University of Saint Louis

Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

CASE STUDY
ON
ACUTE SPINAL CORD
INJURY

JHOANNA MAE T. ROMIAS

BSN 4 Group A
 University of Saint Louis
Tuguegarao City, Cagayan 3500
SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

INTRODUCTION

Definition
The spinal cord is a long bundle of nerves and cells that extends from the lower portion of the
brain to the lower back. It carries signals between the brain and the rest of the body.
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent
changes in its function. Symptoms vary, from numbness to paralysis, including bowel or bladder
incontinence. Long term outcomes range from full recovery to permanent tetraplegia.
A traumatic injury causes acute spinal cord damage (SCI). The spinal cord may be bruised
(contusion), partially torn, or completely ruptured (transection) as a result of the injury. Men
and young adults are more likely to suffer from SCI.

Types of Spinal Cord

As most spinal cord injuries are caused by trauma, there are numerous ways in which injuries
can occur and various types of spinal cord injuries.

The majority of spinal cord injuries consist of two categories;

1. A complete spinal cord injury results in irreversible damage to the damaged portion of
the spinal cord. Complete spinal cord damage result in paraplegia or tetraplegia.

Types of Complete Spinal Cord Injury

 Tetraplegia

Tetraplegia (sometimes referred to as quadriplegia) is a term used

to describe the inability to voluntarily move the upper and lower parts of
the body. The areas of impaired mobility usually include the fingers,
hands, arms, chest, legs, feet and toes and may or may not include the
head, neck, and shoulders.

 Paraplegia

Paraplegia is a term used to describe the inability to voluntarily

move the lower parts of the body. The areas of impaired mobility usually
include the toes, feet, legs, and may or may not include the abdomen.
 University of Saint Louis
Tuguegarao City, Cagayan 3500
SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

 Triplegia

Triplegia is a medical condition that is considered an incomplete

spinal cord injury, in which three limbs are paralyzed. Put another way,
the condition causes loss of sensation and movement in one arm and
both legs.

2. A partial spinal cord injury is referred to as an incomplete spinal cord injury. The extent
of movement and sensation is determined by the affected portion of the spine and the
severity of the injury. The patient's health and medical history determine the outcome.

Common causes of spinal cord injuries

The most common causes of spinal cord injuries in the United States are:

 Motor vehicle accidents. Auto and motorcycle accidents are the leading cause of
spinal cord injuries, accounting for almost half of new spinal cord injuries each
year.
 Falls. A spinal cord injury after age 65 is most often caused by a fall.
 Acts of violence. About 12% of spinal cord injuries result from violent encounters,
usually from gunshot wounds. Knife wounds also are common.
 Sports and recreation injuries. Athletic activities, such as impact sports and diving
in shallow water, cause about 10% of spinal cord injuries.
 Diseases. Cancer, arthritis, osteoporosis and inflammation of the spinal cord also
can cause spinal cord injuries.

Symptoms

Symptoms vary depending on the severity and location of the SCI. At first, the person may have
spinal shock. This causes loss of feeling, muscle movement, and reflexes below the level of
 University of Saint Louis
Tuguegarao City, Cagayan 3500
SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

injury. Spinal shock often lasts from several hours to several weeks. As the shock lessens, other
symptoms appear. This depends on the location of the injury.

For SCI, the higher up on the spinal cord, the more severe the symptoms. For example:

• Injury at C2 or C3. These are the second and third vertebrae in the spinal column. This
affects the respiratory muscles and the ability to breathe.
• Injury in the lumbar vertebrae. This may affect nerve and muscle control to the bladder,
bowel, and legs.

Spinal cord injuries can cause one or more of the following signs and symptoms:

 Loss of movement
 Loss of or altered sensation, including the ability to feel heat, cold and touch
 Loss of bowel or bladder control
 Exaggerated reflex activities or spasms
 Changes in sexual function, sexual sensitivity and fertility
 Pain or an intense stinging sensation caused by damage to the nerve fibers in the
spinal cord
 Difficulty breathing, coughing or clearing secretions from the lungs

Emergency signs and symptoms of a spinal cord injury after an accident include:

 Extreme back pain or pressure in the neck, head or back

 Weakness, incoordination or paralysis in any part of the body
 Numbness, tingling or loss of sensation in the hands, fingers, feet or toes
 Loss of bladder or bowel control
 Difficulty with balance and walking
 Impaired breathing after injury
 An oddly positioned or twisted neck or back
 University of Saint Louis
Tuguegarao City, Cagayan 3500
SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

Levels of Spinal Cord Injury

 Cervical Spinal Cord Injuries

Cervical spinal cord injuries affect the head

and neck region above the shoulders. It is the
most severe level of spinal cord injury.

 Thoracic Spinal Cord Injuries

Thoracic spinal cord injuries affect the upper

chest, mid-back and abdominal muscles. Arm
and hand function is usually normal with this
level of spinal cord injury.

 Lumbar Spinal Cord Injuries

Lumbar spinal cord injuries affect the hips and
legs. Individuals may need a wheelchair or
walk with braces with this level of spinal cord
injury.
 University of Saint Louis
Tuguegarao City, Cagayan 3500
SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

 Sacral Spinal Cord Injuries

Sacral spinal cord injuries affect the hips,
back of the thighs, buttocks and pelvic
organs. Individuals are most likely able to
walk with this level of spinal cord injury.

Risk Factors
Although a spinal cord injury is usually the result of an accident and can happen to anyone,
certain factors can predispose you to being at higher risk of having a spinal cord injury,
including:

 Being male. Spinal cord injuries affect a disproportionate number of men. In fact,

females account for only about 20% of traumatic spinal cord injuries in the United
States.
 Being between the ages of 16 and 30. More than half of spinal cord injuries occur
in people in this age range.
 Being 65 and older. Another spike in spinal cord injuries occurs at age 65. Falls
cause most injuries in older adults.
 Alcohol use. Alcohol use is involved in about 25 % of traumatic spinal cord injuries.
 Engaging in risky behavior. Diving into too-shallow water or playing sports without
wearing the proper safety gear or taking proper precautions can lead to spinal
cord injuries. Motor vehicle crashes are the leading cause of spinal cord injuries for
people under 65.
 Having certain diseases. A relatively minor injury can cause a spinal cord injury if
you have another disorder that affects the joints or bones, such as osteoporosis.

Complications
Changes in the way the body works can be daunting at first. The rehabilitation team, on the
other hand, will work towards developing strategies to address the changes brought on by the
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Tuguegarao City, Cagayan 3500
SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

spinal cord injury, as well as recommend equipment and resources to improve the quality of life
and independence. The following areas are frequently affected:

 Bladder control. The bladder will continue to store urine from the kidneys. However,
the brain might not control the bladder as well because the message carrier (the spinal
cord) has been injured. The changes in bladder control increase the risk of urinary tract
infections. The changes may also cause kidney infections and kidney or bladder stones.

 Bowel control. Although the stomach and intestines work much like they did before the
injury, control of the bowel movements is often altered. A high-fiber diet might help
regulate the bowels.

 Pressure injuries. Below the neurological level of the injury, the body might have lost
some or all skin sensations. Therefore, the skin can't send a message to the brain when
it's injured by certain things such as prolonged pressure. This can make the person
susceptible to pressure sores, but changing positions frequently, with help, if needed,
can help prevent these sores.

 Circulatory control. A spinal cord injury can cause circulatory problems ranging from
low blood pressure when you rise (orthostatic hypotension) to swelling of the
extremities. These circulation changes can also increase the risk of developing blood
clots, such as deep vein thrombosis or a pulmonary embolus. Another problem with
circulatory control is a potentially life-threatening rise in blood pressure (autonomic
dysreflexia).

 Respiratory system. The injury might make it more difficult to breathe and cough if the
abdominal and chest muscles are affected. The neurological level of injury will
determine what kind of breathing problems a person have. If it’s a cervical and thoracic
spinal cord injury, it may have an increased risk of pneumonia or other lung problems.
Medications and therapy can help prevent and treat these problems.

 Bone density. After spinal cord injury, there's an increased risk of osteoporosis and
fractures below the level of injury.
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Tuguegarao City, Cagayan 3500
SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

 Muscle tone. Some people with spinal cord injuries have one of two types of muscle
tone problems: uncontrolled tightening or motion in the muscles (spasticity) or soft and
limp muscles lacking muscle tone (flaccidity).

 Fitness and wellness. Weight loss and muscle atrophy are common soon after a spinal
cord injury. Limited mobility can lead to a more sedentary lifestyle, placing at risk of
obesity, cardiovascular disease and diabetes. A dietitian can help you eat a nutritious
diet to sustain an adequate weight. Physical and occupational therapists can help
develop a fitness and exercise program.

 Sexual health. Men might notice changes in erection and ejaculation; women might
notice changes in lubrication after a spinal cord injury. Physicians specializing in urology
or fertility can offer options for sexual functioning and fertility.

 Pain. Some people have pain, such as muscle or joint pain, from overuse of particular
muscle groups. Nerve pain can occur after a spinal cord injury, especially in someone
with an incomplete injury.

 Depression. Coping with the changes a spinal cord injury brings and living with pain
causes depression in some people.
Diagnostics

In the emergency room, a doctor may be able to rule out a spinal cord injury by examination,
testing for sensory function and movement, and by asking some questions about the accident.

But if the injured person complains of neck pain, isn't fully awake, or has obvious signs of
weakness or neurological injury, emergency diagnostic tests may be needed.

These tests can include:

 X-rays. X-rays can reveal vertebral (spinal column) problems, tumors, fractures or

degenerative changes in the spine.
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Tuguegarao City, Cagayan 3500
SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

 CT scan. A CT scan can provide a clearer image of abnormalities seen on X-ray. This
scan uses computers to form a series of cross-sectional images that can define
bone, disk and other problems.

 MRI. MRI uses a strong magnetic field and radio waves to produce computer-
generated images. This test is helpful for looking at the spinal cord and identifying
herniated disks, blood clots or other masses that might compress the spinal cord.
Treatments

Unfortunately, there's no way to reverse damage to the spinal cord. But researchers are
continually working on new treatments, including prostheses and medications, that might
promote nerve cell regeneration or improve the function of the nerves that remain after a
spinal cord injury.

In the meantime, spinal cord injury treatment focuses on preventing further injury and
empowering people with a spinal cord injury to return to an active and productive life.

1.Emergency actions
Urgent medical attention is critical to minimize the effects of head or neck trauma.
Therefore, treatment for a spinal cord injury often begins at the accident scene.
Emergency personnel typically immobilize the spine as gently and quickly as possible
using a rigid neck collar and a rigid carrying board, which they use during transport to
the hospital.

2. Early (acute) stages of treatment

In the emergency room, doctors focus on:

• Maintaining the ability to breathe

• Preventing shock
• Immobilizing the neck to prevent further spinal cord damage
• Changes in the way the body works can be daunting at first. The rehabilitation
team, on the other hand, will work towards developing strategies to address the
 University of Saint Louis
Tuguegarao City, Cagayan 3500
SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

changes brought on by the spinal cord injury, as well as recommend equipment
and resources to improve the quality of life and independence. The following areas
are frequently affected:
• Medications. Methylprednisolone (Solu-Medrol) given through a vein in the arm
(IV) has been used as a treatment option for an acute spinal cord injury in the past.
But recent research has shown that the potential side effects, such as blood clots
and pneumonia, from using this medication outweigh the benefits.
Because of this, methylprednisolone is no longer recommended for routine use
after a spinal cord injury.

• Immobilization. Traction may be required to stabilize or correct the spine. Soft

neck collars and varied braces are among the options.
• Surgery. Often surgery is necessary to remove fragments of bones, foreign objects,
herniated disks or fractured vertebrae that appear to be compressing the spine.
Surgery might also be needed to stabilize the spine to prevent future pain or
deformity.
• Experimental treatments. Scientists are trying to figure out ways to stop cell death,
control inflammation and promote nerve regeneration. For example, lowering
body temperature significantly — a condition known as hypothermia — for 24 to
48 hours might help prevent damaging inflammation. More study is needed.

3. Ongoing care

Doctors focus on preventing secondary problems such as deconditioning, muscle

contractures, pressure ulcers, bowel and bladder disorders, lung infections, and blood
clots after the underlying injury or ailment has stabilized. The length of the hospital stay
will be determined by the medical condition and difficulties. 

4. Rehabilitation
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BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

During the initial stages of rehabilitation, therapists usually emphasize maintaining and
strengthening muscle function, redeveloping fine motor skills, and learning ways to
adapt to do day-to-day tasks.

5. Medications
Medications might be used to manage some of the effects of spinal cord injury.
These Include medications to control pain and muscle spasticity, as well as medications
that can improve bladder control, bowel control and sexual functioning.

6. New technologies
Inventive medical devices can help people with a spinal cord injury become more
independent and more mobile. These include:

 Electrical stimulation devices. Often called functional electrical stimulation systems, these
sophisticated devices use electrical stimulators to control arm and leg muscles to allow
people with spinal cord injuries to stand, walk, reach and grip.

Statistics

In the United States, the current spinal cord injury prevalence (persons living with an SCI) is
estimated to be between 243,000 and 347,000 persons. According to the World Health
Organization (WHO), it's believed that there are between 250,000-500,000 new spinal cord
injuries every year. About 54 per million, or 12,500 per year.

Annual global spinal cord injury

incidence (new instances of SCI’s)
is estimated to be between 40 and
80 cases per million. But currently,
there is no truly accurate estimate
of global spinal cord injury
prevalence or incidence – for a
variety of reasons, including limited
 University of Saint Louis
Tuguegarao City, Cagayan 3500
SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

access to data in developing countries, we don’t yet know how many people are affected by a
spinal cord injury worldwide.Motor vehicle accidents are the most common cause of a spinal
cord injury (SCI), making up 38.4% of all cases. This is followed by falls (30.5%) violence (13.5%),
sports-related incidents (8.9%) and medical/surgical incidents (4.7%). In the UK, where SCIs
prevalence is lower, the top two causes of injury are reversed – falls are the number one cause
at 41.7%, followed closely by motor vehicle accidents at 36.8%.

PATIENT’S PROFILE

Name: J. P. G
Sex: Male
Age: 17
Birthdate: May 30, 2005
Birthplace: Manuel A. Roxas District Hospital
Address: Roxas, Isabela
Nationality: Filipino
Dialect: Tagalog
Religion: Roman Catholic
Educational Attainment: Senior High School
Occupation: Student
Civil Status: Single
Height: 5’8
Weight: 62
BMI: 20.8 (Normal)
Date of Admission: 5-18-2022
Chief Complaint: Paralysis
Admitting Diagnosis: Acute Spinal Cord Injury ASIA-A (Complete) C2 level secondary to
hyperflexion injury
Attending Physician: Dr. Sabado
Consultant: Dr Primrose Piringit
Admitting vital signs Temperature: 36.2
Pulse rate: 80 bpm
Respiratory rate: 20 cpm
Blood pressure: 100/70 mmHg

Final vital signs;

Temperature: 37
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BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

Pulse rate: 55 bpm
Respiratory rate: 25 cpm
Blood pressure: 90/60 mmHg
Oxygen saturation: 97%

Patient’s Profile
Patient J.P.G was born on May 30, 2005, and is 17 years old. He currently lives  with his mother
in Roxas, Isabela. He attends Roxas Stand-Alone Senior High School and is in grade 11. He is a
Filipino citizen who follows the Roman Catholic Church's teachings. He was admitted to Manuel
A. Roxas District Hospital after a bicycle accident, but due to a lack of resources (orthopedic
specialist), he was referred to Cagayan Valley Medical Center, where he was admitted to the
Orthopedic Ward for spine stabilization, and then to Rehabilitation Medication for bed sore
prevention, muscle strengthening exercises, and general body conditioning exercises.

History of Present Illness

According to the patient's mother, he was riding his bicycle with his companions on their way
home from the mountain when he realized he was going too fast and fell off. He was taken to
Manuel A. Roxas District Hospital in Isabela, and then referred to Cagayan Valley Medical
Center, where he was admitted with a chief complaint of paralysis and diagnosed with Acute
Spinal Cord Injury ASIA-A (Complete) C2 level secondary to hyperflexion injury conditioning
exercises.

History of Past Illness

Patient J.P.G received his vaccines when he was younger. He had health issues like fever, cough,
and colds, which he was able to treat with over-the-counter medications like paracetamol and
Solmux. He had no dietary or drug allergies, and no previous medical history. He has never been
hospitalized before.
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Tuguegarao City, Cagayan 3500
SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

Social History
J.P.G is a nonsmoker and does not consume alcoholic beverages. As an only child, he enjoys a
solid bond with his family and his needs are met. He has numerous friends, but he rarely sees
them because he prefers to ride his bicycle.
 University of Saint Louis
Tuguegarao City, Cagayan 3500
SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

FAMILY HEALTH HISTORY

FATHER MOTHER

(43 years old) (38 years old)

No Medical Diagnosed with

Significance Hypertension

Patient J.P.G

(17 years old)

Diagnosed with Acute

Spinal Cord Injury

LEGEND:

MALE

FEMALE

PARENTS

PATIENT
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SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

GORDONS 11 FUNCTIONAL HEALTH PATTERN

HEALTH PATTERNS BEFORE HOSPITALIZATION DURING HOSPITALIZATION

HEALTH PERCEPTION- Patient J.P.G rated himself an 8 Patient stated, "Hindi ko na po
HEALTH MANAGEMENT out of 10 health rating, with 10 masasabing healthy ako
PATTERN being the best and 0 being the ngayon." The patient defines
worst. When the patient and his health as the absence of any
family experience health illness or condition that
difficulties that interfere with interferes with everyday
their daily activities, they visit activities. As a result, he feels
the doctor or a health center unhealthy as a result of his
right away. They always heed inability to move. He gave
the recommendations of himself a 4 out of 10 health
medical professionals. They rating while in the hospital, with
address treatable health 10 being the best. He added
concerns like fever, cold, and that because of his condition,
cough with over-the-counter he can only rely on his mother
medications like paracetamol and health-care providers for
and Solmux. In addition, the his care.
patient is fully immunized. The
second dose of Pfizer COVID19
vaccine was his most recent
vaccination. The patient had
never had surgery before. He
exclusively rides his bike for
exercise and does not smoke or
use alcohol.
NUTRITIONAL- Patient J.P.G eats three times a He eats through an NGT which
METABOLIC PATTERN day. He eats anything is put in was inserted on May 18, 2022.
front of him. He eats a lot of His diet consists of osterized
food. His typical diet consists of food with a daily caloric intake
veggies and meat. Every day, he of 1600 kcal divided into six
drinks approximately 8-10 feedings (10 am, 2pm, 6pm, 10
glasses of water. He takes pm, 2 am, 6 am,). His daily fluid
vitamins such Poten-Cee 500 consumption is 3400 ml.
mg/tab on a daily basis.
Height: 172.72 cm
Height: 172.72 cm Weight: 62 kgs.
Weight: 67 kgs. BMI: 20.8 (Normal)
BMI: 22.5 (Normal)
ELIMINATION PATTERN Patient J.P.G voids light-yellow When questioned if he has
urine 6-7 times per day. He trouble defecating while in the
urinates around 800 ml of urine hospital, Patient J.P.G said,
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BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

per day. He also stated that "Nararamdaman ko nalang po
voiding did not cause him any na parang may nakukuryente sa
difficulty or suffering. He claims likod ko at alam ko na pong
to defecate once a day, with a tumatae ako non." His diaper
semi-formed, brown-colored was changed twice during an 8-
feces. hour shift, and his urine output
was 550 cc. His feces is usually
As he stated, "Okay naman po brown and soft in tone, and his
yung pagtae ko, hindi ako urine is light yellow in color.
nahihirapan at minsan lang po
ako nagtatae kapag may nakain
siguro akong ayaw ng tiyan ko,"
he rarely gets constipation or
diarrhea.
ACTIVITY-EXERCISE He views biking to be a form of Patient J.P.G sees a physical
PATTERN exercise. He stated that the only therapist twice a week for
time he gets outside is to ride treatment. His mother helps
his bicycle. When he is not him with passive ROM exercises
cycling, he helps with household sometimes. His activities were
chores and considers it his reliant on his mother and health
physical activity. He also stated care providers since his
that he has no respiratory issues hospitalization.
and does not experience any
weakness as a result of his
exercises.
COGNITIVE- PERCEPTUAL Patient J.P.G is aware to The patient's mental functions
PATTERN persons, time, and location. are unaffected. He states that
Through explanation and he can still concentrate easily,
multimedia presentation, he that his memory has not
learns quickly. He states that he changed, and that he has no
has no difficulties with his vision or hearing impairments.
senses. He is in the eleventh When the surroundings is noisy,
grade and claims to do well in he becomes angry.
school.
SLEEP-REST PATTERN Patient J.P.G sleeps for 8 hours "Nakakatulog naman po ako,
on average, with no pero nagigising ako lagi dahil sa
interruptions. He goes to bed at init at sa ingay," he says. As his
9 p.m. and gets up around 6 typical sleeping length at the
a.m. He normally takes his nap hospital was inconsistent, he
in the afternoon, around 2-3 verbalized, "Minsan po
p.m., for 30 minutes to an hour. nagigising ako dahil sa pagbisita
The patient stated, sakin ng mga nurse at doctor."
"Nakakatulog po ako ng maayos He also wakes up twice in the
 University of Saint Louis
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SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

at nakakapagpahinga po ako evening between sleeps.
noon." When the patient sleeps Furthermore, after each
for the recommended amount
of time, he feels rested. He naps frequently, usually for
30 minutes to an hour, after
NGT feeding.
SELF PERCEPTION- SELF "Okay naman po ako sa sarili ko "Sana di nalang ako nagbike
CONCEPT PATTERN noon, nagpapasalamat nga din noon," the patient expressed
po ako na meron po yung his frustration with the
parents ko para suportahan ako accident's consequences, as
sa mga gusto ko," he said when well as his uncertainty about his
asked about his self-perception. future and desire to regain his
Patient was content and normal abilities. When asked
satisfied with his situation. He about his description of himself,
does, however, want to be a he stated, "Wala naman pong
seaman in the future. nagbago sakin, mabait at
palabiro padin naman po ako."
Despite the severity of his
condition, he has not lost
ROLES-RELATIONSHIP He stated that he is not in a He mentioned that he is still not
PATTERN relationship. He has lots of in relationship. Because he is
friends and only goes out for unable to care for himself, his
cycling. He is the family's only mother performs all self-care
child and gets along well with activities for him in the hospital.
his parents. His father is a In the family, the choice is made
mechanic, while his mother is a by the parents.
housewife. Theirs is a nuclear
family.
SEXUALITY- Patient J.P.G was circumcised Patient J.P.G claims that his
REPRODUCTIVE PATTERN when he was 11 years old. sexual and reproductive
When he was 12 years old, he functions have not changed.
began to notice changes in his
physical structure and voice.
The patient stated that he had
never had any sexual contact.
He has no sexual or
reproductive issues, either.
COPING-STRESS The main source of stress for His recent accident was the
TOLERANCE PATTERN patient J.P.G was his modules. most stressful and tragic event
He de-stresses by riding his in his life. He reported that he
bicycle and checking his social acquires comfort from himself,
media profiles. He admitted and his mother which
that he rarely plays mobile accompanies and supports him
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BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY

games. at the hospital. He also takes
nap and rest when he feels
tired. When he feels rested, he
asks his mother to hold the
phone for him to watch on
Youtube or Facebook.
VALUES-BELIEF PATTERN Patient J.P.G and his family are Patient J.P.G and his mother
Roman Catholic. He and his aren’t able to attend the mass
parents attend the mass twice a due to their stay at the hospital.
month. He does not believe in However, they reported that his
superstitious beliefs as he only father now goes to mass
believes in God. regularly since the accident.
During their stay, they always
remember to pray and believes
that prayer can help them
overcome their struggles.
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ANATOMY AND PHYSIOLOGY

The Central and the Peripheral Nervous System

The central nervous system (CNS) consists of the brain and spinal cord. The brain is housed
within the braincase; the spinal cord is in the vertebral column. The peripheral nervous system
(PNS) consists of all the nerves and ganglia outside the brain and spinal cord. The PNS collects
information from numerous sources both inside and on the surface of the body and relays it by
way of sensory neurons to the CNS, where one of three results is possible: The information is
ignored, triggers a reflex, or is evaluated more extensively. Motor neurons in the PNS relay
information from the CNS to muscles and glands in various parts of the body, regulating activity
in those structures. The nerves of the PNS can be divided into two groups: 12 pairs of cranial
nerves and 31 pairs of spinal nerves.

Neurons
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FIGURE 1. TYPICAL NEURON
Neurons are responsible for carrying information throughout the human body. Using electrical
and chemical signals, they help coordinate all of the necessary functions of life. Each neuron is
connected to another 1,000 neurons, creating an incredibly complex network of
communication. Neurons are considered the basic units of the nervous system.

Neurons can only be seen using a microscope and can be split into three parts:

 Soma (cell body) — this portion of the neuron receives information. It contains the cell’s
nucleus.
 Dendrites — these thin filaments carry information from other neurons to the soma.
They are the “input” part of the cell.
 Axon — this long projection carries information from the soma and sends it off to other
cells. This is the “output” part of the cell. It normally ends with a number of synapses
connecting to the dendrites of other neurons.

If a neuron receives a large number of inputs from other neurons, these signals add up
until they exceed a particular threshold. Once this threshold is exceeded, the neuron is
triggered to send an impulse along its axon — this is called an action potential. Most
often, it is potassium (K+) and sodium (Na+) ions that generate the action potential. Ions
move in and out of the axons through voltage-gated ion channels and pumps.

Most axons are covered by a white, waxy substance called myelin. This coating insulates
nerves and increases the speed at which impulses travel. Myelin is created by Schwann
cells in the peripheral nervous system and oligodendrocytes in the CNS. There are small
gaps in the myelin coating, called nodes of Ranvier. The action potential jumps from gap
to gap, allowing the signal to move much quicker.

 Synapses
Neurons are connected to each other and tissues so that they can communicate messages;
however, they do not physically touch — there is always a gap between cells, called a
synapse.

Synapses can be electrical or chemical. In other words, the signal that is carried from the
first nerve fiber (presynaptic neuron) to the next (postsynaptic neuron) is transmitted by
an electrical signal or a chemical one.

Once a signal reaches a synapse, it triggers the release of chemicals (neurotransmitters)

into the gap between the two neurons; this gap is called the synaptic cleft. The
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neurotransmitter diffuses across the synaptic cleft and interacts with receptors on the
membrane of the postsynaptic neuron, triggering a response.

FIGURE 2. SYNAPSE

The Spinal Cord

The spinal cord extends from the foramen magnum at the base of the skull to the second lumbar
vertebra. Spinal nerves communicate between the spinal cord and the body. The inferior end of
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the spinal cord and the spinal nerves exiting there resemble a horse’s tail and are collectively
called the cauda equina (kaw′dă, tail; ē-kwī′nă, horse).

A cross section reveals that the spinal cord consists of a superficial white matter portion and a
deep gray matter portion. The white matter consists of myelinated axons, and the gray matter is
mainly a collection of neuron cell bodies. The white matter in each half of the spinal cord is
organized into three columns, called the dorsal (posterior), ventral (anterior), and lateral
columns. Each column of the spinal cord contains ascending and descending tracts, or pathways.
Ascending tracts consist of axons that conduct action potentials toward the brain, and descending
tracts consist of axons that conduct action potentials away from the brain.

The gray matter of the spinal cord is shaped like the letter H, with posterior horns and anterior
horns. Small lateral horns exist in levels of the spinal cord associated with the autonomic nervous
system. The central canal is a fluid-filled space in the center of the spinal cord.

Spinal nerves arise from numerous rootlets along the dorsal and ventral surfaces of the spinal
cord. The ventral rootlets combine to form a ventral root on the ventral (anterior) side of the
spinal cord, and the dorsal rootlets combine to form a dorsal root on the dorsal (posterior) side of
the spinal cord at each segment. The ventral and dorsal roots unite just lateral to the spinal cord
to form a spinal nerve.

The dorsal root contains a ganglion, called the dorsal root ganglion (gang′glē-on; a swelling or
knot). It contains the cell bodies of pseudo-unipolar sensory neurons. The axons of these neurons
originate in the periphery of the body. They pass through spinal nerves and the dorsal roots to the
posterior horn of the spinal cord gray matter. In the posterior horn, the axons either synapse with
interneurons or pass into the white matter and ascend or descend in the spinal cord.

FIGURE 3. SPINAL CORD AND SPINAL NERVE ROOTS

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FIGURE 4 . CROSS SECTION OF THE SPINAL CORD

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FIGURE 5. WITHDRAWAL REFLEX

Withdrawal Reflex

The function of the withdrawal reflex, or flexor reflex, is to remove a limb or another body part
from a painful stimulus. The sensory receptors are pain receptors, and stimulation of these
receptors initiates the reflex. Following painful stimuli, sensory neurons conduct action
potentials through the dorsal root to the spinal cord, where the sensory neurons synapse with
interneurons, which in turn synapse with motor neurons. These neurons stimulate muscles,
usually flexor muscles, that remove the limb from the source of the painful stimulus.

Spinal Nerves

The spinal nerves arise along the spinal cord from the union of the dorsal roots and ventral roots.
All the spinal nerves contain axons of both sensory and somatic motor neurons and thus are
called mixed nerves. Some spinal nerves also contain parasympathetic or sympathetic axons.
Spinal nerves are categorized by the region of the vertebral column from which they emerge—
cervical (C), thoracic (T), lumbar (L), sacral (S), and coccygeal (Co). The spinal nerves are also
numbered (starting superiorly) according to their order within that region. The 31 pairs of spinal
nerves are therefore C1 through C8, T1 through T12, L1 through L5, S1 through S5, and Co. The
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nerves arising from each region of the spinal cord and vertebral column supply specific regions
of the body. A dermatome is the area of skin supplied with sensory innervation by a pair of
spinal nerves. Each of the spinal nerves except C1 has a specific cutaneous sensory distribution.
Most of the spinal nerves are organized into three major plexuses (plek′sŭs-ēz; braids) where
neurons of several spinal nerves come together and intermingle. The three major plexuses are the
cervical plexus, the brachial plexus, and the lumbosacral plexus.

Cervical Plexus

The cervical plexus originates from spinal nerves C1 to C4. Branches from this plexus innervate
several of the muscles attached to the hyoid bone, as well as the skin of the neck and posterior
portion of the head. One of the most important branches of the cervical plexus is the phrenic
nerve, which innervates the diaphragm. Contraction of the diaphragm is largely responsible for
our ability to breathe.

FIGURE 6. PLEXUSES AND DERMATOMAL MAP

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DRUG STUDY

LACTULOSE
BRAND –
CONTRAINDICATIO INDICATION ADVERSE PRIORITIZED NURSING
DRUG CLASS GENERIC ACTION
N S REACTION CONSIDERATIONS
NAME
Brand Lactulose is a Hypersensitivity to Constipation Significant: Intervention/
Hyperosmotic name- synthetic lactulose. Pts Electrolyte evaluation
laxative Lilac, disaccharide requiring a low- imbalance,  Encourage adequate
Movelax, derivative of galactose diet. diarrhea (long- fluid intake.
Dosage/Route/ Duphala lactose that term treatment  Assess bowel
Freq uency: c consists of one or excessive sounds for
30cc/ODHS/PO molecule of doses). peristalsis.
Generic galacto- and Gastrointestina  Monitor daily
Name- fructose-based l disorders: pattern of
Lactulos polyunsaturate Nausea, bowel activity, stool
e d fats. vomiting, consistency; record
Saccharolytic flatulence, time of evacuation.
bacteria abdominal pain.  Assess for
present in the Metabolism abdominal
large intestine and nutrition disturbances.
subsequently disorders:  Monitor serum
break the Dehydration. electrolytes in pts
substance with prolonged,
down into frequent, excessive
organic acids use of medication.
like lactic acid
and small
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amounts of
formic and Patient/family teaching
acetic acids.  Evacuation occurs in
The formation 24–
of such acids via 48 hrs of initial dose.
the metabolism  Institute measures
of lactulose by to promote
colonic bacteria defecation: increase
also acidifies fluid intake,
the contents of exercise, high fiber
the colon, diet.
thereby  Drink plenty of
contributing to fluids.
the treatment
of portal-
systemic
encephalopathy
(PSE).
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DRUG STUDY

PARACETAMOL
PRIORITIZED
BRAND –
CONTRAINDICATIO INDICATION ADVERSE NURSING
DRUG CLASS GENERIC ACTION
N S REACTION CONSIDERATION
NAME
S
Brand Acetaminophe Hypersensitivity to Temporary Body as a Whole:  Assessment &
Analgesic, Name- n acetaminophen or relief of mild Drug Effects
Antipyretic Biogesic, (paracetamol) phenacetin to moderate Negligible with Monitor for
Calpol, pain. recommended S&S of:
Tempra is one of the
dosage; rash. hepatotoxicity,
Dosage/Route/ Forte, most even with
Freq uency: Opigesic, commonly moderate
Acute poisoning:
300mg/IV/ q4 PRN Sanmol prescribed Anorexia, nausea, acetaminophen
NSAIDs dizziness, doses,
Generic (nonsteroidal diaphoresis, especially in
Name- anti- epigastric or individuals
Paracetamol abdominal pain, with poor
inflammatory nutrition or
diarrhea; onset of
drugs) for pain hepatotoxicity— who have
relief. The elevation of serum ingested
exact transaminases alcohol
mechanism of (ALT, AST) and prolonged
action of this bilirubin; periods;
hypoglycemia, poisoning,
drug is not fully
hepatic coma, usually from
understood at acute renal failure accidental
this time, but (rare). ingestion or
future research suicide
may contribute Chronic attempts;
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to deeper potential abuse
knowledge. ingestion: from
One theory is Neutropenia, psychological
pancytopenia, dependence
that (withdrawal has
leukopenia,
acetaminophen thrombocytopenic been associated
increases the purpura, with restless
pain threshold hepatotoxicity in and excited
by inhibiting alcoholics, renal responses).
two isoforms of damage.
cyclooxygenase Patient Education
& Family
, COX1 and
COX-2, which  Do not take
are involved in other
prostaglandin medications
(PG) synthesis. (e.g., cold
preparations)
containing
acetaminophen
without
medical advice;
overdosing and
chronic use can
cause liver
damage and
other toxic
effects.

 Do not self-
medicate adults
for pain more
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than 10 d (5 d
in children)
without
consulting a
physician.

 Do not use this

medication
without
medical
direction for:
fever persisting
longer than 3 d,
fever over
39.5° C (103°
F), or recurrent
fever.

 Do not give
children more
than 5 doses in
24h unless
prescribed by
physician.

DRUG STUDY
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OMEPRAZOLE
BRAND –
ADVERSE PRIORITIZED NURSING
DRUG CLASS GENERIC ACTION CONTRAINDICATION INDICATIONS
REACTION CONSIDERATIONS
NAME
Brand Inhibits Hypersensitivity to Symptomatic Pancreatitis, Intervention/evaluation
Name- hydrogen- omeprazole, other GERD hepatotoxicity,
Proton pump PriLOSEC potassium proton pump interstitial  Evaluate for
inhibitor adenosine inhibitors. Erosive nephritis occur therapeutic response
Generic triphosphatase Concomitant use with Esophagitis rarely. May (relief of GI
Dosage/ Name- (H+ /K+ ATP products containing increase risk of symptoms).
Omeprazole pump), an rilpivirine. C. difficile
Route/Frequency: enzyme on the infection.  Question if GI
40mg/IV/OD surface of discomfort, nausea,
gastric parietal diarrhea occurs.
cells.
Patient/family teaching

 Report headache,
onset of black, tarry
stools, diarrhea,
abdominal pain.

 Avoid alcohol.

 Swallow capsules
whole; do not chew,
crush, dissolve, or
divide.
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 Take before eating.

Physiological Nursing Diagnosis #1

Assessment/Cues Nursing Background Goals and Objectives Nursing Interventions Evaluation

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Diagnosis Knowledge and Rationale
“Hindi po ako Ineffective It is considered the After 8 hours of nursing Independent:
masyadong breathing state in which the and collaborative
makahinga.”as pattern related rate, depth, timing, interventions, the  Assess respiratory
verbalized by the rhythm, or pattern rate, depth, and
to respiratory patient will be able to:
patient of breathing is breathing effort
muscle
altered. When the along with a full
weakness
breathing pattern is set of vital signs
 Establish normal or every four hours
ineffective, the
Objective: effective respiratory and as needed.
body will likely not
get enough oxygen pattern.
Vital signs taken: RATIONALE:
RR – 21 cpm to the cells.
Respiratory failure Trending these values
 Demonstrate proper provides information
PR – 60 bpm may be correlated
about changes that can
with variations in breathing exercises
reveal respiratory
respiratory rate, compromise early.
abdominal and
thoracic patterns.  Establish relaxation  Observe for
 techniques to perception of
reduce his anxiety. anxiety.

RATIONALE: Most
people panic when
they cannot breathe or
have difficulty
breathing. This
anxious state may
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worsen the ability of

breathing.

 Assess the
patient’s emotional
state.

RATIONALE:
Emotions and feelings,
such as fear of a
procedure or new
diagnosis, can cause
severe anxiety, leading
to hyperventilation
episodes.

 Provide a relaxing
environment.

RATIONALE: To
promote adequate rest
periods to prevent
fatigue.

 Encourage pursed-
lip breathing and
diaphragmatic or
abdominal
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breathing
exercises.

RATIONALE:
Pursed-lips breathing
can slow down
breathing, reducing
the work of breathing
by keeping your
airways open longer.
Also, breathing
exercises help
strengthen the
respiratory muscles
and fill the lungs with
air more efficiently.

 Assist the client in

the use of
relaxation
technique.

RATIONALE: To
provide relief of
causative factors.

 Provide air
ventilation or
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provide a fan for

the patient.

RATIONALE:
Moving air can
decrease feelings of
air hunger.

Collaborative:

 Teach the mother

proper breathing
techniques.

RATIONALE: To
increase the mother’s
awareness of the
benefits and proper
techniques to improve
breathing
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Physiological Nursing Diagnosis #2

Assessment/Cues Nursing Diagnosis Background Goals and Nursing Evaluation

Knowledge Objectives Interventions and
Rationale
Subjective: Impaired physical Impaired physical After 8 hours of Independent:
“ Hindi po ako mobility related to mobility is a nursing and
makagalaw” as motor impairment common nursing collaborative
verbalized by the  Provide a quiet
secondary to spinal diagnosis found intervention the
patient and safe
cord injury among most patient will be
environment by
Objective: patients at one time able to: raising the side
- Inability to perform or another. It can be rails
action as instructed a temporary,
- Decrease in fine and permanent or  verbalize RATIONALE:
gross motor skills worsening problem willingness to Promote comfort
and has the and prevent further
and
injuries
potential to create demonstrate
larger issues such as participation  Provide
skin breakdown, in activities pressure-
infections, falls, and reducing
social isolation. mattress like
 verbalize egg crate
understanding
RATIONALE: To
Advancing age is the
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most common risk of situation
factor of impaired maintain position
physical mobility of function and
reduce risk of
which increases the
pressure ulcer
risk of morbidity
and mortality for  Schedule
this population. activities with
Enhancing mobility adequate rest
is important to also periods during
improve the quality the day
of life of patients
RATIONALE: To
and lessen the
reduce fatigue
burden on
caregivers and the  Assist with
healthcare system. treatment of
underlying
condition
causing
dysfunction

RATIONALE: To
maximize the
potential for
mobility and
function

 Monitor
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nutritional
needs as they
relate to
immobility

RATIONALE:
Good nutrition also
gives required
energy for
participating in an
exercise or
rehabilitative
activities

Collaborative:

 Reposition
patient every
two hours with
the help of
nursing
attendant/signifi
cant others.

RATIONALE:
Promotes and risks
with circulation
reduces associated
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immobility.
Seeking help
injuring and the
patient.

 Execute passive
or active
assistive ROM
exercises to all
extremities.

RATIONALE: This
enhances increased
return, stiffness,
maintains strength
venous prevents
and muscle.
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Psychological Nursing Diagnosis #3

Assessment/Cues Nursing Diagnosis Background Goals and Nursing Evaluation

Knowledge Objectives Interventions and
Rationale
Subjective: Impaired skin The skin is the After 8 hours of Independent:
“ May sugat po ako sa integrity related to body’s outermost nursing and
likod”, as verbalized physical immobility defense system that collaborative
by the patient  Provide a quiet
keeps pathogens intervention the
and safe
Objective: from entering and patient will be
environment by
- presence of pressure causing illness. able to: raising the side
ulcer at sacral area When the skin is rails
compromised due
to cuts, abrasions,  Participate in RATIONALE:
ulcers, incisions, prevention Promote comfort and
and wounds, it prevent further
measures and
injuries
allows bacteria to treatment
enter causing program  Assess the
infections. It is specific risk
important that factor for
nurses understand  Get stage- pressure ulcer
how to assess, appropriate
prevent, treat, and wound care RATIONALE: For
proper identification
educate patients on and has
of nursing
impaired skin controlled risk
integrity.
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factors
prevention intervention
additional
ulcers  Assess the site of
impaired tissue
integrity and its
condition
 Describes
measures to RATIONALE: To
protect and know the severity of
heal the the condition
tissue,
 Assess the
including
patient’s
wound care awareness of the
sensation of the
pressure

RATIONALE:
Patient’s with
decrease sensation
are unaware of
unpleasant stimuli
and do not shift
weight thereby
exposing the skin to
excessive pressure

 Assess an
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increase in body
temperature

RATIONALE:
Increase body
temperature is a
manifestation
infection

 Determine
presence of
necrotic tissue

RATIONALE:
Necrotic tissue must
be remove before
healing can take
place

 Maintain the
head of the bed
at the lowest
degree of
elevation as
possible

RATIONALE:
Reduce shear and
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friction

 Provide tissue
care as needed

RATIONALE: To
prevent infection

 Keep the area

clean, dry, and
dress the wound
aseptically

RATIONALE: To
assist body’s natural
process of repair and
prevent infection

Collaborative:

 Logroll the
patient every two
hours with the
help nursing
attendant or
significant other.
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RATIONALE:
Promotes
circulation and
reduces risks or
further
complications
associated with
immobility.
Logrolling the
patient should be
performed
enough avoid
yourself and the
patient

 Provide optimum
nutrition and
increased protein
and high calorie
intake.

RATIONALE:
Nutrition plays a
vital role in wound
healing. Balance of
nutrients is needed in
the wound healing
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process.
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REFERENCES

https://en.wikipedia.org/wiki/Spinal_cord_injury

https://www.shepherd.org/patient-programs/spinal-cord-injury/levels-and-types

https://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/symptoms-causes/syc-20377890

https://www.uab.edu/medicine/sci/faqs-about-spinal-cord-injury-sci/what-is-tetraplegia

https://www.nursetogether.com/impaired-skin-integrity-nursing-diagnosis-care-plan/

https://www.nursetogether.com/impaired-skin-integrity-nursing-diagnosis-care-plan/

https://www.mims.com/philippines/drug/info/omeprazole?mtype=generic

https://nurseslabs.com/12-spinal-cord-injury-nursing-care-plans/5/

https://www.nursetogether.com/impaired-skin-integrity-nursing-diagnosis-care-plan/

https://www.nursetogether.com/impaired-physical-mobility-nursing-diagnosis-care-plan/
 University of Saint Louis
Tuguegarao City, Cagayan 3500
SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV

MS 2 – SCHOOL DUTY ROTATION ACTIVITY