- Spinal cord injuries occur most often in males aged 16-30 and result from motor vehicle accidents, violence, falls, or sports. - Medical management includes immobilizing the spine, administering steroids to reduce swelling, and surgery to decompress the spinal cord if needed. - Nursing management focuses on respiratory care if needed, skin integrity, bowel and bladder care, pain management, and preventing complications like infection, blood clots, and autonomic dysreflexia.

1. TIME
SPECIFIC
OBJECTIVE
CONTENT MATTER
30secs
TEACHING LEARNING
ACTIVITIES
EVALUATION
INTRODUCTION
Spinal cord injury is a
major health problem. It
occurs almost four times
more often in males than
in females. Young people
aged 16-30 suffer more
than half of new spinal
cord injuries each year.
30secs Define spinal cord
injury
Definition
The student teacher
What do you
Any injury to the spinal cord is known as defines spinal cord injury understand by
spinal cord injury and is characterized
using power point
spinal cord injury?
by decrease or loss of sensory and motor
function below the level of injury.
1min
Causes
 Motor vehicle crashes
 Violence
 Falls
 Sports
Other causes can be
 Hyperflexion
 Hyperextension
 Compression
Enlist the causes of
spinal cord injuries
30secs Enumerate the risk
factors of spinal
cord injuries
Risk factors
 Age
 Gender
The student teacher
enlists the causes by
flannel chart
What are the
causes of spinal
cord injuries?
The student teacher
Enumerates the risk
What are the risk
factors of SCI?

2.  Alcohol
 Drug use
2mins
3mins
Describe the
pathophysiology of
spinal cord injury
Pathophysiology :
Classify the spinal
cord injuries
Types:
The spinal cord injuries may be
classified by location or by degree of
damage to the cord.
Spinal cord injuries can be separated
into two categories:
a) Primary injuries or complete
transaction of the cord
The spinal cord is made up of nerve
fibers that allow communication
between the brain and the rest of the
body. Damage to the spinal cord ranges
from transient concussion to contusion,
laceration and compression of the cord
substance to complete transaction of
the cord and results in interference with
the communication process. Damage
may be caused by bruising , cutting, or
bleeding into the cord, external forces or
by fragments of fractured bone.
The most frequently involved vertebrae
are:
1. Cervical 5,6 and 7
2. Thoracic 12
3. Lumber 1
factors using power
point.
The student teacher
describes
pathophysiology by
showing power point
What is the
pathophysiology of
spinal cord
injuries?
The student teacher
explains types of SCI by
using flannel chart.
What are types of
spinal cord
injuries?

3. b) Secondary injuries or incomplete
transaction of the cord
Primary injuries are the result of the
initial trauma and are usually
permanent.
Secondary injuries are usually result of a
contusion or tear injury in which nerve
fibres begin to swell and disintegrate. A
secondary chain of events produces
ischemia, hypoxia, edema, and
hemorrhagic lesions which in turn result
in destruction of myelin and axons.
These secondary reactions , believed to
be the principal causes of spinal cord
degeneration at the level of injury and
thought reversible after 4 -6 hours after
injury. Therefore if the cord has not
suffered irreparable damage , some kind
of early treatment is needed to prevent
partial damage from developing into
total and permanent damage.
4mins
Discuss the clinical
manifestations of
spinal cord injuries
Clinical manifestations:
Cervical injuries:
Cervical cord injuries can affect all four
extremities, causing paralysis and
parasthesias, impaired respiration and
loss of bowel and bladder control.
Paralysis of all the four extremities is
called quadriplegia; weakness of all the
extremities is called quadriparesis. If
The student teacher
discusses the clinical
manifestations using
flash cards
What are the
clinical
manifestations of
SCI?

4. the injury is at C3 or above, the injury is
usually fatal because muscles used for
breathing are paralysed.
An injury at the fourth or fifth
cervical vertebrae will affect breathing
and may necessitate some type of
ventilator support. These clients
typically need long term assistance with
activities of daily living.
Thoracic/lumber injuries
Thoracic and lumber injuries affect the
legs, bowel and bladder. Paralysis of the
legs is called paraplegia; weakness of the
legs is called paraparesis. Sacral injuries
affect the bowel and bladder continence
and may affect foot function. Individuals
with thoracic, lumbar and sacral injuries
can usually learn to perform activities of
daily living independently.
Spinal shock
Spinal cord injury has profound effect
on the autonomic nervous system.
Immediately following injury the cord
below the injury stops functioning
completely. This causes a disruption of
the sympathetic nervous system,
resulting in vasodilation, hypotension,
and bradycardia.
Dilation of the blood vessels
allow more blood flow just beneath the

5. skin. This blood cools and is circulated
throughout the body, causing
hypothermia. Keep the client covered as
much as possible but avoid overheating.
This may last from a week to many
weeks in some clients.
3mins
Explain the effects
of spinal cord
injuries
Effects of spinal cord injuries
1. Central cord syndrome
Characteristics: motor deficits (in
the upper extremeties compared
to the lower extremities; sensory
loss varies but more pronounced
in the upper extremities);
bowel/bladder dysfunction is
variable or function may be
completely preserved.
Cause: injury or edema of the
central cord usually of the cervical
area.
2. Anterior cord syndrome
Characteristics: loss of pain,
temperature and motor function is
noted below the level of lesion;
light touch, position, and
vibration, sensation remain intact
Cause: the syndrome may be
caused by acute disk herniation or
hyperflexion injuries associated
with fracture- dislocation of
vertebrae. It may also occur as a
result of injury to the anterior
The student teacher
explains the effects by
showing Chart and
power point slides
What are the
various effects of
SCI?

6. spinal artery, which supplies the
anterior two thirds of the spinal
cord
3. Brown- sequard syndrome
(lateral cord syndrome)
Characteristics: ipsilateral
paralysis or paresis is noted,
together with ipsilateral loss of
touch, pressure and vibration and
contralateral loss of pain and
temperature
Cause: the lesion is caused by a
transverse hemisection of the cord
usually as a result of a knife or
missile injury, fracturedislocation of a unilateral articular
process or possibly an acute
ruptured disk.
4. Conus medullaris syndrome
It follows damage to the lumber
nerve roots and conus medullaris
in spinal cord
Client experiences bowel and
bladder arefelxia and flaccid lower
extremities
5. Cauda equine syndrome
It occurs from injury to the
lumbosacral nerve roots below the
conus medullaris
The patient experiences areflexia
of the bowel, bladder and lower

7. 4mins
Enumerate the
complications of
spinal cord injuries
reflexes.
Complications
1. Infection
Impared respiratory effort,
decreased cough, mechanical
ventilation and immobility all
predispose the cervical cord
injured client to pneumonia.
Catheterization whether
indwelling or intermittent places
the client at risk for urinary tract
infection.
2. Deep vein thrombosis
Lack of movement in the legs
inhibits normal blood circulation.
Compression stockings, sequential
compression devices and
subcutaneous heparin may be
used separately or together to
reduce the risk of deep vein
thrombosis
3. Orthostatic hypotension
Spinal cord injured clients no
longer have muscular function in
their legs to promote venous
return to the heart. They also have
impaired vasoconstriction. This
leads to the pooling of the blood in
the legs when the client moves
from supine to a sitting position. If
the movement is sudden the client
may faint. Gradual elevation of the
The student teacher
enumerate the
complications by using
chart
What are the
complications of
spinal cord
injuries?

8. head, use of elastic stockings and a
reclining wheelchair help lessons
this response.
4. Skin breakdown
Clients or their caregivers must be
diligent about relieving pressure
on the skin by position changes
and cushioning of the body
prominences. Development of the
pressure ulcers can lead to
infection and loss of skin, muscle
or bone. Treatment of pressure
ulcers is time consuming and
expensive and may interfere with
work .
5. Renal complications
Urinary tract infections are an
ongoing concern to spinal cord
injured clients. Both urinary reflex
and untreated urinary tract
infections can cause permanent
damage to the kidneys
6. Depression and substance
abuse
Clients with spinal cord injury
have a higher than average
incidence of depression and
substance abuse. Both of these
factors can interfere with the
client’s ability to care for himself
or herself. Individual or family
counseling may be helpful. Some

9. rehabilitation centers have
support groups for spinal cord
injured clients
7. Autonomic dysreflexia
This life threatening complication
occurs in clients with injuries
above the T6 level. The spinal cord
injury impairs the normal
equilibrium between the
sympathetic and parasympathetic
autonomic nervous system
Stimulation of the
sympathetic nervous system
results in cool. Pale skin,
gooseflesh and vasoconstriction
seen below the level of injury. The
blood pressure may rise to
300mmHg systolic. The
parasympathetic response results
in vasodilation, causing flushing
and diaphoresis above lesion and
bradycardia as low as 30 beats per
minutes. The client complaints of a
pounding headache and nasal
congestion secondary to the
dilated blood vessels.
1min
Discuss the
diagnostic tests
used to diagnose
spinal cord injuries
Diagnostic tests
A detailed neurological examination is
performed. Diagnostic X-rays and CT
scanning are usually performed initially.
An MRI scan may be ordered as a further
The student teacher
discusses the diagnostic
tests by using power
point
How can we
diagnose the spinal
cord injuries?

10. workup if a ligamentous injury is
suspected. Continuous
electrocardiographic monitoring may
be indicated if a cord injury is
suspected since bradycardia and
asystole are common in acute spinal
cord injuries.
2mins
Explain the
emergency
management of the
client with spinal
cord injury
Emergency management
The immediate management of the
patient at the scene of injury is critical,
because improper handling can cause
further damage and loss of neurologic
function.
 Initial care must include a rapid
assessment, immobilization,
stabilization or control of life
threatening injuries and
transportation to the most
appropriate medical facility
 One member of the team must
assume control of the patient’s
head to prevent flexion , rotation
or extension. This is done by
placing the hands on both sides of
the patient’s head at about ear to
limit the movement and maintain
alignment while spinal board or
immobilizing device is applied
 Any twisting movement may
irreversibly damage the spinal
cord by causing a bony fragment
The student teacher
explains the emergency
management by showing
transparency
What is the
emergency
management of the
patient with SCI?

11. of the vertebrae to cut into, crush
and sever the cord completely
 The patient must always be
maintained in extended position
and no part of the body should be
twisted or turned nor the patient
should be allowed to sit
 Once the extent of the injury is
determined the patient may be
placed on the rotating bed(roto
rest) or in a cervical collar
5mins
Describe the
medical
management .
Medical management
The goals of the medical management is
to prevent further SCI and to serve for
the symptoms of progressive neurologic
deficits.
 The patient is resuscitated as
necessary and oxygenation and
cardiovascular stability is
maintained
 Regeneration therapy can also be
given which involves the
transplantation of the fetal tissue
into the injured spinal cord in the
hopes of regenerating the
damaged tissue
Pharmacological therapy
 The administration of high dose
The student teacher
describes the medical
management by using
power point slides and
chart
What is the
medical
management of the
patient with SCI?

12. corticosteroids specifically
methylprednisolone has been
found to improve motor and
sensory outcomes at 6 weeks, 6
months, and 1 year if given within
8 hours of the injury.
 Use of high dose
methylprednisolone is accepted as
standard therapy in many
countries and remains an
established clinical practice in
most institutions.
Respiratory therapy
 Oxygen is administered to
maintain a high arterial PO2
because hypoxemia can create or
worsen a neurologic deficit of the
spinal cord.
 If endotracheal intubation is
necessary extreme care is to taken
to avoid flexing or extending the
patient’s neck which can result in
an extension of a cervical injury
 In high cervical spine injuries,
spinal cord innervations to the
phrenic nerve which stimulates
the diaphragm is lost.
Diaphragmatic pacing attempts to
stimulate the diaphragm to help
the client breathe

13. Skeletal fracture reduction and traction
Management of SCI requires
immobilization and reduction of
dislocations and stabilization of the
vertebral column.
 Cervical fractures are reduced and
cervical spine is aligned with some
form of skeletal traction such as
skeletal tongs or calipers or halo
device.
a) Skull or skeletal tongs
- Skull tongs are inserted into
the outer aspect of the
client’s skull and traction is
applied
- Weights are attached to the
tongs and the client is used
as countertraction
- Monitor neurological status
of the client
- Determine the amount of
weight prescribed to be
added to the traction
- Ensure that the weights
hang freely at all times
- Ensure that the ropes for the
traction remain within the
pulley
- Turn the client every 2
hours
- Provide sterile pin site care

14. as prescribed
b) Halo traction
- Halo traction is a static
traction device that consists
of a headpiece with four
pins, two anterior, inserted
into client’s skull
- The metal ring may be
attached to a vest or cast
when the spine is stable
allowing increased client
mobility
- Monitor the client’s
neurological status and
never move or turn the
client by holding or pulling
on the halo traction device
- Assess the skin integrity to
ensure that the jacket or
cast not causing pressure
2mins
Describe the
surgical
management
Surgical management
Surgery is indicated in any of the
following instances
 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 cord
 The patient’s neurologic status is
The student teacher
discusses the surgical
management by using
chart
What is the
surgical
management of the
patient with SCI?

15. deteriorating
Surgery is performed to reduce the
spinal fracture or dislocation or to
decompress the cord.
A laminectomy(excision of the
posterior arches and spinal processes
oof a vertebrae) may be indicated in the
presence of progressive neurologic
deficit, suspected epidural hematoma,
bony fragments or penetrating injuries.
4mins
Explain the nursing
management
Nursing management
Assessment
 Obtain the information about the
injury
 Perform neurologic assessment
 Assess vital signs with a focus to
respiratory status
 Ongoing monitoring: neurologic,
motor, sensory abilities, bowel
and bladder pattern and signs of
respiratory distress and spinal
shock
Nursing diagnosis





Ineffective breathing pattern
Ineffective airway clearance
Risk for impaired gas exchange
Pain
Impaired physical mobility
The student teacher
explains the nursing
management with the
help of power point and
chart.
What is the
nursing
management of the
patient with SCI?

16.  Risk for impaired skin integrity
 Altered elimination
 Imbalanced nutrition
Respiratory support
 Mechanical ventilator
 Chest physical therapy
 Suctioning
 Kinetic bed
 Tracheostomy
 Abdominal binder to facilitate
abdominal breathing
 Incentive spirometry
Thermoregulation
 Rectal and core temperature
monitoring
 Environmental control
 Prevention of cool draught
 Top linen to protect warmth
 Hypothermia blanket
Maintaining urinary elimination
 Intermittent catheterization is
carried out to avoid the distention
of the bladder and UTI
 If latter is not feasible then
indwelling catheter is inserted
temporarily.
 Intake output chart is maintained.
Physical mobility
 Position to avoid contractures and

17. foot drop
 Maintain skin integrity by 2 hourly
position, massaging bony
prominences , keep the skin clean
and dry and use pressure relieving
devices
 Assist to perform isometric, active
and passive exercises
Psychological support
 Provide psychological support or
psychotherapy to the patient
 Provide opportunity to ventilate
the feelings
 Assist the individual to adjust to
the impairment if permanent
injury is there
Spinal rehabilitation
The spinal rehabilitation begins on
admission. During acute stage the care
should focus on prevention of infection,
pressure sores, contractures facilitates
rehabilitation and reduce sufferings and
limits disability.
Establish functional goals and motivate
client and family amd involve them in
the care.
Goals of rehabilitation
 Promote mobility
 Reduce spasticity

18.  Improve bowel and bladder
control
 Prevent pressure sores
 Reduce respiratory dysfunction
 Control pain
 Nutritional management
 Effective health management
1min
Summarization
Today we discussed
about:
 Definition
 Causes of SCI
 Risk factors
 Pathophysiology
 Clinical
manifestations
 Effects of spinal
cord injuries
 Diagnostic
measures
 Emergency
management
 Medical
management
 Surgical
management
 Nursing
management

19. 30secs
Conclusion
From above discussion
we can say that Spinal
cord injuries are major
health problems. So the
nurses must be efficient
enough to provide care to
these clients in order to
minimize disability and
highest possible level of
functioning.
Websites:www.ispub.com
www.en.wikipedia.orge
www.en.wikipedia.org
www.slideshare.net
www.RightHealth.com
www. Scribd.com
www.answers.com
wiki.answers.com
www.steadyhealth.com
www.authorstream.com
Books:1)Black M. Joyce ; Medical surgical nursing ; 5th edition ; W.B Saunders Company ; Singapore 2008 ; pg no. 1948-1960.

20. 2)William S. Linda; understanding medical surgical nursing; 1st edition; F.A davis company; Philadelphia 1999; pg .no.
937-940
3)Suddarth’s and brunner; Textbook of medical surgical nursing; 11th edition; Lippincott Williams and Wilkins ; United
states of America 2009; pg. No. 1926-1933
4) Silvistri Anne Linda; Saunders comprehensive review for the NCLEX –RN examination;5th edition; Elsevier; St. Louis;
pg. no.947-942
General Information:
Subject: Educational methods and media.
Topic: Nursing management of a patient with spinal cord injury
Group: B.Sc Nursing 4TH year students
Size of the group: 9 students
Venue: Room No. 12
Time: 12.10-12.50pm
Duration: 40 mins (30 mins : teaching, 10 mins: discussion)
Roll no. of Student Teacher: 1917
Supervisor: Examiner
Method of Teaching: lecture cum discussion.

21. A.V Aids: power point slides, chart, flannel charts, flash cards, chalk board and handouts.
Previous knowledge: Students have general idea about levels of disease prevention.
General objectives: At the end of teaching group of students will be able to
 Explain the spinal cord injuries in detail.
 Apply this knowledge in practical field.