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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 atient stated that
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 atient stated that
he 7as the rovider of
the family and that he
hels in taing are of
his hildren
he atient stated that
his 7ife and hildren
visit and tae are of
him in the hosital
D) Se8ualityB
Rerodutive
Pattern
he atient stated that
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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Nursin/ Considerations:
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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Nursin/ Considerations:
"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
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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
Recommended