Mr. White is a 17 year old male who was injured in a snowboarding accident 3 weeks ago. He sustained a vertebral fracture and complete spinal cord injury at T7. His fracture has been stabilized with rods and screws.  The plan is for him to be discharged home in 3 days with home health and family care.

The CNA reports to you that the bath has been completed, there was no BM or incontinence of urine. However, Mr. White’s blood pressure has risen to 189/100 with a heart rate of 56. You immediately go to the room to check on Mr. White.

You note that Mr. White is warm to touch, his temp is 103.6°F. You palpate his abdomen, which is soft and nondistended throughout. His bladder is also nondistended. He tells you he’s starting to feel very anxious  You ask the CNA to help you turn Mr. White and you find a washcloth had been left under his back.

Together with the CNA, you remove the cloth, straighten Mr. White’s sheets, and make him comfortable. You provide a cool cloth for his forehead, and place a small ice pack under each armpit. You administer Nitroglycerin 0.4 mg SL as ordered. In 5 minutes you recheck and his BP has come down to 142/90, and his HR is 70. He reports his anxiety is decreasing and his temperature has come down to 100.6°F.