Spinal Cord Disorders Definition:- Spinal Cord Injury(SCI) is an injury to the Spinal Cord that results in temporary or permanent changes in the spinal cords Normal motor sensory or autonomic function. In most Spinal Cord Injuries, the balance ligaments or disc material pinch the cord, causing it to become bruised or swollen. 1. Incidence 2. Etiology 3. Pathophysiology of SCI 4. Clinical Manifestation 5. Diagnosis 6. Management 7. Nursing Process 8. Nursing Diagnosis 9. Nursing Interventions Spinal Bifida Spinal Bifida is a birth defect that occurs when the spinal cord doesn’t form properly. It is the type of neural tube defect. The neural tube is the structure in a developing embryo that eventually becomes the body’s Brain, Spinal cord & the tissue that encloses them. 1. types 2. Causes 3. Symptoms 4. Complications REFERENCES:- 1. Brunner & Siddarth's, Textbook of Medical-Surgical Nursing,

1. Topic:-
Spinal Cord disorders
Spinal Cord Injury (SCI)
Spinal Bifida

2. INDEX
 Spinal cord disorders
 Spinal Cord Injury (SCI)
 Definitions
 Etiology
 Pathophysiology of SCI
 Clinical Manifestation
 Diagnosis
 Management
 Nursing Process
 Nursing Diagnosis
 Nursing Interventions
 Spinal Bifida
 Types
 Causes
 Symptoms
 Complications

3. SPINAL CORD DISORDERS
Definition:-
Spinal Cord Injury(SCI) is on injury to the Spinal Cord that results in
temporary or permanent changes in the spinal cords Normal motor
sensory or autonomic function.
In most Spinal Cord Injuries, the balance ligaments or disc material
pinch the cord, causing it to become bruised or swollen.

4. Incidence - 4 times more in males than females
& sex
Age - Young people 16 to 30 years suffer more than half of new SCI
every year.
Race - African or Americans are high in risk

5. ETIOLOGY
 Vehicle Crashes
 Falls
 Act of violence (primarily gunshot wounds)
 Sports/ Recreation Activities

6. PATHOPHYSIOLOGY OF SCI
. Mechanisms of Acute SCI
Primary Injury
mechanism
Secondary Injury
Mechanism
•Acute Compression
•Impact
•Missile
•Destruction
•Laceration
•Shear
•Systemic effects
•Local vascular changes
•Electrolyte changes
•Biochemical changes
[Neurotransmitter
accumulations]
•Edema
•Loss of energy metabolism
(decreased ATP)
•Apoptosis
•Loss of Neurotrophic factor
support

7. Damage to Spinal Cord ranges from:-
 Transient Concussion (from which pt. fully recovers)
Contusion
Laceration
Compression of Cord Substance
to complete transaction of cord (makes pt. paralysed below the injury)
Primary SCI Secondary SCI
• Occurs due to trauma & are usually
permanent.
• Cannot be treated fully & only
symptomatic treatment is given.
• Result of contusion or tear injury.
• It is reversible 4-6 hours after injury.
• It Cord has not suffered irreparable
damage some method of early
treatment given to prevent permanent
damage.

8. CLINICAL MANIFESTATION
Muscular- Muscle weakness, problems with coordination, stiff
muscles, muscle spasm or over active reflexes.
Whole Body- Feeling faint and sweating.
Sensory- Reduce sensation of touch or pain & Needles.
Urinary- Leaking of urine or urinary retention.
Also Common- Abnormal and painful sensation, leaking of stool or
shortness of breath.
Paraplegia- Paralysis of lower body.
Quadriplegia- Paralysis of all four extremities.

9. DIAGNOSIS
1. History Collection
2. Neurological Assessment
3. X- Rays
4. Myelogram
5. MRI
6. Computed Tomography
7. Nerve Conduction velocity
8. Electromyography (EMG)
9. EEG
10. Physical Examination.

10. MANAGEMENT
Medical Management :-
1. Administer high – dose corticosteroids
2. Use high – dose methylprednisolone
Respiratory Therapy :-
1. O2 is administered to maintain a high arterial PO2 because
hypoxia can worsen a neurologic deficit of the spinal cord.
2. Diaphragmatic pacing electrical may be considered for the
patients with a high cervical lesion but is usually carried out after
acute phase.

11. Surgical Management :-
Surgery is indicated in any of the following instance :-
 Compression of the cord is evident
 The injury results in a Fragmented or unstable vertebral body.
 The injury involves a wound that penetrates the cord.
 There are bony fragments in the Spinal Cords.
 The pt. is neurologic studies is deteriorating.

12. NURSING PROCESS
Assessments…
1. Pt. have difficulty in breathing & Coughing.
2. Assess the patient for any change in meter or sensory function.
3. Assess pt. for progressive Neurological damage.
4. Assess the patient for edema of spinal cords.
5. Assess the motor ability of the patient by asking pt. to spread the
fingers, squeeze the examiner’s hand & more the toes or turn the
feet.
6. Assess the sensation of the pt. by gently pinching the skin or
touching it slightly with a small object such as Tongue blade,
starting at shoulder level & working down both sides of the
extremities.

13. NURSING DIAGNOSIS
Based on the Assessment Data the patient major Nursing Diagnosis may
include the following :-
1. Ineffective Breathing pattern related to weakness or paralysis of
abdominal & intercostals muscles & inability to clear secretions.
2. Ineffective airway clearance related to weakness of intercostals
secretions.
3. Impaired Physical mobility related to motor & sensory impairment.
4. Disturbed Sensory perception related to motor & sensory
impairment.
5. Risk for impaired skin Integrity related & immobility & sensory less.

14. NURSING INTERVENTIONS
1. Suctioning can be done with caution not to stimulate the vagus nerve, to
clear Bronchial & Pharyngeal secretions.
2. Provide chest physiotherapy to the patient & assist in coughing.
3. Assess the patient for the sign of respiratory infections.
4. Assess patient with specific breathing exercise to increase the strength &
endurance of the respiratory muscles.
5. Maintain body alignment of the patient.
6. Repositioned the patient frequently.
7. Use various type of splints to prevents foot drops. Splints are used &
reapplied very 2 hours.
8. Patients skin should be kept clean by washing with a mild soap, rinsed
well & be blotted dry.
9. Pressure sensitive area kept well lubricated & soft with bland cream and
lotion.
10. Maintain urinary elimination pattern of the patient.

15. 11. Intermittent catheterization is carried out to avoid over distention of the
bladder & UTI.
12. At an early stage, family member are shown hour to carry out intermittent
catheterization & are encouraged to participate in this facet of care.
13. Keep the genital are clean and dry to patient UTI.
14. Maintain Input/output chart of the patient.

16. SPINAL BIFIDA
Spinal Bifida is the birth defect that occurs when the
spinal cord don’t form properly.
It is the type of neural tube defect .
The neural tube is the structure in a developing embryo that eventually
becomes the body’s Brain, Spinal cord & the tissue that enclose them.

17. TYPES
1. Spinal Bifida Occulta
It is small separation or gap in are or more of the bones of the spine.
2. Myelomeningocele
Also known as open spinal bifida, myelomeningocele is the most severe
type the spinal canal is open along several vertebrae in the longer or
middle back.

18. CAUSES
1. Idiopathic
2. Risk Factors :-
• Folate Deficiency
• Family history of Neural tube defect.
• Some medications
• Diabetes
• Obesity
• Increased body temperature.

19. SYMPTOMS
1. The spinal cords remains open along several vertebrae in the lower
or middle back.
2. Both the membranes & the Spinal Cord or Nerve protrude at birth
forming a sac.
3. Tissue & Nerves usually are exposed through sometimes skin
covers the sac.

20. COMPLICATIONS
1. Walking & mobility problems
2. Orthopedic Complications
→ Curved spine
→ Abnormal growth
→ Dislocation of the hip
→ Bone and joint deformity
→ Muscle Contractures
3. Bowel & Bladder Problems
4. Accumulations of fluid in the brains (Hydrocephalus)
5. Shunt Malfunction
→ Headache

21. → Irritability
→ Sleepiness
→ Vomiting
→ Swelling or redness
→ Changes in the eyes
→ Trouble Feeding
→ Seizures
6. Sleep disordered breathing

22. Thank you