Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Methylpred-nisolone

30 mg/kg IV as a loading dose, followed by a 48-hr IV infusion of 5.4 mg/kg per hour

Corticosteroid

Reduces inflammation and improves motor and sensory function

Inotropic agents

Varies by drug

Dopamine, dobutamine

Improve systemic vascular resistance and blood pressure

Atropine

1 mg IV as needed

Anticholinergic

Manage symptomatic bradycardia

Other Drugs: Prophylactic anticoagulants may prevent the formation of deep vein thrombosis when the patient is no longer at risk for hemorrhage. Histamine-receptor antagonists decrease gastric acid secretion by inhibiting the receptor sites in the parietal cells and reducing the risk of stress ulcers. Antacids may be administered to neutralize gastric acid.

Independent

The most critical nursing intervention for the patient with an acute SCI is to maintain airway, breathing, and circulation. Maintain cervical alignment and immobilization. An abdominal binder may be beneficial in patients with SCIs to provide additional support of the abdominal musculature, a major contributor to respiratory excursion. A potentially life-threatening complication associated with acute SCI is autonomic dysreflexia. This dysfunction may occur after the acute phase and is characterized by a hypersympathetic response to some noxious stimuli; this response is commonly found in patients with SCIs above the T8 level (Box 1). Deep vein thrombosis may also occur. Apply sequential compression devices or foot pumps as prescribed.

• BOX 1 Autonomic Dysreflexia

Precipitating Factors

Clinical Manifestations

Bladder distension or urinary tract infection

Paroxysmal hypertension

Bowel distension

Pounding headache

Pressure ulcers

Blurred vision

Thrombophlebitis

Bradycardia

Gastric ulcers, gastritis

Diaphoresis above the level of injury

Pulmonary emboli

Piloerection

Menstruation

Nasal congestion

Constrictive clothing

Nausea

Pain

Pupillary dilation

Sexual activity; ejaculation

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