group j- case study

8/11/2019 GROUP J- Case Study

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College of NursingPamantasan ng Lungsod ng Maynila

(University of the City of Manila)Intramuros, Manila

A Case Study on

Spinal Cord Injurysecondary to

Giant Cell Tumor

IN PARIAL !ULL!ILM"N !#R $" R"%UIR"M"NS

IN &RAN' CAS" PR"S"NAI#N

Submitted by:&rou

Agustin , Christian efferson *+Aliando, -arah aneAe, oan #livia &+

A.uino, Rae Marie &+Arlegui, ey/el $+

Austria, Alesi Marian S*aani, Aeimil Clari/e '

*ara.uia, Maria Leona 0itoria &+*arrientos, 1atrina*atingan, Irene C+

*riones, Aillene adeCa2anela, essia

Submitted to:Prof+ Raymond !ernande/ RN, MAN

August 34, 4354

I. INTRODUCTION

Sinal ord in6ury is a damage to any art of the sinal ord or nerves at the end

of the sinal anal+ It often auses ermanent hanges in strength, sensation and other


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2ody funtions 2elo7 the site of the in6ury+ 'eending on 7here the sinal ord

and nerve roots are damaged, the symtoms an vary 7idely, from ain to aralysis to

inontinene+It is estimated that the annual inidene of sinal ord in6ury not inluding

those 7ho die at the sene of the aident, is aro8imately 93 ases er million

oulation in the U+ S+ or aro8imately 54,333 ne7 ases eah year+ Sinal ord

in6uries tyially our during an individual:s most rodutive years, 2et7een the ages of

5; and


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5. 'etermine the diagnosti tests, their imliations, signifiane and analysis of the

atient+6. Utili/ation of the medial and or surgial roedures ossi2le or indiated for the

management of the atient7. Identify and rioriti/e the need of our atient+8. !ormulate an aroriate nursing are lan 2ased on the assessment identified

needs and ro2lems of the atient+

III. NURSING #!$%T# #ISTOR&:

A+ *iograhi data>a+ Name > AP2+ Address> Parana.ue+ Age> August 33ml+ 'ate reeived> uly 4 Patient himself, atient@s sister and the atient@s

hart 7hih 2oth have 533F relia2ility+

*+ Chief Comlaint>#2tained from admitting history > *a ain

Admitting 'iagnosis> Sinal ord in6ury, 54, omlete, Asia A seondary to giant ell tumor

C+ $istory of Present Illness

he atient e8lained that D months rior to his admission, he had

aute onset of lo7 2a ain, loali/ed, 7ith ain sale of =53, aggravated 2y


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rolonged standing, usually noted in the afternoon, usually relieved 2y rest+ $e

selfBmediated 7ith unrealled ain mediations 7ith temorary relief+ No

assoiated signs and symtoms+ Condition tolerated+ here 7as no history of

trauma+ G months rior to admission, there 7as ersistene of ondition thus,

deided to see onsult at a rivate hosital 7here 7or u 7as done 7ith an

imression of Pott@s disease+ Patient follo7ed u fre.uently ho7ever there 7as

no relief of symtoms+ E months rior to admission, ondition ersisted 7ith

inreased severity of ain to 5353+ his 7as relieved 2y overnight rest+ =

months rior to admission, there 7as ersistene of ain 2ut no7 7ith

involvement of the thighs do7n to the level of the nees+ Patient still had intat

motor and sensory funtion as laimed+ Sought onsult 7here MRI 7as done

sho7ing tumor on 54 verte2ral 2ody 7ith L9BL= diffused dis 2ulge+ $e 7as

advised for surgial management ho7ever, did not ursue due to finanial

onstraints+ 4 months rior to admission, atient 7as admitted for 4 7ees for

alternative mediine treatment 7ith no relief of symtoms+ 5 7ee rior to

admission, atient had refle8ology treatment 7here atient strething 7as done

and laimed to have aggravated the ain, and fre.ueny+ Pain 7as no7 artially

relieved 2y rest and ain relievers+ < days rior to admission, atient 7as una2le

to move lo7er e8tremities and gradual onset of num2ness+ At August 33m, he 7as admitted 7ith a hief omlaint of *a ain at Philiine

&eneral $osital +

'+ Past Medial $ealth $istory


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Patient stated that he has 2een vainated 2ut he ould no longer

remem2er 7hat vaines 7ere given+Patient reorted that he has no allergies to

foods, mediations, dust, ollen, animals, et+ and had never 2een in any

aident+ $e stated that he has never 2een hositali/ed 2efore+

"+ !amily $istory of Illness

he atient e8lained that he have no family history of any disease

!+ Lifestyle>


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he atient stated that he 7ors as a 2odyguard during 7eedays

as a soure of their inome+ $e also stated that they have a sariBsari store

as another soure of inome+ $e stated that he has a good aetite and

7as eating < times a dayB 2reafast, lunh and suer resetively+ $e

stated that he eats vegeta2les and meat+ he atient also stated that he

has an average of G hours of slee er day, usually from G>33m to

9>33am+ #n 7eeends, the atient hels out 7ith household hores lie

going to the groery and 7ashing dishes+ $e also taes his turn in selling

at their sariBsari store+ he atient stated that this is his regular time

alloation 2ut it still varies 7ith regards to different fators 7hih he named

as 7eather, and emergeny situations 7hih needed his resene+&+ Soial 'ata>

he atient stated that he has a good relationshi 7ith his 7ife and

hildren+ hey seldom .uarrel at home+ $is four sons, 2oth living 7ith him

also share their ro2lems and they haven@t enountered any ro2lem in

ommuniating 7ith one another+ he atient stated that they see hel

from their neigh2ours and other family mem2ers in the times of

emergeny situations or in ase of alamity+$+ Psyhologi 'ata>

In the ast, the atient usually goes out to lay 7ith his hildren, read

the ne7s aer, does household hores (ie+ going to 7et maret to 2uy

food), and sells at their sariBsari store in order to ass the time+ Currently,

he finds time to read the ne7s, listen to musi, and lay hess 7ith his

hildren 7hen they ome to visit

I+ Patterns of $ealth Care


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he atient has e8lained of not having any family hysiian, he

usually self mediates and onsults hositals if the symtoms still ersists

I". GORDON'S (UNCTION$% #!$%T# )$TT!RNS

*"!#R" $#SPIALI-AI#N 'URIN& $#SPIALI-AI#N5) $ealth Peretion

$ealth

Management

Pattern

he atient ereives

that he is healthy

2eause he an

erform his ativities of

daily living 7ell+

he atient feels

healthy e8et for his

disa2ility

4) Nutritional

Meta2oli Pattern

he atient@s

signifiant other stated

that HAng alat niya asi

magtimla ng ulam,

he atient stated that

during his

hositali/ation, H?ala

naman aong relamo


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taos ang hina a

uminom ng tu2ig+ he

atient also stated that

HMadalas 49hours ang

2iyahe ng ta8i o, ero

hindi o nauu2os yung

isang 2ote (referring to

a 5 liter 2ottle) ng tu2ig

na 2aon o+

sa again o+


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2eause of his duty as

a ta8i driver+

stated 2y his signifiant

other+

;) Cognitive

Peretual Patter

he atient is 7ell

oriented 7ith time,

lae and erson+

he atient is still

oriented 7ith time,

lae and erson+

E) SelfBPeretion

SelfBConet

Pattern


he is a erson that

hels his family+

H'aat ao nagBaalaga

ero ngayon ao ang

inaalagaan, as stated

2y atient+

G) RoleBRelationshi

Pattern


he 7as the rovider of

the family and that he

hels in taing are of

his hildren


his 7ife and hildren

visit and tae are of

him in the hosital

D) Se8ualityB

Rerodutive

Pattern


they are ative during

their rest days+

he atient and his

signifiant other are not

having se8ual

interourse+

53)CoingBStress

olerane Pattern

HPalagi ong nilili2ang

ang sarili o, naglalaro

ng 2aset2all asama

ang mga ana o,

namamalenge o

nagtitinda sa tindahan

namin as stated 2y

the atient+

HMas rela8ed ao

ngayon asi alagi

aong naahiga+ Sana

nga lang maaBinBash

yung guarantee letter

o, as stated 2y

atient I0+


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55)0alueB*elief Pattern HPalagi aong

nasam2a at

namamanata sa aming

ailya as stated 2y

the atient

he atient offers u a

rayer every no7 and

then+

". R!"I!* O( S&ST!+S

S,inhe atient stated that he doesn@t have any feeling of ithiness all over his 2ody+

$e also stated that he has a sar on his 2a from the oeration and also ulerations

that have healed on the alaneal region

!yeshe atient stated that he is not e8eriening visual distur2anes lie e8essive

tearing or night 2lindness+ $e said that he has no sensation of ain in his eyes+ $e also

stated that he doesn@t use eye glasses or ontats+

!ars

he atient stated that he doesn@t e8eriene any hearing defiits, feeling of light

headedness, or ringing in the ears+ he atient said that he doesn@t use hearing aid and

he doesn@t have any disharge or ain in the ears+

+out-he atient stated that he 2rushes his teeth every morning+ $e said that he

doesn@t use dental floss or any mouth 7ash+ $e stated that he is not having tooth ahe,

2leeding or s7ollen gums, diffiulty in he7ing, or hange in taste sensation+

Breast and $illahe atient stated that he doesn@t feel ain or tenderness in his 2reast+ $e said

that he doesn@t have any 2reast disease or aner and resene of unusual disharge+

!ndocrine


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he atient said that he is not e8eriening mood s7ings+ $e said that he doesn@t

have allergi reations to any food or drugs+ $e also stated that he doesn@t e8eriene

e8essive hunger, thirst, or inrease in urination+

Neurolo/icalhe atient stated that he doesn@t have any sensory imairment+ $e also said

that sometimes he is e8eriening di//iness or 7hen he tries to stand+ $e said that he

doesn@t e8eriene loss of memory, hange in seeh, or any involuntary movements+

Cardio0ascularhe atient stated that he doesn@t e8eriene hest ain and alitations+ he

atient said that he doesn@t e8eriene any diffiulty in sleeing in suine osition+

Respiratoryhe atient stated that he has no diffiulty in 2reathing+ $e also stated that he

does not e8eriene any ain 7hen oughing

Gastrointestinalhe atient stated that he doesn@t have diarrhea or onstiation+ $e admitted that

he does not feel ain in his a2domen+ $e said that he defeates at least one every

other day+

+usculos,eletalhe atient stated that he has no vasular ain in e8tremities+ $e also said that

he ould not move his lo7er e8tremities and a feeling of num2ness+

Urinaryhe atient stated that he does not e8eriene hysial disomfort even 7ith a

foley atheter inserted+


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"I. )-ysical $ssessment

General Sur0eyhe atient 7as reeived onsious, oherent and oriented+ he atient is lying

on 2ed 7ith ind7elling foley atheter attahed to a urine 2ag draining 7ell+ he atient

sho7s no signs of distress+ he atient@s movement is oordinated+he atient@s vital signs are as follo7s>

*lood Pressure> 543G3Resiratory Rate> 44 mPulse Rate> G5 2memerature>


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atient oens her eyes+ "yelashes are evenly distri2uted and urve out7ard+ &lo2e of

the eye neither rotrudes nor is sunen into the or2it+ "ye2ro7s are of e.ual si/e, olor

and distri2ution+ Nystagmus is not resent+ he atient has a ale on6untiva+ ?hite

slera is visi2le through on6untiva+ Lids of 2oth eyes lose 7hen stoe eah ornea

7ith a 7is of otton+ Puils are round, reative to light and aommodation+ *oth uils

onstrit 7hen you light on one+ "yes are roerly aligned+ "ye movement in eah of

the si8 ardinal fields of ga/e is arallel+ "yelids sho7 no evidene of s7elling or

tenderness+ &lo2es feel e.ually firm, not overly hard or songy+

!ars Auriles are 2ilaterally symmetrial and roortionately si/ed+ i of the ear

rosses the eyeBoiut line+ "ars and faial sin are the same olor+ No inflammation,

lesions, or nodules are aarent+ No raing, thiening, saling or lesions are

deteta2le 2ehind the ear+ No visi2le disharge from the auditory anal 7as aarent+

"8ternal meatus is atent+ Sin olor on the mastoid roess mathes the sin olor of

the surrounding area+ No masses or tenderness on the aurile tragus is deteta2le

during alation+ Mastoid roess has 7ellBdefined 2ony edges 7ith no signs of

tenderness+

NoseNose is symmetrial and lesion free, 7ith no deviation of the setum or

disharge+ Nostrils are atent 7ithout any o2strutions and nasal flaring is not aarent+

Uon alation, there 7ere no masses as 7ell as tenderness and lesions on his

sinuses+ Patient an identify familiar odors+ No evidene of foreign 2odies or dried 2lood

in the nose+ "8ternal nose is free from strutural deviation, tenderness and s7elling+

+out-


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Lis are in and nonBtender 7ith no fissures, lesions, or yanosis and 7ith

dryness+ Patient an urse his lis and uff out her hee+ Patient an easily oen and

lose his mouth+ #ral muosa is light in and moist 7ith no ulers or lesions+ Palate is

in and soft+ &ums are in, 7ith no inflammation and 2leeding+ ongue is in, 7ith

no s7elling, oating, ulers, or lesions+ ongue moves easily and 7ithout tremor+ onsils

are lesion free and are right in si/e for the atient@s age+ 0oie is lear yet minimal+

Uvula moves u7ard 7hen the atient says Hah+ Lis are free from ain and

indurations+ !loor of the mouth is free from tenderness, nodules and s7elling+

Nec, Ne is symmetrial 7ith intat sin and no visi2le ulsations, masses, s7elling,

venous distention, or thyroid or lymh node enlargement+ Lymh nodes are not

ala2le+

Breast*reast sin is smooth, undimled, and the same olor as the rest of the sin+

*reasts are symmetrial+ he atient has edema 2ut no erythema, sin or nile

dimling or nile disharge is aarent+ Niles are round and rotrude+ No nodules

or unusual tenderness is aarent+ A8illary nodes feel soft, small and not tender+

T-ora and %un/sChest onfiguration is symmetrial sideBtoBside+ Anteroosterior diameter is less

than the transverse diameter, 7ith a ratio 5>4+ Chest shae is normal 7ith no

deformities, lie 2arrel hest, yhosis, retration, sternal rotrusion, or deressed

sternum+ Costal angle is less than D3 degrees, 7ith the ri2s 6oining the sine at a 9=B

degree angle+ Resirations are la2ored+ Chest 7all e8ands symmetrial during

resirations+ Sin olor mathes the rest of the 2ody@s omle8ion+ Sin is 7arm and


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dry+ No tender sots or 2ulges in the hest are deteta2le+ Uon ausultation, rales

7ere heard+

Cardio0ascular System

No ulsations 7ere visi2le, e8et at the oint of ma8imal imulse in the left =th

interostal sae+ No lifts or retrations are visi2le in the four valves area of the hest

7all+ No vi2rations or thrills are deteta2le+ No murmurs 7ere heard+

$bdomen

A2domen is fla22y and soft+ No variations in the olor of the atient@s sin are

deteta2le+ he a2domen moves 7ith resiration+ he liver, sleen and idneys are nonB

ala2le+

Urinaryhe atient has a !oley atheter in lae 7ith a urine outut level of ==3 ml for

a2out G hours+

+usculos,eletal System

No gross deformities are aarent+ *ody arts are symmetrial+ *ody is in

alignment+ No involuntary movements are deteta2le+ All musles and 6oints of uer

e8tremities have ative range of motion, 7ith no ain+ *ilateral lim2 strength of uer

e8tremities is e.ual+ Lo7er e8tremities have no sensory and motor funtion+ No

involuntary ontrations or t7ithing is deteta2le+

Neurolo/ic SystemPatient an shrug his shoulders+ Puils are e.ual, round, and reative to light+

he lids of 2oth eyes lose 7hen you stroe eah ornea 7ith a 7is of otton+ Patient

an identify familiar odors+ Patient an hear a 7hisered voie+ Patient an urse his

lis and uff out his hees+ ongue moves easily and 7ithout tremor+ No involuntary


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movements are deteta2le+ Patient is oriented to herself, to other eole, lae, and

time+ Memory and attention san are intat+ 'ee tendon refle8es are resent+ Strength

in the faial musles is symmetrial+ he atient@s ranial nerves 7ere assessed as

follo7>CN I> the atient an identify the smell of offee 7hile eyes are losed+CN II> the atient an read 7ritten 7ords+CN III2 I"2 "I> Puils are e.ually round and reative to light and aommodation+"8tra oular eye movements are intat and move in unison+CN "> he is a2le to lenh her teethCN "II> the atient is a2le to uff out hees and urse lis 7ith symmetry+ $e

an demonstrate different faial e8ression+CN "III> $e is a2le to hear and resond to soen 7ords 7ith a normal voie

toneCN I42 4> the atient@s voie is negative for hoarseness+ $e an s7allo7 7ithout

diffiulty+ $e an move his tongue sideBtoBside and uBandBdo7n+CN 4I> ne musle strength resistane is e.ual+CN 4II> Patient an rotrude tongue and an move it sideBtoBside+

"II. $N$TO+& $ND )#&SIO%OG&

S5!%!T$% S&ST!+

(unctions o6 T-e S,eleton

5+ Suort

he seleton is the frame7or of the 2ody, it suorts the softer tissues

and rovides oints of attahment for most seletal musles+4+ Protetion

he seleton rovides mehanial rotetion for many of the 2ody:s

internal organs, reduing ris of in6ury to them+!or e8amle, ranial 2ones rotet the 2rain, verte2rae rotet the sinalord, and the ri2age rotets the heart and lungs+


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Bones o6 t-e (ace:he 2ones of the fae (Splanc-nocranium) are 59 in total+ heyare> 4 nasal, 4 ma8illa, 4 /ygomati, 4 larimal, mandi2le, 4 alatine, 4 inferior nasalonhae and vomer+

%acrimal*one> is the smallest 2one of the fae, from art of the inside 7all of

the eye or2it+Nasal *one> the t7o nasal 2ones meet in the middle and this forms the 2ridge ofthe nose+Inferior Nasal Conhae> these 2ones form the lateral 7all of the nasal avity andause the inhaled air to s7irl and 2e filtered+

"omer*one> is a triangular shaed 2one that forms art of the nasal setum+

-ygomati *one> it is a aired 2one, 7hih maes u the lo7er eye or2it and isfre.uently referred to as the hee2one+

+ailla*one> the largest 2ones of the faeK they form together to mae the

7hole uer 6a7+ hese 2ones hold the uer teeth+

+andible*one> the strongest 2one of the faeK it forms the lo7er 6a7 and holdsthe lo7er teeth+ It is the only 2one of the sull that moves+

he -yoid2one is a 2one in the ne, 7hih does not artiulate 7ith any other

2one+ Musles of the ne suort it and it rovides suort for the root of thetongueK it is involved in the rodution of seeh+

Bones o6 t-e Inner !ar: he 2ones of the inner ear are alled the (a) Malleus(hammer), (2) Inus (anvil) and () Staes (stirru)+ hese 2ones funtion together totransmit sound 7aves from the e8ternal environment to the fluid filled ohlea+

+alleus(hammer)> he malleus, or hammer, is a hammershaed 2one that isattahed to the inus+ It is attahed to the inner surfae of the eardrum and,therefore, it moves as the eardrum vi2rates in resonse to inoming sound+

Incus(anvil)> is an anvilBshaed 2one in 2et7een the malleus and the staes+ Itis the 2ridge that onnets the inoming sound 7aves to the inner ear+

Stapes(stirru)> he staes, or stirru, transmits the sound vi2rations from theInus to the oval 7indo7+ he oval 7indo7 onnets the inner ear 2ones 7ith theohlea+

Bones o6 t-e C-est

Claviles (or ollar 2ones) are long 2ones, 7hih suort the ri2age and shoulder6oints+ he laviles rovide an attahment for the saula and rotate 7hen the arm ismoved for7ard+ here are t7elve ri2s in the ri2 age, 53 airs that are 6oined to thesternum and sine and 4 floating airs+ he ri2s rotet the underlying organs andassist in resiration+

Scapula> also no7n as the shoulder 2ladeK it is a air of 2road flat 2ones that

onnet the arm 2one 7ith the lavile+


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Sternum> also no7n as the 2reast2oneK it is a long flat 2one in the enter of the

hest+ It onnets to the ri2s via artilage and omletes the ri2 age+ It has threeortions, from the to do7n7ard> (A)+anubrium, (*) Bodyand(C) 4ip-oidProess+

T-e "ertebral Column:

Cer0ical> he ervial region is the first ortion of the sinal olumn and is madeu of E verte2ras+ he first and seond verte2rae are uni.ue, and they are alledthe atlas and the a8is+

T-oracic> he thorai region of the verte2ral olumn is loated in the hest+ Itontains 54 verte2rae and is onneted to the lum2ar region of the sine+

%umbar> he lum2ar region of the verte2ral olumn is the last main ortion of theverte2ral olumn and is loated in the lo7er 2a+ It ontains = verte2rae and isonneted to the elvis, through the sarum and oy8+

Sacrum> he sarum is a triangular shaed 2one that is made u of = fusedsaral verte2rae+ It artiulates 7ith and rovides a strong foundation for theelvis+

Coccy> he oy8 is also a triangular shaed 2one that is made of 9 fused

oygeal verte2rae, and is also no7n as the tail2one+ It is attahed to thesarum 2y artilage, and this allo7s some movement 2et7een them and shoa2sor2ane+

S)IN$% CORD

The spinal cord has two functions:

Transmission of nerve impulses.Neurons in the 7hite matter of the sinal ord

transmit sensory signals from eriheral regions to the 2rain and transmit motor

signals from the 2rain to eriheral regions+

Spinal reflexes.Neurons in the gray matter of the sinal ord integrate inoming

sensory information and resond 7ith motor imulses that ontrol musles

(seletal, smooth, or ardia) or glands+

he sinal ord is an e8tension of the 2rainstem that 2egins at the foramen magnum

and ontinues do7n through the verte2ral anal to the first lum2ar verte2ra (L 5)+ $ere,the sinal ord omes to a taering oint, the onus medullaris+ he sinal ord is heldin osition at its inferior end 2y the filum terminale, an e8tension of the ia mater thatattahes to the oy8+ Along its length, the sinal ord is held 7ithin the verte2ral anal2y dentiulate ligaments, lateral e8tensions of the ia mater that attah to the duralsheath+

External features of the spinal cord:


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Sinal nerves emerge in airs, one from eah side of the sinal ord along its

length+ he ervial nerves form a le8us (a omle8 inter7oven net7or of nerves

nerves onverge and 2ranh)+ he ervial enlargement is a 7idening in the uer art of the sinal ord (C 9

5)+ Nerves that e8tend into the uer lim2s originate or terminate here+ he lum2ar enlargement is a 7idening in the lo7er art of the sinal ord ( D

54)+ Nerves that e8tend into the lo7er lim2s originate or terminate here+ he anterior median fissure and the osterior median sulus are t7o grooves that

run the length of the sinal ord on its anterior and osterior surfaes,resetively+

he auda e.uina are nerves that attah to the end of the sinal ord and

ontinue to run do7n7ard 2efore turning laterally to other arts of the 2ody+ here are four le8us grous> ervial, 2rahial, lum2ar, and saral+he thorai

nerves do not form a le8us+

(i/ure 7. !ternal 6eatures o6 t-e spinal cord.

Features of the cross section of the spinal cord:

Roots are 2ranhes of the sinal nerve that onnet to the sinal ord+ 7o ma6orroots form the follo7ing>


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A ventral root (anterior or motor root) is the 2ranh of the nerve that

enters the ventral side of the sinal ord+ 0entral roots ontain motornerve a8ons, transmitting nerve imulses from the sinal ord to seletalmusles+

A dorsal root (osterior or sensory root) is the 2ranh of a nerve that

enters the dorsal side of the sinal ord+ 'orsal roots ontain sensorynerve fi2ers, transmitting nerve imulses from eriheral regions to thesinal ord+

A dorsal root ganglion is a luster of ell 2odies of a sensory nerve+ It is

loated on the dorsal root+

&ray matter aears in the enter of the sinal ord in the form of the letter $ (or

a air of 2utterfly 7ings) 7hen vie7ed in ross setion>

he gray ommissure is the ross2ar of the $+

he anterior (ventral) horns are gray matter areas at the front of eah

side of the $+ Cell 2odies of motor neurons that stimulate seletalmusles are loated here+

he osterior (dorsal) horns are gray matter areas at the rear of eah

side of the $+ hese horns ontain mostly interneurons that synase 7ithsensory neurons+

he lateral horns are small ro6etions of gray matter at the sides of $+

hese horns are resent only in the thorai and lum2ar regions of thesinal ord+ hey ontain ell 2odies of motor neurons in the symatheti2ranh of the autonomi nervous system+

he entral anal is a small hole in the enter of the $ ross2ar+ It

ontains CS! and runs the length of the sinal ord and onnets 7ith

the fourth ventrile of the 2rain+

?hite olumns (funiuli) refer to si8 areas of the 7hite matter, three on eah side

of the $+ hey are the anterior (ventral) olumns, the osterior (dorsal) olumns,and the lateral olumns+

!asiuli are 2undles of nerve trats 7ithin 7hite olumns ontaining neurons

7ith ommon funtions or destinations>

Asending (sensory) trats transmit sensory information from various arts

of the 2ody to the 2rain+

'esending (motor) trats transmit nerve imulses from the 2rain tomusles and glands+


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(i/ure 8. $ cross section o6 t-e spinal cord.

"III. )$T#O)#&SIO%OG&


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SPINAL CORD INJURY SECONDARY TO GIANT CELL TUMOR

Predisposing and Precipitating factors

!or"ation of giant ce## t$"or

Prod$ction of c%e"oattractants

Attraction of osteoc#asts and osteoc#ast prec$rsors

!or"ation of #esions !$rt%er gro&t% of

t%e t$"or

Destr$ction of corte' Incrreased Press$re

Pa#pa(#e "ass

Irritation of t%e perioste$" Spina# Cord Co"pression

)ea*ening of t%e (one Spina# Cord In+$r,

Pain in t%e site Li"ited Mo-e"ent

4III. DI$GNOSTIC )ROC!DUR!S $ND %$BOR$TOR&


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#ematolo/y 9;7


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immunodefense 2rought a2out 2y the e8isting disease of the atient ontri2utes to the

dereased lymhoyte ount+

4.+!DIC$% SURGIC$% +$N$G!+!NThe goal for the medial management of the atient is to ontrol symtoms and

fators ontri2uting to the atient@s ondition+


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7. (oley Cat-eter

!oley Catheter is a thin, sterile tu2e inserted in the 2ladder to drain urine+

It is also inserted to monitor the intae and outut of the atient+ It is also indiated

sine the atient@s lo7er lim2s don@t have a sensory and motor funtion thus the reason

for his immo2ility+

Nursin/ Considerations:

Use strit aseti tehni.ue for atheter insertion

Minimi/e urethral trauma during insertion> use generous amount of lu2riant

Sta2ili/e the atheter to minimi/e urethral trauma

Maintain drainage 2ag 2elo7 2ladder level and tu2ing in deendent osition to

failitate urine flo7

Inrease fluid intae

&ently leanse erineum and ro8imal atheter daily and after eah 2o7el

movement

Assess 2o7el funtion and imlement measures to eliminate imation or orret

onstiation

8. )osterolateral Resection o6 t-e tumor

he osterolateral resetion of the tumor is a surgial aroah in

7hih the surgeon removes the tumor 2y 7oring from the 2a and to the side+ It is a

2oneBsaring roedure 7hih fouses on maintaining the strutural sta2ility of the

sine+ It onserves anatomial struture during the removal of the tumor+


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Reinfore the health are rovider@s e8lanations of the surgery and related

roedures

A.uaint the atient 7ith ostoerative treatment devies, roedures, e8erises

and other measures

Provide routine reoerative nursing are

=. Diet

Diet as Tolerated

he atient 7as ordered a 'A 7hen his aetite, a2ility to eat and

tolerane for ertain foods hanged+ his means that the atient an tolerate all tyes of

foods and that he an have regular deserts and fluids as long as it is tolerated+

Nursin/ Considerations

#ffer atient assistane 7ith hand 7ashing and oral hygiene 2efore and after a

meal Assist atient in a omforta2le osition

"nourage atient to have a 7ellB2alaned food suh as food high in rotein,

ar2ohydrates, et+

>. )-armacolo/ic T-erapy:

7. Caltrate 1Calcium Carbonate3At as an ativator in the transmission of nerve imulses and ontration

of ardia, seletal, and smooth musle+ It is essential for 2one formation and

2lood oagulation+ It is also a relaement of alium in defiieny states+ And it

serves as a ontrol of hyerhoshatemia in endBstage renal disease 7ithout

romoting aluminum a2sortion (alium aetate)+


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"8lain to the atient the effet of the drug

Monitor the vital signs of the atient eseially 2lood ressure and ulse

rate

#2serve atient losely for symtoms of hyoalemia(aresthesia,

musle t7ithing, laryngosasm, oli, ardia arrhythmias, Chvoste@s or

rousseau@s sign

Inset a2domenK ausultate 2o7el soundsK assess for heart2urn,

indigestion, and a2dominal ain

Monitor serum alium or ioni/ed alium hloride, sodium, otassium,

magnesium, al2umin, and arathyroid hormone (P$) onentrations

2efore and eriodially during theray for treatment of hyoalemia

Monitor ardia rate and rhythm losely

'o not administer onurrently 7ith foods ontaining large amounts of

o8ali aid(sinah, rhu2ar2), hyti aid(2rans, ereals), or

hoshorus(mil or dairy roduts)

'o not tae 7ithin 5B4 hours of other mediations if ossi2le

Advise atient to avoid e8essive use of to2ao or 2everages ontaining

alohol or affeine

8. !noaparinIt is a lo7 moleular 7eight hearin 7ith antioagulant roerties+ It ats

2y enhaning the inhi2ition rate of ativated lotting fators inluding

throm2in and fator a through its ation on antithrom2in III+Nursin/ Considerations:

"8lain to the atient the effet of the drug

Administer mediation through dee su2utaneous in6etionsK do

not give 2y IM in6etion

Aly ressure to all in6etion sites after needle is 7ithdra7nK do

not massage the in6etion sites

Inset in6etion sites for hematoma 'o not mi8 7ith other in6etions or infusions

Che atient for signs of 2leedingK monitor for 2lood tests

Provide safety measures (eletri ra/or, tooth2rush) to revent

in6ury to atient 7ho is at ris for 2leeding


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4I. NURSING +$N$G!+!NT

Monitor the atient@s vital signs

Administer the resri2ed mediations on the right time, "8onaarin and Caltrate

Assist lient in reositioning self to avoid ressure ulers

Provide roer 7ound dressing+

Assist in hanging the urinary atheter

Instrut in the use of side rails, overhead trae/e, roller ads for osition

hangestransfer

"nourage to suort affeted 2ody arts using illo7s, foot suorts, air

mattress, 7ater 2ed and so forth

Provide regular sin are to inlude ressure area management+

"nourage intae of fluidsnutritious foods+

"nourage artiiation in rereationalsoial ativities and ho22ies aroriate

for situation+


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Provide roer health teahing regarding the lient@s ondition


32/51

4I". NURSING C$R! )%$N

Nursin/ )riority No. 7: Imaired hysial mo2ility related to aralysis of the lo7er e8tremities

ASSESMENT DIAGNOSI

S

INFERENCE PLANNING INTERVENTI

ON

RATIONALE EVALUATIO

N

O.JECTI/E0

Co"p#ete

ASIA A T12

#e-e#

345 Motor

f$nction

345 Sensor,

f$nction

365 Li"itedROM

/7S ta*en as

fo##o&s0

T0 89:1 C

I"paired

p%,sica#

"o(i#it,

re#ated to

para#,sis of

t%e #o&er

e'tre"ities

Giant ce##t$"or

Co"pression

of t%e T12

-erte(rae

Modest (ac*

pain

Ting#ing

sensation

and s#ig%t

After ; %o$rs

of n$rsing

inter-entions

group j- case study

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