Case Information
A 50-year-old male is admitted to the trauma ICU from surgery to stabilize a spinal cord injury to C5-6 from an MVA. He is on mechanical ventilation and is expected to be weaned off within 24 hours. It was reported he has no movement in his extremities. He has no next of kin.
Medication
- Metformin (Glucophage) 500 mg po bid
- Carvedilol (Coreg) 40 mg po a day
- Paroxetine (Paxil) 40 mg po q day
- Meloxicam (Mobic) 15 ma po a day
- Sildenafil (Viagra) 100 mg po as needed
Clinical Practice Guidelines
The patient should be rehabilitated after surgery to stabilize his spinal cord injury to C5-6 from a Manual Vacuum Aspiration (MVA). The Cardiometabolic Risk after Spinal Cord Injury is a clinical practice guideline for healthcare providers to improve the care offered to patients with spinal cord injuries (Nash et al., 2018). It is recommended to address cardiometabolic disease (CMD) using the American Heart Association (AHA) definitions and evaluate the patient’s condition before discharge. Diabetes is another diagnosis to screen the patient for, and the American Diabetes Association (ADA) guidelines must be applied. Lifestyle interventions should be considered to promote caloric assessment and dietary habits, physical exercises (150 minutes per week), and education on medication and nutrition (Nash et al., 2018). The patient’s temporary immobility, diabetic risks, and heart failure should be admitted to the chosen clinical practice guideline.
Medical Orders
Regarding the fact that the patient has diabetes, metformin remains one of the immediate and actual medical orders. This order is necessary to stabilize the body’s response to insulin (Sabharwal, 2019). Nonsteroidal anti-inflammatory drugs or NSAIDs are usually not recommended by experts as they elevate blood pressure, but antihypertensive medications like thiazide are effective for managing fluid retention (Nash et al., 2018). Finally, a lack of calibration in patients on mechanical ventilation after a spinal cord injury is observed, and statin monotherapy is recommended to control blood cholesterol levels and prevent the growth of heart failure symptoms (Nash et al., 2018; Sabharwal, 2019). If medical intolerance is observed, the assessment is required to identify the current problems and define a new treatment plan.
Collaborative Orders
Considering the current problems and treatment expectations, the patient should be informed about several collaborative anticipated orders. First, a neurologist’s consultation is required to monitor the treatment progress and the spinal cord’s condition after surgery. The work of peripheral nerves and muscles may be damaged by stroke or diabetes. The patient also needs a cardiology follow-up meeting to develop a new heart care program and assess if the recent operative intervention affects the heart (Nash et al., 2018). Finally, stopping mechanical ventilation presupposes a follow-up consultation with a respiratory therapist. This expert will examine the patient, exclude complications after surgery, and assess mechanical ventilation outcomes.
References
Nash, M. S., Groah, S. L., Gater Jr, D. R., Dyson-Hudson, T. A., Lieberman, J. A., Myers, J., Sabharwal, S., & Taylor, A. J. (2018). Identification and management of cardiometabolic risk after spinal cord injury: clinical practice guideline for health care providers.Topics in Spinal Cord Injury Rehabilitation, 24(4), 379-423. Web.
Sabharwal, S. (2019). Addressing cardiometabolic risk in adults with spinal cord injury: Acting now despite knowledge gaps.Spinal Cord Series and Cases, 5(1). Web.