This document provides information on spinal cord injuries. It discusses causes such as trauma, diseases, and congenital defects. It describes the anatomy of the spinal cord and classifications of spinal cord injuries as complete or incomplete. Complications involving different body systems are outlined. Nursing diagnoses for a patient with a spinal cord injury include risks for ineffective breathing, airway clearance, infection, and impaired skin integrity. Treatment focuses on prevention of secondary injuries, complications, and rehabilitation.

1. Matthew Rollosson, RN
Haydom Lutheran Hospital
28 August 2014

2.  Collaboration
 Emergency personnel
 Care begins at the place where the patient
was injured
 Doctors
 Nurses
 Physiotherapists
 The patient’s family

3.  Basi, kwa kuwa ninyi ni wateule wa Mungu,
wapendwa na watakatifu, vaeni moyo wa
huruma, wema, unyenyekevu, upole na
uvumilivu.
- Wakolosai 3:12
 Therefore, as God’s chosen people, holy and
dearly loved, clothe yourselves with
compassion, kindness, humility, gentleness and
patience.
- Colossians 3:12

4.  Causes
 Trauma
 Interruption of blood supply
 Diseases
 Cancer
 Infectious diseases
 Bone degeneration
 Congenital defects

5.  Mechanisms of injury
 Motor vehicle accidents
 Falls
 Violence
 Sports injuries
 Demographics
≥ 80% male
 Young age
 20 to 40 years of age

6.  Brain injury
 Chest trauma
 Abdominal injuries
 Limb fracture
 Patient may not feel pain below level of
spinal cord injury

7.  Vertebral column
 7 cervical vertebrae
 12 thoracic vertebrae
 5 lumbar vertebrae
 Spinal cord
 From medulla
oblongata
 To first lumbar vertebra
 Conus medullaris
 Cauda equina
 “Horse tail”

9.  Quadriplegia (tetraplegia)
 Impairment/loss of function of upper and lower
limbs
 Cervical spine injury
 Most common type of spinal cord injury (55%)
 Paraplegia
 Impairment/loss of function of lower limbs
 Thoracic, lumbar, sacral injuries

10.  Complete
 Loss of all motor and sensory function
below the level of injury
 Incomplete
 Preservation of motor and/or sensory
function below the level of injury
 Spinal cord syndromes
 Anterior cord syndrome
 Brown-Séquard syndrome
 Central cord syndrome

12. Nursing diagnoses:
 Ineffective
breathing
patterns
 Ineffective
airway
clearance
 Risk for
infection
Respiratory
complications are
the most common
cause of death in
people with spinal
cord injuries

14.  Cardiovascular
 Decreased cardiac output
 Ineffective thermoregulation
 Autonomic dysreflexia
 Gastrointestinal
 Risk for constipation
 Bowel incontinence

15.  Genitourinary
 Risk for infection
 Urinary incontinence
 Musculoskeletal
 Risk for injury
 Disuse syndrome
 Integument
 Risk for impaired skin integrity

16.  Psychosocial
 Anxiety
 Fear
 Chronic grieving
 Interrupted family processes
 Risk for caregiver role strain
 Risk for disturbed self-concept
 Risk for ineffective sexuality patterns
 Risk for social isolation

17.  Acute
 Save the person’s life
 Prevent secondary injuries
 Subacute
 Prevent complications
 Rehabilitation
 Prepare patient for life after spinal cord injury
 Learn skills for a productive life

18.  Nursing diagnosis:
 Risk for ineffective cerebral tissue
perfusion

19.  Nursing diagnosis:
 Risk for ineffective cerebral central
nervous system tissue perfusion

20.  Nursing diagnosis:
 Risk for ineffective central nervous system
tissue perfusion
 Hypotension (low blood pressure)
 Loss of vasomotor tone
Inability to constrict blood vessels
 Bradycardia (slow heart rate)
 Unopposed parasympathetic
stimulation
 Shock

21.  Nursing diagnosis:
 Risk for ineffective central nervous
system tissue perfusion
 Monitor vital signs
 Intake and output
 Abdominal binder
 Compression stocking/ACE wrap legs
 Prevents pooling of blood in the legs

22.  Nursing diagnosis:
 Risk for ineffective central nervous
system tissue perfusion
 Medical interventions:
 IV fluid boluses
 Vasopressor drugs
Keep mean arterial pressure ≥ 90 mmHg
MAP = [SBP + (DBP x 2)] ÷ 3

23.  Unstable spine
 Fracture
 Dislocation
Thompson et al., 2012 Browner et al., 2009

24.  Log roll
Swartz, 2014

25.  Nursing diagnoses
 Ineffective airway clearance
 Risk for infection
 Risk for impaired skin integrity
 Risk for constipation

26.  Loss innervation of respiratory accessory
muscles, intracostal muscles, and abdominal
muscles
 Quad coughing:
Atrice et al., 2013

27.  Turn every 2 hours
 Log roll
Douglas et al., 2013

28.  Establish regular bowel pattern
 What time of day does the patient usually
have a bowel movement?
 Gastrocolic reflex
 Food in the stomach increases bowel
motility
 Especially first meal of the day
 Hot liquids
 Chai
 Coffee

29.  Encourage oral fluid intake
 “At least 8 glasses per day”
≈ 2 liters

30.  High fiber diet

31.  Digital stimulation
 Gloved finger in rectum
 Dilate the anal sphincter
 Medications
 Stool softener
 Suppository
 Laxative
 Avoid regular use
 Do not use enema
 Risk of autonomic dysreflexia

32.  Life-threatening
 Injuries above the 6th thoracic vertebra (T6)
 Risk begins after the return of spinal reflexes
 3 to 6 weeks after injury
 Uncontrolled sympathetic discharge from the
spinal cord

33.  Hypertension (high blood pressure)
 Sudden rise to 20 to 40 mmHg above
baseline
 Bradycardia (slow heart rate)
 Headache
 Blurred vision
 Sweating, flushing (red skin), goose bumps
above the level of injury
 Cool, pale skin below the level of injury

34.  Complications:
 Seizures (convulsions, fits)
 Stroke
 Retinal detachment (blindness)
 Death

35.  Cause
 Painful stimulation, irritation below the
level of injury
 Most commonly caused by
 Distended bladder
Kinked, blocked catheter
 Distended bowel
Constipation
Fecal impaction

36.  Treatment
 Remove the cause
 Check catheter tubing
 Check for stool in the rectum
 Look for other sources of noxious
stimulation
 Put patient in sitting position
 Short-acting antihypertensive medications
 Nifedipine
 Captopril

37.  How will the patient’s injury affect his family?
 How will the patient’s injury affect his
community?
 What resources are available in the
community?
 What can be done to prevent
spinal cord injuries?

38.  Hatimaye, ninyi nyote muwe na nia moja,
mhurumiane, mpen dane kama ndugu, muwe
na mioyo ya upole na ya unyenyekevu.
- 1 Petro 3:8
 Finally, all of you, be like-minded, be
sympathetic, love one another, be
compassionate and humble.
- 1 Peter 3:8

39.  Chuma hunoa chuma, Ndivyo mtu aunoavyo
uso wa rafiki yake.
- Mithali 27:17
 As iron sharpens iron, so one person sharpens
another.
- Proverbs 27:17

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