SOURCES: Straight A's Medical Surgical Nursing and Medical-Surgical Nursing Concepts and Clinical Application 2nd Edition by Josie Quiambao-Udan RN, MAN

1. Presented by:
LIBALIB, Rhenalynne A.

2. Traumatic injury to
the spinal cord that
results in sensory
and motor deficits.

3. 1. Paraplegia : paralysis of the legs.
2. Quadriplegia: (also termed as
TETRAPLEGIA) paralysis of all four(4)
extremities.

4. • Car accidents
• Falls
• Gunshot wounds
• Stab wounds
• Diving into shallow water
• Infections
• Tumors
• Congenital anomalies

8. Mechanism of Injury
• Physical manner and forces involved in
producing injuries or potential injuries
• Valuable tool in determining if a particular set
of circumstances could have caused a spinal
injury
• Mechanisms likely to produce spinal injuries
occur in, falls, violence, and sports (including
diving accidents)

9. Hyperflexion
- Excessive/abnormal
bending forward of the
chin toward the chest.
This is one mechanism
seen when patients are
ejected from moving
vehicles

10. Hyperextension
- Excessive/abnormal
bending back of the
head beyond its normal
range of motion

11. Hyperotation
-Excessive/abnormal
rotation. This may
produce injuries in any
area of the spine.

12. Axial Loading
-Sudden/excessive
compression of the spine.
Examples include falling
and landing on your feet
or ejection from a vehicle
and landing on your head

13. Axial Distraction
- by sudden/excessive
elongation at the spine
caused by stretching or
tearing anywhere along
the spinal column. Ex.
hanging

14. Sudden/Extreme Lateral Bending
• Excessive/abnormal lateral movement of the
spine
• Can affect any portion of the spine
• Example: T-bone MVAs

16. INJURY
Complete transection of the
Spinal Cord
Associated edema and hemorrhage from
the injury
Ischemia
NECROSIS and SCAR TISSUE form in the area of the traumatized
cord
May result in
PARAPLEGIA
Or
QUADRIPLEGIA

18. • Paralysis below the level of the injury
• Paresthesia below the level of the injury
• Neck pain
• Loss of bowel and bladder control
• Respiratory distress
• Numbness and tingling
• Flaccid muscle
• Absence of reflexes below the level of the injury
• Loss of perspiration below level of the injury

19. Paralysis
Loss of reflexes
Loss of sensory function
Loss of motor function
Autonomic dysfunction

24. 1.) Cervical SCI
- injury at C2 and C3 is usually fatal.
- QUDRIPLEGIA (paralysis of all four
extremities)
- respiratory muscle paralysis
- bowel and bladder retention

25. 2.) Thoracic SCI
- PARAPLEGIA (paralysis involving the
lower extremities)
-poor control of upper trunk
- bowel/bladder retention
- autonomic dysreflexia with lesion or
injury above T6 and in cervical lesions.

26. 3.) Lumbar SCI
- PARAPLEGIA (flaccid paralysis)
- bowel and bladder retention
4.) Sacral SCI
- injury above s2 in males allows erection but there
is no ejaculation.
- injury between S2 to S4 prevents erection and
ejaculation.
- PARAPLEGIA
- bowel and bladder incontinence

28. The higher the level of lesion, the greater is
the probability to perform sexually.
The lower the level of lesion, the lesser is the
probability to perform sexually.
The PARAPLEGIC MALE may experience
IMPOTENCE.
The PARAPLEGIC FEMALE is capable of
PREGNANCY, but is unable to experience
ORGASM.

29. ASIA Impairment Scale for classifying spinal cord injury[11][13]
Grade Description
A
Complete injury. No motor or sensory function is
preserved in the sacral segments S4 or S5.
B
Sensory incomplete. Sensory but not motor function is
preserved below the level of injury, including the sacral
segments.
C
Motor incomplete. Motor function is preserved below
the level of injury, and more than half of muscles tested
below the level of injury have a muscle grade less than 3
(see muscle strength scores table).
D
Motor incomplete. Motor function is preserved below
the level of injury and at least half of the key muscles
below the neurological level have a muscle grade of 3 or
more.
E
Normal. No motor or sensory deficits, but deficits existed
in the past.

31. Actions of the spinal nerves
Level Motor Function
C1–C6 Neck flexors
C1–T1 Neck extensors
C3, C4, C5 Supply diaphragm (mostly C4)
C5, C6 Move shoulder, raise arm(deltoid); flex elbow (biceps)
C6 externally rotate (supinate) the arm
C6, C7
Extend elbow and wrist (tricepsand
wrist extensors); pronatewrist
C7, T1 Flex wrist; supply small muscles of the hand
T1–T6 Intercostals and trunk above the waist
T7–L1 Abdominal muscles
L1–L4 Flex thigh
L2, L3, L4 Adduct thigh; Extend leg at theknee (quadriceps femoris)
L4, L5, S1
abduct thigh; Flex leg at the knee
(hamstrings); Dorsiflexfoot (tibialis anterior); Extendtoes
L5, S1, S2
Extend leg at the hip (gluteus maximus); Plantar flex foot
and flex toes

32. • Spinal X-rays : vertebral fracture
• CT Scan : spinal cord edema, vertebral
fracture, spinal cord compression
• MRI : spinal cord edema, vertebral
fracture, spinal cord compression

33. • Diet : low-calcium, high-protein
• I.V therapy: saline lock
• Oxygen therapy
• Intubation and mechanical ventilation
• GI decompression : NG tube
• Position: flat, neck immobilized
• Activity : bed rest, passive ROM exercises

34. • Monitoring : VS, I/O, ECG, ICP, and
neurovital signs
• Laboratory studies: Na, K, and glucose levels
and WBC count
• Indwelling urinary catheter
• Antacids: Mg and Al hydroxide (Maalox), Al
hydroxide gel (AlternaGEL)
• Anticonvulsant: phenytoin (Dilantin)

35. • Glucocorticoid : dexamethasone (Decadron),
methylprednisolone sodium succinate (Solu-
Medrol)
• Histamine antagonists: cimetidine (Tagamet),
ranitidine (Zantac)
• Cervical collar
• Maintenance of vertebral alingment: Stryker
turning frame, Crutchfield tongs, Halo brace
• Laxative : bisacodyl (Dulcolax)
• Antianxiety agent : diazepam (Valium)

36. • Antihypertensives: diazoxide ( Hyperstat),
hydralazine (apresoline)
• Muscle relaxant : dantrolene (Dantrium)
• Pulse oximetry
• Specialized bed : rotation (Rotorest, Tilt and
Turn, Paragon)
• Mucosal barrier fortifier : sucralfate (Carafate)

37. • Maintain the patient’s diet
• Encourage fluids
• Administer I.V fluids
• Administer oxygen
• Provide suction and turning; encourage
coughing and deep breathing
• Assess neurologic and respiratory status
• Keep the patient flat

38. • Monitor and record VS, I/O, laboratory
studies, and pulse oximetry
• Administer medications, as prescribed
• Encourage the patient to express his/her
feelings about changes in his body image,
changes in sexual expression and function, and
altered mobility
• Turn the patient every 2 hrs. using the
logrolling technique

39. • Maintain body alignment
• Initiate bowel and bladder retraining
• Provide sexual counseling
• Provide passive ROM exercises
• Check for autonomic dysreflexia
• Assess for spinal shock
• Provide skin care
• Provide heel and elbow protectors and sheepskin

40. • Apply antiembolism stockings
• Provide information about the National Spinal
Cord Injury Association
• Individualize home care instructions:
- exercise regularly to strengthen muscles
- recognize the S/Sx of autonomic dysreflexia,
UTI, and upper respiratory tract infections
- continue bowel and bladder program
- maintain acidic urine with cranberry juice

41. - consume adequate fluids : 3L/day
- use assistive devices for ADL’s
- maintain skin integrity
- stay mobile using a wheelchair
- reinforce independence

43. • Spinal shock – loss of all neurological activity
below the level of injury.
• Autonomic dysreflexia - is a potentially
dangerous clinical syndrome that develops in
individuals with spinal cord injury, resulting in
acute, uncontrolled hypertension.
• Respiratory distress
• Osteomyelitis - inflammation of bone or bone
marrow, usually due to infection.
• Pressure ulcers

45. • Laminectomy - is
surgery that creates
space by removing the
lamina — the back part
of the vertebra that
covers your spinal canal.
Also known as
decompression
surgery, laminectomy enl
arges your spinal canal to
relieve pressure on the
spinal cord or nerves.

46. • Spinal fusion - is a
surgical procedure
used to correct
problems with the
small bones of
the spine (vertebrae).
It is essentially a
"welding" process.
The basic idea is to
fuse together the
painful vertebrae so
that they heal into a
single, solid bone.

49. Is caused by violent
hyperextension and
flexion of the neck. It
usually results from
vehicular accident.
There is damage to
muscles, disks,
ligaments and nervous
tissues of the cervical
spine.

51. • Pallor
• Weakness
• Gait disturbance
• Dizziness
• Nausea and
vomiting
• Occipital headache
• Nuchal rigidity

52. • Promote bed rest.
• Apply cervical collar as needed.
• Apply hot packs to the neck as indicated.
• Administer analgesic and muscle relaxant as
prescribed.

57.  References:
- Medical-Surgical Nursing:
Concepts and Clinical Application
by: Josie Quiambao-UDAN RN, MAN
- Straight A’s Medical-Surgical
Nursing
Thank you…