Following a severe spinal cord injury in the lumbar region, the voluntary muscles in the legs and the hips will be paralyzed. Describe the effects of the paralysis on the skeleton. * As I begin this it might be wordy but, if anyone has any questions please ask, this being a perspective of a Paramedic and related references. In the beginning stages of the trauma, there are many bodily processes that are affected, some are immediate, and some are a result of the insult to the surrounding structures. If the patient still being in a trauma ward of a hospital, the patient must be continually evaluated for any cardiac compromise that could be an issue from the swelling due to the injury. The description of how body systems and functionality are compromised begins with chemical changes that cascade to the possibility of irreversible damage. . (Sole, Klien, Mosley, 2005) The cellular response secondary to the damage begins the with cell death with Na+ movement into the cells to begin the process of the edema as the influx of Ca++ begins it begins to breakdown the neurons and the eventual breakdown of the cells membrane and the cells rupture. As the assaults on the cells continue, it stimulates other body responses of the histamine, immune responses to begin the vasoconstriction of the blood vessels. (Sole, Klien, Mosley, 2005) In the end the blood vessels eventually rupture with the spinal cord having a decrease in blood flow, there being irreversible neuro cell death and the patient is then given the diagnosis of a “complete lesion”, or total permanent loss of motor and sensory function below the injury. (Sole, Klien, Mosley, 2005)
The effects of the paralysis on the skeleton are almost simultaneous after the trauma. The nerves that connect to all the connected areas die the dysfunction of the organs to include the bladder, intestines, and also the sexual areas. As there is decreased function of the musculature, the blood supplies to all areas are decreased so there being eventual organ death, skin breakdown which can lead to increased infections that can be overlooked due to the inability of the patient to feel pain. The eventual result of the patient in a long term process, the muscles of the lower limbs can cause the legs to contracture.
A 5 month old infant is brought to a clinic after having diarrhea for 2 days.
The nurse checks the baby’s anterior fontanel and notices that it appears sunken. What has caused this?
The observation of the sunken fontanel in an infant is especially important as we continue to learn how to not only assess them, but, it can be a determining factor in our treatment. The sunken fontanel in an infant is usually the result of dehydration; there are other determining factors to go along with it such as diarrhea or vomiting. Since infants are so small and have only just a small amount of blood and water volume, the results of dehydration can begin with very few occurrences of fluid loss. In the case of increased dehydration, or, there being the alteration in the mental status of the infant, hypovolemic shock can ensue which, in infants especially, could cause there to cardio-respiratory compromise which could be avoided by careful observation upon assessment and aggressive treatment. In some instances of severe hypovolemia, vascular access can be difficult, Intraosseous cannulation of an infant’s distal tibial tuberosity, can be used for temporary fluid, blood and medication administration. (AHA, AAP, 2010)
Mary L. Sole, D. L. (2005). Introduction to Critial Care Nursing. St. Louis, Mo: Elsevier-Saunders. Monica E. Kleinman, C. (2010). Pediatric Advanced Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics, 172-179, 181.
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Topic: A & P- Pediatric trauma and Dehydration
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