1

I. INTRODUCTION

A spinal cord injury often causes permanent disability or loss of movement (paralysis)
and sensation below the site of injury. The ability to control limbs after spinal cord injury
depends on two factors: the neurological level of the injury and the completeness of injury. The
lowest normally functioning segment of spinal cord is referred to as the neurological level of
injury. The completeness of the injury is classified as either: Complete. If all sensory (feeling)
and motor function (ability to control movement) is lost below the neurological level.
Incomplete. An incomplete spinal cord injury is the term used to describe damage to the spinal
cord that is not absolute. The incomplete injury will vary enormously from person to person and
will be entirely dependent on the way the spinal cord has been compromised. People with an
incomplete injury may have feeling, but little or no movement. The effects of incomplete lesions
depend upon the area of the cord (front, back, side, etc) affected. The part of the cord damaged
depends on the forces involved in the injury. A spinal cord injury isn’t always obvious.
Numbness or paralysis may result immediately after a spinal cord injury or gradually as bleeding
or swelling occurs in or around the spinal cord. In either case, the time between injury and
treatment can be a critical factor that can determine the extent of complications and the amount
of recovery.

Although a spinal injury is usually the result of an unexpected accident that can happen to
anyone, certain factors may predispose to a higher risk of sustaining a spinal cord injury,
including: Being a man, being between the ages of 16-30, being active in certain sports, having
an underlying bone or joint disorder. The most common causes of spinal injuries are: Motor
vehicle accident, acts of violence, falls, sports and recreation injuries, alcohol and diseases.
Possible difficulties that may encounter include: Bladder control, Bowel Control, Impaired skin
sensation, circulatory control, muscle tone (spastic or flaccid muscle), pain (nerve pain aka
neuropathic or central pain) can occur especially in someone with an incomplete injury.
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II. ASSESSMENT

A. Nursing Health History of the patient

Biographic Data

The patient is a 25-year old male, 5 feet 4 inches in height, and weighing 117lbs.

As computed in his Body Mass Index (BMI), the patient’s small built is not proportional

to his height and weight. He is presently residing in Bicol, a Catholic and currently not

working.

Chief Complaints

Patient M.T. was admitted for the first time in the institution on June 12, 2010

complaining of weakness on both upper and lower extremities.

History of Present Illness

Eleven (11) months PTA, the patient experienced low back pain after a fall from a

basketball game. Symptoms would wax and wane.

Eight (8) months PTA, patient felt a sudden snap at the lower back area after

lifting a heavy object. Pain recurred and the patient was unable to ambulate. The patient

was confined at a local hospital where pelvic traction was applied for possible HNP based

on X-ray findings. Pain was relieved and the patient was able to ambulate temporarily.

Six (6) months PTA, pain recurred this time associated with claudication.

One (1) week PTA, condition worsened and the patient was unable to ambulate.

The patient was admitted at a local hospital and subsequently advised transfer to this

institution for further evaluations and due to lack of Magnetic Resonance Imaging (MRI).
 3

Diagnosis

T/C Spinal Cord Injury, Incomplete SL: T10: R/O Potts disease lumbar spine vs.
ascending myelitis

Past Medical History

The patient cannot recall if he has completed the required vaccines since

childhood. The patient was previously taking anti-Koch’s medicines for six (6) months.

Social Profile

The patient is living with his parents in the province of Bicol. Since the patient is

jobless, he plays basketball regularly for his past time. He also drinks beer occasionally

and smokes to socialize with his friends who smoke as well. He started smoking since

second year high school until December 2009. The patient consumes 16 sticks of

cigarette per day. Family and friends serve as his strength during times of difficulties.

Family Health History

The patient’s family has no known health history of Tuberculosis. Both of his

parents are healthy. He has four (4) siblings and all of them have no known disease as

well.
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B. Review of Systems

1. Subjective Data

• Gordon’s Pattern of Functioning (PATIENT)

BEFORE DURING
PATTERN INTERPRETATION ANALYSIS
HOSPITALIZATION HOSPITALIZATION

1. Health • He takes over-the- • The patient takes • There are specific To enhance adherence,
Perception -Health counter medicines only the drugs for a specific nurses need to ensure that
Management when needed such as prescribed condition. the client is able to perform
Pattern medicines for medicines by the the prescribed therapy,
headache, fever, pain physician understands the necessary
instructions volume
Fundamentals of Nursing
by Kozier; Page 304).

• He doesn’t give • The patient is • Lack of knowledge

priority on the aware that there’s about the severity
importance of health something wrong of his condition.
w/ his condition.
 5

2. Nutritional - • His diet intake on • The patient • Eating right An adequate diet is
Metabolic 24-hour period was becomes aware on amount of composed of the various
management not different from the importance nutritious food is nutrients which the body
his usual diet habit and benefits of the important for needs for maintenance,
balanced diet. human being. repair, the living processes
and growth or
development. (Basic
Nutrition and Diet Therapy,
Caudal; p.118)

3. Elimination Bowel:
pattern • The client • The • He gains Laxatives are used for
eliminates bowel physician knowledge about short-term relief of
once a day. prescribed laxative the use and effects constipation and to evaluate
to ease his bowel of laxatives. the bowel for diagnostic
movement. procedures. (Nursing drug
Handbook, Lippincott;
pp.1288)
Bladder:
• Presence of One of the complications of
• He urinates 3 to 4 • The bacteria in the urine SCI is difficulty in bladder
times a day. urinalysis result might indicate control
reveals the urinary tract
presence of infection.
bacteria (refer to
lab result)
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Skin: It is important to consider

• Appropriate client’s ability to assume
• The client has a position is position. (volume
moist skin. important to
• The client fundamentals of Nursing by
had a pale and dry maintain skin Kozier page 567)
skin. integrity.

4. Activity – • He helps his parents • He is • He cannot do his Any patient involved in a

Exercise Pattern in doing some unable to do his daily chores motor vehicle accident, fall or
household chores. daily activities. because of contact sports injury must be
He shops for food hospitalization and considered to have SCI until
whenever the need strength loss. such an injury is ruled out.
arises. Initial care must include
immobilization to prevent
• He is actively further complications. (MS
involved in • During Nsg., Brunner & Suddarth,
basketball team as a hospitalization, he p.2251)
form of his exercise. can’t ambulate
himself alone.

5. Sleep – Rest • The patient normally
Pattern goes to bed late and
wakes up late in the
morning.
• He’s • The patient is Anxiety is a common
having a hard time anxious about his denominator for a patient
sleeping. real condition confined in a hospital. (MS
Nsg., Brunner&Suddarth,
p.2246)
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6.Cognitive – • The client has the • The • The patient is able Formal operation phase uses
Perceptual Pattern ability to understand. physician can to understand rational thinking. Reasoning is
He knows his easily serious matters deductive and futuristic (Kozier
current situations in communicate with since he is already Fundamentals of nursing 8th
life and he knows him. on a formal
what he is going edition page 357)
operation phase
through. based on Jean
He could easily Piaget’s phases of
communicate with cognitive
others. He could development.
make decisions on
his own

7. Self – • The patient is a shy • The patient • Faith is a common For the client who is ill, faith-
Perception – Self – type person but he although soft- trait seen among whether in higher authority
Concept Pattern has the will to face spoken was able to Filipino people in (e.g. God, Allah, Jehovah), in
hard situations verbalize what he times of the client’s own self, in the
especially for the really feels. difficulties. health care team or in a
sake of his family. combination of all- provides
strength and trust.
(fundamental on nursing 8th
edition page 361)
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8. Role • Felt moral and • The moral support • Support from Social support networks
Relationship financial given by friends family, relatives (family, friends or a confidant)
support from and relatives and friends gave helps people avoid illness.
his father and contributes a lot him strength and Support people also provide the
other family on what he is confidence to get stimulus for an ill person to
members. going through. well soon. He become well again. (FN v1
realized the p302)
importance of
having neighbours
and relatives
around

9.Sexuality- • Aware of having a • The patient is still • The patient is Coping strategies varies among
Reproductive loyal and only one loyal to his partner oriented on a individual and are often related
Pattern sex partner thus and still protecting monogamous to the patient’s perception of
prevents acquiring himself from any culture. the stressful events.(vol.II of
sexually form of infection Fundamentals of Nursing by
transmitted disease Kozier page1068)

10. Coping and • He is determined • The patient is still • Fighting spirit and Appraisal and coping are
Stress to go through optimistic about good adaptation to influenced by antecedent
Tolerance treatment no his condition. stress is the key to variables, including the internal
matter what his achieve what a and external resources of the
condition is. person desires. individual person.(MS Vol.1 by
Brunner and Suddarth page 93)
 9

11. Value-Belief • Seldom went to • The patient does • Roman Catholic Nurses needs to consider
Pattern church but still self reflection individual specific religious practices that
have faith in God whenever alone. especially Filipinos will affect negative care, such
have strong faith as the client’s beliefs about
that God could help birth, death, stress, diet, prayer,
them in time of sacred symbols, sacred writings
needs. and holy drugs. (FN vol2
p1051)
 10

Physical Examination

conscious, coherent, at cp distress

(+) Tenderness at Para-lumbar area

(+) Straight leg raising test at Right lower extremities

(-) Sensory deficit lower extremities bilateral

Neurological Examination

GCS Score: E4 M6 V5

Motor

Upper Extremities R L

C5 3/5 3/5

C6 5/5 5/5

C7 4/5 4/5

C8 4/5 4/5

T1 4/5 4/5

Lower Extremities R L

L2 4/5 4/5

L3 4/5 4/5
 11

L4 4/5 4/5

L5 4/5 4/5

S1 3/5 4/5

Sensory = C2-T9: 2/2 (B)

T10-L2: ½ (R); 2/2 (L)

L3-L3: 2/2, (B)

S1: ½ (B)

(-) Babinski (-) Clonus

Radiographs – Neither fracture discoloration nor lytic lesion appreciated

Admitting Diagnosis – SCI, Incomplete SLT10, related to Pott’s Disease

 12

HEENT: Pink palpebral conjunctivae, anicteric sclera, (-) nasoaural discharge

Non hyperenic posterior pharengeal walls; supple neck, no palpable lymph nodes

Pulmonary: Symmetrical chest expansion, no retractions, clear breath sounds

 13

DIAGNOSTIC AND LABORATORY PROCEDURES

• Urinalysis

• Immunology

• Hematology

• Blood Chemistry

• Magnetic Resonance Imaging

 14

Urinalysis

NORMAL
PROCEDURE June 15, 2010 July 2, 2010
VALUES
CLINICAL CLINICAL
OBTAINED OBTAINED
INTERPRE INTERPRET
VALUES VALUES
TATION ATION

Pus cells 2-5/hpf 5-8/hpf

Amorphous
++ ++
Urates

Epithelial Cells few few

Mucus theads few -

Bacterial + -

Cloudy urine may be caused by the presence of pus.

Immunology

June 16, 2010

 15

Hepatitis A, B, C Profile Normal Range Result Clinical Inrterparetation

HBsAg w/ Titer
CO. V 1.000 H 245.900 Reactive
(ECLIA)

HBeAg (ECLIA) CO.V. 1.000 H 821.200 Reactive

Anti HBc Ig G CO. V. 1.000 0.013 Reactive

Anti HAV Ig G CO. V. 2.000 >60.00 Reactive

Note: Specimen rechecked, result verified. AHBC x AHBC Ig C count below the cut-off value is considered
reactive specimen

Hematology

June 28, 2010

Procedure Normal Range Obtained Value Clinical Interpretation

↓ - Low Hgb concentration may

Hgb Mass 127-183 g/L 106 indicate anemia, fluid retention
causing hemodilution

Hct 110-138 g/L 132

Leukocyte 4.5 – 10x109/L 5.80

Differential Ct.

Segmenters 0.50 – 0.70 0.73 ↑

Lympocytes 0.20 – 0.40 0.16 ↓ - decreased by severe debilitating

illness such as advanced TB, defective
lymphatic circulation,
 16

immunodeficiency

↑ - infections, hepatitis, TB,

Monocytes 0.00 – 0.07 0.9
Carcinomas

↑ - detects allergic reactions and

Eosinophils 0.05 – 0.05 0.2
parasitic infections and its severity

Reticulonocytes

Platelet Ct. 150-400x109/L 207

Indices 82 – 92 fl 78 ↓ - classify and diagnose anemias

↓ - low MCV & MCHC indicate

microcytic, hypochromic anemias
MCV 28 – 32 pg 26 caused by iron deficiency anemia,
pyridoxine-responsive anemia or
thalassemia

MCHC 32 – 38 % 33

Blood Chemistry

June 28, 2010

SI Units (NR) Obtained Value Clinical Interpretation

BUN 2.18 – 8.33 mmol/L 7.99 mmol.L

↑ - serum creatinine
levels generally indicate
renal disease that has
seriously damage 50%
Creatinine 59 – 104 mmol/L 146.63 mmol/L or more of the nephrons,
diminished kidney
function, may also
associated w/
acromegaly
 17

Sodium 135 – 148 mmol/L 141.10 mmol/L

Potassium 3.50 – 5.30 mmol/L 3.79 mmol/L

Chloride 98 – 107 mmol/L 101.60 mmol/L

Magnetic Resonance Imaging (MRI)

Clinical History: Low back pain related to Pott’s disease

Comparison: None

Findings:

L1, L2, and L5 vertebrae show decreased signal from the T1 and T2 images

L5 vertebrae show exaggerated concavity of its endplate which maybe developmental

Rest of bones shows preserved marrow signal

L1-L5 vertebrae exhibit mild convex bulging of its posterior margin into the spinal canal

L4-L5 and L5-S1 disc show mild decreased signal

No frank disc herniation seen

The neural foramina are adequate in size

Conus medullaris terminate at L1

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Clear paravertebral spaces

Impression:

• Heterogenous decreased marrow signal changes probably representing sclerotic changes involving
L1, L2 and L5 vertebrae

• Falls:margin
Mild convex bulging of the posterior Sportsofinjury
L1 and L5 without significant spinal canal
compromised

• No disc herniation Injury in the spinal cord

Microscopic hemorrhage in
gray matter

Impaired microcirculation to
the cord caused by edema
and hemorrhage

Injured tissue

It will release vasoactive

substances cause vasospasm

Decrease vascular perfusion

and oxygen tension

Ischemia (when prolonged)

PATHOPHYSIOLOGY
Necrosis both gray and white
matter begins

Function of nerves passing through the

injured area is interrupted

Claudication of legs Incomplete spinal cord injury Numbness

Limited motor function below

the level of injury ( T10 )
 19

Anatomy of Spinal Cord

20
 21

List of Prioritized Nursing Diagnosis

1. Weakness on the upper and lower extremities related to potential tissue damage

2. Impaired physical mobility related to prescribed position and movement limitations.

3. Risk for impaired skin integrity r/t motor and physical immobility.
 22

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Weakness on the After 8 hours of Independent: After 8 hours of

upper and lower nursing intervention nursing intervention
“ Nanghihina at extremities related the client’s Asses the patient Baseline data for the client’s
nanakit ang mga to potential tissue weakness on upper vital sign, level of future comparison. weakness on upper
galamay ko, braso damage and lower consciousness, input and lower
at binti ko” as extremities will be and output extremities was
erbalized by the partially relieved partially relieved
patient Encourage use of Provide comfort and
relaxation technique sense of control
Objective: (e.g. Deep breathing
pattern)
 Client seen
lying flat on Encourage the Exercise as allowed,
bed. patient to perform decrease venous
gentle ROM stasis and helps
 Bed rest as exercise for maintain muscle
unaffected tone
prescribed
extremities;
by the encourage alternate
physician. flexion and
extension or
 Dry, pale quadriceps-setting
skin exercise for the
affected limb as
permitted

Teach muscle Optimal muscle

strengthening strength is required
exercise to maintain balance
 23

A trapeze allows
Provide a trapeze to regain muscle
assist movement strength the patient
to assist with
repositioning

Dependent:
May be designed to
Administer relieved muscle
medications as spasm associated
prescribed (muscle with specificity or
relaxant analgesics) to alleviate anxiety
and promote rest

To decrease
Reposition the complications
client in supine and associated with
promote bed rest immobility

Collaborative:

-Assist on any
Laboratory
procedures.
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ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: Impaired physical After 2 weeks of Independent: After 2 weeks of

mobility related nursing intervention nursing intervention
“Hindi na ako to prescribed the patient will -Assess the patient Baseline data for the patient
masyadong nanghihina position and maintain proper vital signs, level of future comparison. maintained proper
pero pinagbawalan movement alignment of the consciousness and alignment of the
akong umupo at limitations. affected extremity Input and output. affected extremity
tumayo ng doctor” as to prevent further to prevent further
verbalized by the damage. damage.
patient. -Immobilizes the To promote comfort
patient on a firm, and prevent further
OBJECTIVE:
wrinkle free surface. damage.
 Client seen
-Initiate measures to Patient on bed rest
lying flat on commonly assume a
promote effective
bed. slumped position,
breathing.
decreasing the
 Bed rest as
adequacy of chest
prescribed by
expansion.
the physician.
Immobilize patient
 Dry, pale skin. -Provide skin care is at increased risk
with special for skin breakdown
attention to bony from constant
prominences. pressure. A warm,
moist environment
encourages bacterial
growth. Careful
 25

skincare prevent
pressure ulcers.
-Encourage
verbalizations of Prolonged
feelings. Provide immobilization
diversionary contributes to
activities. depression, anxiety
and frustration.
Verbalization may
help decrease stress.
Diversionary
activities decrease
boredom.

Dependent:
Promote healing
-Administered
and fast recovery
prescribed
medicine. When constant
pressure on some
-Reposition the
areas and minimizes
patient as per
risk of skin
advised by the
breakdown
physician.

-Assist the patient in

 26

performing gentle
ROM exercises for
unaffected Exercise, as
extremities. allowed, decrease
venous stasis and
Collaborative: helps maintain
muscle tone.
-Assist on any
Laboratory
procedures.
 27

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: Risk for impaired After 1 month of Independent: After 1 month of

skin integrity r/t continuous nursing continuous nursing
“Hindi na ako motor and intervention, the -Assess the patient’s Provides interventions, the
masyadong nanghihina physical patient will condition, the skin information patient maintained
pero pinagbawalan immobility. maintain clear, for open wounds, regarding skin clear, intact skin.
akong umupo at intact skin. rashes and circulation and
tumayo ng doctor” as discoloration. problems that
verbalized by the maybe caused by
patient. restrictions that may
require further
OBJECTIVE: medical
 Client seen interventions.
lying flat on -Provide clean, dry Immobilized patient
bed. bedding and special is at increased risk
mattress as needed. for skin breakdown
 Bed rest as
from constant
prescribed by
pressure. A warm,
the physician.
moist environment
 Dry, pale skin. encourages bacterial
growth.

-Encourage deep Pulmonary hygiene

breathing exercise measure help
while the patient is prevent respiratory
awake.
 28

infections related to
immobility.

-Urge adequate
fluid intake, when Forcing fluids helps
allowed. maintain hydration,
liquefy secretion,
maintain renal
function, and
minimize risk of
-Document intake urinary infection.
and output.
Documenting input
and output identifies
fluid imbalances.
-Encourage
verbalization of Prolonged
feelings. Provide immobilization
diversionary contributes to
activities. depression, anxiety
and frustration.
Verbalization may
help decrease stress.
Diversionary
activities decrease
boredom and give
the patient some self
control.
 29

Dependent:

-Reposition the
patient as advised.
minimizes risk of
skin breakdown.

-Administer
prescribed
medicine. Promote healing
and fast recovery
-Assist the patient in
performing gentle
ROM exercise for Exercise, as
unaffected allowed, decrease
extremities. venous stasis and
Collaborative: helps maintain
muscle tone.
Assist on any
laboratory
procedures
 30

Drug Study
 31

Drug Name Cefuroxime 750mg IV q8

Classification ANTIINFECTIVE; ANTIBIOTIC; SECOND-GENERATION

CEPHALOSPORIN

Adverse effect Body as a Whole: Thrombophlebitis(IV site); pain,

burning, cellulites (IM site); super infections

GI: Diarrhea, nausea, antibiotic- associated colitis.

Skin: Rash, pruritus, urticaria.

Urogenital: Increased serum creatinine and BUN,

decreased
creatinine clearance

Indication Effectively treats bone and joint infections, bronchitis

meningitis, lower respiratory tract infections, skin and
soft tissue infections, urinary tract infections, and is
used for surgical prophylaxis, reducing or eliminating
infection.

Contraindications Hypersensitivity to cephalosporins and related

antibiotics; pregnancy (category B), lactation

Nursing • Determine history of hypersensitivity reactions to

Consideration cephalosporins, penicillins, and history of allergies,
particularly to drugs, before therapy is initiated.
• Inspect IM and IV injection sites frequently for
signs of
phlebitis.
• Monitor I&O rates and Pattern: Especially
important in severely ill patients receivinghigh
doses. Report any
significant changes.
32
 33
Drug Name Ambroxol 30mg HCl 1tab/TID

Classification Antiasthmatic, Mucolytic

Adverse effect Mild GI side effects and rashes

Indication Acute and Chronic disorders of the respiratory tract

associated with pathologically thickened mucus and
impaired mucus transport.

This medicine should not be used if you are allergic to one or

Contraindications
any of its ingredients.

Nursing • Advice patient to drink plenty of fluids, particularly

Consideration hot fluids to facilitate moist air passages and to
refrain from things that can irritate the throat such
as smoke
 34

Drug Name Salbutamol 1neb q6

Classification Bronchodilator (respiratory smooth muscle

relaxant), beta-agonists

Adverse effect CNS: tremor, nervousness, dizziness, insomnia,

headache, hyperactivity, weakness, CNS stimulation,
malaise.

CV: tachycardia, palpitations, hypertension.

EENT: dry and irritated nose and throat with inhaled

form, nasal congestion, epistaxis, hoarseness.

GI: heartburn, nausea, vomiting, anorexia, altered

taste, increased appetite.

Musculoskeletal: muscle cramps.

Indication To relieve bronchospasm associated with acute or

chronic asthma, bronchitis, or other reversible
 35

obstructive airway diseases.

• This medicine should not be used if you are allergic to

Contraindications
one or any of its ingredients.

• Use cautiously in patients with CV disorders

(including coronary insufficiency and
hypertension), hyperthyroidism, or diabetes
mellitus and in those who are unusually
responsive to adrenergic.

Nursing • Drug may decrease sensitivity of spirometry used

Consideration for diagnosis of asthma.

Drug Name Bisacodyll supp if w/o BM >3days

Classification Laxative; Stimulant/Chemical irritant

Adverse effect Excessive bowel activity. Perianal irritation.

Abdominal cramps. Weakness. Dizziness. Cathartic

Indication Short-term relief of constipation. Prevents straining.

To evacuate the bowel for diagnostic procedures.

Contraindications In cases of allergy to bisacodyll, acute abdominal

pain.

Nursing • Used as a temporary measure. Don’t take this

Consideration drug within 1 hour of any other drugs. Report
 36

sweating, flushing, muscle cramps, excessive

thirst

Drug Name Paracetamol 500mg 1tab q4 >38oC

Classification Analgesic, Antipyretic

Adverse effect Allergic skin reactions. GI disturbances. Chest pain,

dyspnea, myocardial damage (5-8 g/day for several
weeks) Jaundice.

Indication Relief of fever, minor aches, and pains.

Contraindications Anemia, heart and pulmonary disease.

Hepatic/severe renal disease.
 37

Nursing • Do not take longer for 10 days. Report rash,

Consideration unusual bleeding or bruises, yellowing of skin and
eye, changes in voiding patterns.
• Don’t exceed the recommended dosage.

Drug Name Buscopan 1tad/TID

Classification Anti-spasmodic

Adverse effect Constipation, dry mouth, trouble urinating, or nausea

could occur. If these continue or are bothersome,
notify your doctor promptly. Very unlikely but report:
rash, itching, swelling of the hands or feet, trouble
breathing, increased pulse, dizziness, diarrhea, vision
problems, eye pain. If you notice other effects not
listed above, contact your doctor or pharmacist.

Indication Used to relieve bladder or intestinal spasms

 38

Contraindications Tell your doctor your medical history, especially of:

glaucoma or other eye problems, heart disease,
enlarged prostate (males), allergies, stomach or
intestinal diseases.

Nursing • . Take as directed. The usual maximum number of

Consideration tablets per day is 6. Swallow tablets whole with a
glass of water. Take at least one hour before
antacids or certain anti-diarrhea drugs (e.g.,
kaolin-pectin type

EVALUATION

Medication

Instruct the patient to take his medications on time and explain their actions, side
effects and schedules. Report adverse effects. Salbutamol/nebulizer as needed,
Bisacodyl/Suppository without bowel movement greater than or equal three days,
Paracetamol/500mg per tablet for temperature that is greater than or equal 38 degree
Celsius and Buscopan/10mg tablet to relieve bladder and intestinal spasms.

Exercise

• Encourage patient to perform gentle Range of Motion exercises for unaffected

extremities as allowed.

• Encourage alternate flexion and extension and quadriceps-setting exercise for the
affected limb as permitted.

Treatment
 39

• Pelvic traction

• Bed rest on a firm mattress

• Take iron supplement and Vitamin C for better absorption one tablet each per day.

• Take foods rich in calcium.

Health Teaching

• Bed rest and avoid strenuous activity

• Proper body mechanics.

Out-Patient

• Strict compliance for scheduled follow-up check-up.

Diet

• Diet as Tolerated

References:

Fundamentals of Nursing Vol.I by Kozier and Erb

Fundamentals of Nursing Vol.II by Kozier and Erb

Medical-Surgical Nursing Vol I & II by Brunner and Suddarth

Foundation of Clinical Application to Nutrition, 3rd Edition by Grodner

Nursing Drug Handbook by Lippincott

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