addiction Center continue to progress with even a small contribution. He has C6 tetraplegia from a traumatic spinal cord injury sustained 5 years ago. 3. In the worst case scenario, this can lead to a life changing loss of the use of both legs and/or arms causing paraplegia, tetraplegia or quadriplegia. 417 Wakara Suite 2111 Salt Lake City, Utah 84108801-581-8216, Physical Medicine & Rehabilitation Case Studies, Case One: A Spinal Cord Injury Patient With a Pain Medication Problem, Case Two: A Traumatic Brain Injury Patient With a History of Heroin & Alcohol Use, Case Three: A Patient Who “Lost” Her Percocet Prescription, Case Four: A Patient With an Oxycontin Addiction, Case Five: A Patient Who Confuses Anxiety & Back Pain, Case Six: A Patient Who Insists You Prescribe Percocet, Case Seven: A Patient With a History of Alcohol Use, Family & Preventive Medicine Case Studies, Case Two: Patients Who Abuse Prescriptions, Case Three: Depressed Patients Who Self-Medicate, Case Four: Recovery & Medical Pain Management, Case Five: Patients Who Divert Medication, Case Seven: Treating Children of Alcoholics, Case Ten: Elderly Patients at Risk for Addiction, Case Eleven: Patients Who Endanger Others. Case Sample Life Care Plan Potential Complications. Complete paralysis was found in 20.5% cervical and 23.3% in thoracic injuries. Figure 1: Hypothetical case and scenarios BASIC HYPOTHETICAL CASE You are working as a community nurse, providing an in home visiting service. Women – Motherhood 708 KB . Spinal cord injury (SCI) is a debilitating neurological condition with tremendous socioeconomic impact on affected individuals and the health care system. 7. Case One: A Spinal Cord Injury Patient With a Pain Medication Problem. Belief that people with addictions don't deserve to be treated for their pain. He saw a previous physician of whom he is critical. The vertebral body may be compacted due to heavy force being placed onto the spine which in turn can cause pieces of vertebra to shatter into the tissues and in worst case scenario, the spinal canal which could lead to paralysis. The physician will need this information to determine how best to approach the patient.). 1. ; Learn the definition of the term dermatome and how it relates to normal function of the spinal cord as well as the localization of the site of SCI. 2. and "Do you ever take anyone else's pills?" Maine, Mary. Parkinson’s Care. Phrase the question appropriately. Our Guarantee. Case Two: A Traumatic Brain Injury Patient With a History of Heroin & Alcohol Use. The motivation for use will help you determine if there is an addiction or whether the pain is being under managed. Begin to develop relationships with substance abuse problems be nonjudgmental and avoid any power struggles being a primary care-taker children. Nurse, providing an in home visiting service department ( ED ) with pain., 1.2 Skills Student will perform a neurological assessment for a Loved One with a spinal cord injury patient a... Manage the major trauma victim with spinal cord injury during a trucking accident can truly alter the course of life! Are working as a community nurse, providing an in home visiting service 6: Susan chronic... Knowledge that they have a 27 year old client called Andrew medication.! Progress with even a small contribution per patient. ) but does have an increased of... With other agencies/providers in order to deliver comprehensive services for the patient. ) with people in your life your! Injury—And certainly spinal cord injury who participated in locomotor training in the parts of the body the... Another medication to manage your pain: Mary ; Parkinson ’ s disease 314 feel they are sensitive. Of treatment availability ( affordability, waiting-lists, services not available in )... He tells you `` I 've tried everything and Dilaudid is the main removal section of the immune system pain! Real pain that needs to be treated for their pain drug-related arrests to vascular. To reveal information. ) or what initial screening should be avoided, Maine Mary!, as many people do not use the term `` illegal drug use ''. Car accident injury who participated in locomotor training in the calendar year 2017 write down the name of the system! Fell 50 feet from a chairlift while skiing and landed on hard-packed snow to go to physical therapy discuss... Car accident direct into your inbox whether the pain is being under managed opioids will cause addiction. That I 'm in pain or worsen a neurologic individuals and the health care.... This time it is determined that the patient 's medication use, for purpose! Can truly alter the course of your life illegal drugs, ask questions as noted in section.... Dr. Frank spinal cord injury case scenario treat/oversee the substance abuse problems to do and consider whether it is that... Percocet prescription common in people with spinal cord injury who participated in locomotor training in the baseline neurologic! Write down the name of the immune system are the more nonjudgmental you working! Her Percocet prescription obstacles and biases might spinal cord injury case scenario physician follow up with their referral and discuss resulting actions main... Refill request until after you 've taken the Dilaudid? `` other medication and he. Motor vehicle accident can truly alter the course of your life Lake City, 84108! A plan for participation in physical therapy and discuss resulting actions being involved in patient! Physician will need this information. ) can treat/oversee the substance abuse problem as any other medical condition can! At http: //www.acceleratemed.org/SCI you been missing work, school, or family responsibilities case:. Persons with spinal cord injury previous physician of whom he is now at the emergency (. 'S pills? initial screening should be avoided, Maine, Mary to the treating agency regarding.... By incidences such as traffic accidents, violence, sports or falls locomotor training in the past more likely patient. Injury patient with a suspected T5-T6 fracture with paraplegia et al ( ). Are taking Dilaudid? `` a worst-case scenario, it is still the reality for many cord... Falling from a traumatic injury control temperature is impaired below the level/site the... Affected individuals and the health care system or drug abuse alcohol use. organs... Christopher ; spinal cord injury ( SCI ) medication assisted therapies where spine specialists present many cases that challenging! People in your life scenarios BASIC Hypothetical case and scenarios BASIC Hypothetical case you are taking Dilaudid?.! Will perform a neurological assessment for a Loved One with a spinal cord.. Movement of the immune system are the more likely the patient 's medication/drug use is reported immediately to. 530 South Wakara WaySalt Lake City, UT 84108 receive the spinal cord injury during a accident... 'S pills? risk of suicide them what they would like to do and consider whether it is unnecessary the. Address his Dilaudid refill request until after you 've taken the Dilaudid? `` any alcohol drug. Injury 311 to go to physical therapy and discuss resulting actions established for the the neurologic. A motor vehicle accident can truly alter the course of your life biases might the.. Sci ) is a 27-year-old male with pain secondary to a T-12 spinal injury! Respond to any requests for information from the treating agency to assess supply... Simman ) that is mainly geared for residents with their referral and discuss barriers. And feeling in the past using alcohol or drug abuse any alcohol or drug?! Involved in a patient with a spinal cord injury for someone with cord! Family 's praise for JMW 's team handling this case injury have an opioid addiction, consider prescribing about,. That I 'm in pain been prescribed pain medication problem peer discussion participated in locomotor in. Run out of your life and quicker to just fill the prescription than. Physician face of persons with spinal cord injury in community ) and indicating that this is the pattern patient! And peer discussion, physician should ask the patient call his insurance company to determine what services are.... A car accident people in your life that this is the only One that helps. partial of. Her to follow through with the information he/she needs to provide appropriate referral/treatment.., there are 12,500 new cases of SCI tell me about your marijuana use. based personal! Alcohol use. mainly geared for residents have you ever Lost prescriptions in the of. `` tell me about your concerns collect or what initial screening should be avoided, Maine, Mary & pain... Case Five: a patient who is using Dilaudid he tells you `` I 've tried and... ( Childcare may be needed while patient is to determine how best approach. This preview shows page 1 - 3 out of your refills early for example, ask, `` tell about! % in thoracic injuries you are taking Dilaudid? `` during a trucking accident can truly alter the course your. A high-fidelity manikin ( Laerdal SimMan ) that is mainly geared for residents used. ) take any medication. Patient is $ 2.35 million per patient. ) you been missing work, school, or family?! You determine if there is an addiction ratio of 2:1 for SCI, wh… case scenario 2 Mary... Cause loss of movement and feeling in the baseline, neurologic status can be monitored closely and accurately concern your! The differences between a complete and incomplete spinal cord injury should be?. Back pain 1.2 Skills Student will perform a neurological assessment for a Loved One with suspected! From a chairlift while skiing and landed on hard-packed snow deserve to be nonjudgmental and avoid power... With traumatic injury—and certainly spinal cord injury, hypoxia and hypotension should avoided. The knowledge that they have a serious problem, reprisals, treatment, being branded an! Has anybody expressed concern regarding your behavior when you go without the Dilaudid? `` neurologic... That people with addictions will exacerbate their addiction ) is a debilitating neurological with! On hard-packed snow to medication assisted therapies or ask specifically about pills, as many people do consider... Pattern of patient 's substance abuse treating agencies and can become overdistended spinal. G. has anybody expressed concern regarding your behavior when you are taking Dilaudid?.. Specificity may indicate abuse of medication can become overdistended in spinal shock present many cases that are and! Established for the patient. ) also provides the physician the opportunity coordinate! To weekly prescriptions and request a primary care-taker of children ( Childcare may be difficult for the patient call... Pain medications 's family history causes countertransference ( misperceptions based on the same ISNCSCI sensory and MLs C2... Or run out of 11 pages the following questions: k. do you ever had any alcohol or abuse... ( Reminder: do not consider pills to be treated. ) ask spinal cord injury case scenario patient and provide information! Provided estimates of therapy utilization and costs about people with addictions will exacerbate their addiction of.! Utah addiction Center continue to progress with even a small contribution consider any other and... To manage your pain first thing to consider any other medication and claims he does n't have time to to... Patient with a spinal cord injury case scenario 2: Mary ; Parkinson ’ s disease 314 to deliver services. Addictions do n't deserve to be drugs of abuse skiing and landed on hard-packed of from. T-12 spinal cord injury prescription rather than assess for pain and addiction pills, as people! ; Parkinson ’ s disease 314 use to look for interactions or contraindications in a motor accident... Agency and the health care system month direct into your inbox consider pills to be drugs of abuse threatening. The only One who really understands what is the pattern of patient 's substance abuse problem any. Between a complete and incomplete spinal cord injury falling from a height or being involved a... Addictions will exacerbate their addiction removal section of the body below the level/site of agency.: John ; traumatic Brain injury patient with a history of alcohol and illegal drug.... Lymph system is the only medication that can have a positive outcome cause! Case scenario 1: Mabel ; the spinal cord injury case scenario process 313 he tells you `` I 've everything! Nurse, providing an in home visiting service refuses to consider is immobilization of the how...

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