NUR 200 Week 3 Practice Case Study

C.R. is a 42-year-old white male who fell from a 60-foot scaffold while working on the construction of a
new building. He is admitted to the emergency department (ED) by ambulance and is strapped to a rigid
backboard with cervical immobilization. At the site of the accident, C.R.'s co-workers immobilized his
body until the ambulance arrived. His supervisor called his wife. C.R.'s wife arrives at the emergency
department (ED) at the same time the ambulance arrives. She is very agitated and crying. He sees her as
he is wheeled into the ED, reassures her that he is okay, and tells her he fell at work. You take her to a
waiting room, explaining that she can see her husband as soon as he is stabilized.
Assessment: Initial physical findings include a flaccid paralysis and loss of sensation of the lower
extremities and trunk. He has sensation and movement of the arms and hands with decreased grasp
strength. His extremities are warm and dry. Vital signs: BP 88/50, Heart rate (HR) 40 beats/minute,
Respiratory rate (RR) 26 breaths/minute and shallow, Temperature 97° F (36.1° C). 
His clothing is torn in several places, revealing a large abrasion on his right shoulder, a bruised right
upper arm, and a deeply abraded right upper leg. He complains of burning pain in his right upper arm and
shoulder. He had bowel and bladder incontinence at the site of the accident but does not seem aware of it.
He has a peripheral IV of normal saline running at 75 mL/hr started by the paramedics.

Tanner’s Clinical Judgment Step
Identifying Signs and Symptoms
Gathering Complete and Accurate
Data
Assessing Systematically and
Comprehensively
Definition of thinking Skill Application of thinking Skill to
Case Study
Indicates if the situation is normal  Flaccid paralysis
or abnormal or there has been a  Vital signs: Temp
change in the situation 97, BP 88/50 , heart
rate 40 beats Large
abrasion.
 Loss of sensation of
the lower
extremities and
trucks.
 /minute
Collecting of information about  A 42 year old male
the patient from different source  Fell from 60 foot
to identify the patient problems scaffold
and concerns.
 Admitted to
Emergency
department by
ambulance.
 Flaccid paralysis
 Loss of sensation of
the lower
extremities and
trunk.
 Bowel and bladder
incontinence not
seem aware of.
Assessment of the patient’s  Flaccid paralysis
condition so that nothing of  Large abrasion.
importance is missed
NUR 200 Week 3 Practice Case Study

 Loss of sensation of
the lower
extremities and
trucks.
 Vital signs: Temp
97, BP 88/50 , heart
rate 40 beats/minute