Spinal Case Study 1 . Describe a plan for implementing these physician's orders. Plan for implementing these physician’s orders include basic safety need such as assessing airway, breathing and circulation. The first action is to ensure that the cervical spine is immobilized and then initiate oxygen. As the temperature is low, we need to give warm blankets. Insert a Foley catheter. 2. What other interventions might be done by the ED nurse? 1. Insert NGT 2. Having mechanical ventilation available 3. Providing psychosocial support 4. Skin care should be started early 5. Family support and education 3. Awareness of the prehospital management of an SCI is critical to each patient's ultimate neurologic outcome. What actions will the nurse take to ensure this goal is met? •Assessment and history taking. • Make certain each first responder's transport information is incorporated into the patient's chart. 4. The physician orders the following for T.W.: IV methylprednisolone (Solu-Medrol), bolus of 30 mg/kg over 15 minutes, followed by a maintenance infusion of 5.4 mg/kg body weight/ hr. T. W, weighs 176 pounds. How many milligrams of methylprednisolone (Solu- Medrol) will T.W. receive with the bolus? How many milligrams per hour will T.W. receive with the maintenance infusion? What effect will this medication have on TW. ? 176 pounds/2.2 = 80 kg  30 mg/kg = 2400 mg 5.4 mg/kg 80 kg, or 432 mg/hr. This medication will have effect like anti-inflammatory. High dose will result in decrease in inflammation suppressing his immune system. 5. How would you explain spinal shock to T, W.T s family and why T.W. requires mechanical ventilation at this time? Spinal shock is period of paralysis with complete loss of reflexes below the injury. It might last few days and during this time, the patient might need temporary respiratory support. The return of sacral reflexes indicates resolution.