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Original Question

Please I need help with this case Study assignment: Spinal Cord Injury Patient Profile M.P., a 19-year-old African American male, has a spinal cord injury following a gunshot wound 2 weeks ago. The gunshot injury occurred during a hunting accident when his best friend’s gun accidentally discharged. His injury is at the T5 level. The goal is to prepare him for transfer to a rehabilitation unit in the next few days. Subjective Data Has just completed his first year of college as an engineering student States he is depressed and “he cannot get used to the idea of not walking again” Objective Data Physical Examination Supine blood pressure 120/68, sitting blood pressure 114/62, pulse 68, temperature 99.8° F, respirations 16 Slight edema bilateral lower extremities – ace wraps wrapped around lower extremities Abdominal binder in place Urinary catheter intact and draining dark yellow urine Last bowel movement 2 days ago; it was hard, small and brown Full head, neck, shoulder and upper extremity movement with normal muscle strength and sensation Complete paralysis of lower body and legs with no sensation present Full passive range of motion without crepitation in the bilateral lower extremities Diagnostic Studies Spinal series x-rays: Complete transsection at T5 MRI: Confirmed transection and revealed no clots or masses present Laboratory results: White blood cells: 9500/µL Hemoglobin: 16 g/dL Hematocrit: 45% Discussion Questions List some mechanisms of injury related to spinal cord injury. Name the level of injuries and what clinical manifestations present based on the level of injury. Name the degree of injuries. Name the five syndromes associated with incomplete injuries. What diagnostic studies can be done to diagnose the location and degree of injury? Based on the assessment data, what are the nursing priorities for M.P.at this time? What actions do you need to take based on these priorities? What is the rationale for the lower extremity elastic compression stockings and abdominal binder? Case Study Progress M.P. did not have any signs of autonomic dysreflexia. He had a large bowel movement after receiving a PRN suppository. Antibiotic therapy was initiated after results of a urinalysis with culture and sensitivity indicated a urinary tract infection. After 3 days of medication and fluid therapy, he is being transferred to the rehabilitation unit. What are M. P.’s priority nursing diagnoses while in rehabilitation? Because of the complexity of M.P.’s care, you are coordinating care among many members of the health care team. Who might be participating in M.P.’s rehabilitation? What are potential causes for autonomic dysreflexia? What are priority interventions for autonomic dysreflexia? List three potential adverse conditions to continue to monitor M.P. for throughout his stay. Rehabilitation care includes initiating a bowel retraining program. Outline the components of a program for M.P. List 3 physical rehabilitation goals that M.P. can achieve. Parkinson’s Disease Case Study 67-year-old M.J. presents to clinic with a tremor in his hands that is interfering with writing. He also complains of muscle aches and excessive drooling saliva that he cannot swallow. He doesn’t remember when all this began—says it was “a while ago.” Physical examination reveals: Rigidity in limbs Shuffling gait Blank expression Pill rolling in both hands M.J. is diagnosed with Parkinson’s disease. He is anxious and worries that his tremors will never stop. Discussion Questions: What is the etiology and pathophysiology of Parkinson’s Disease? List clinical manifestations related to Parkinson’s disease. What monitoring do you think should be done for him considering the manifestations of this disease? What are complications to anticipate as this disease progresses? Which diagnostic test are available for Parkinson’s disease? (ex.: TRAP) What can you tell him about treatment options? (Relate to drug therapy also.) What other emotional issues may M.J. have? What changes could M.J. and his wife make to his house? What other teaching should you do for M.J. and his wife? M.J.’s wife tells you that she thinks he has dementia. When you are working with a patient who has cognitive impairment, what modifications in your teaching can you make to facilitate understanding? What medications would you expect to be prescribed and why? What side effects would you monitor a patient who is taking Carbidopa/Levodopa? What is dyskinesia? Provide an example. What nursing interventions would you implement if a patient with Parkinson Disease develops dyskinesia?

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