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Most common location of injury

The most common vertebrae involved in Spinal Cord Injury (SCI) are the 5th, 6th and 7th cervical, the 12th thoracic, and the 1st lumbar.

Classificationvetebrae

Spinal Cord Injury can be separated into two categories:

  • Primary injury is caused by direct trauma and may result is usually permanent.
  • Secondary injury is cause by tear injury, in which the nerve fibers begin to swell and disintegrate.  (Sherwood, et al. 2007)

Types of Injury

Incomplete spinal cord lesion- sensory and motor fibers or both are preserved below the lesion are classified according to the area of spinal cord damage: central, lateral, anterior, or peripheral.

Complete spinal cord lesion- total loss of sensation and voluntary muscle control below the lesion can result in paraplegia or tetraplegia.

Risk factors

Motor vehicle crashes account for 48% of reported cases of SCI, with falls (23%), violence primarily from gunshot wounds (14%), recreational sporting activities (9%) and other events accounting for the remaining injuries.

Etiology (Philippine Statistics)

  • Motor vehicle accidents
  • Acts of violence
  • Falls
  • Sports and recreation injuries
  • Diseases

Signs and Symptoms

  • Pain
  • Loss of movement
  • Loss of sensation
  • Loss of bladder and bowel control
  • Exaggerated reflex
  • Sexual dysfunction
  • Difficulty of breathing

Emergency signs and symptoms

  • Fading in and out of consciousness
  • Extreme back pain and pressure in neck or back
  • Weakness/paralysis
  • Numbness
  • Loss of bladder and bowel control
  • Difficulty with balance and walking
  • Impaired breathing
  • An oddly positioned twisted neck or body

Complications

There are several complications that a patient with spinal cord injury can develop. Patients that are completely immobile are at risk for atelectasis, pressure ulcers, and other respiratory conditions. Also, some complications are life-threatening and needs immediate management. For this reason, nurses should assess and recognize the early signs and symptoms of these complications.

Deep Vein Thrombosis (DVT) can be a complication because patient with SCI is usually immobile.  Signs and symptoms to watch for are pleuritic chest pain, anxiety, and difficulty of breathing.

Autonomic Dysreflexia is caused exaggerated autonomic responses to stimuli.  Clinical manifestations to watch out for are severe pounding headache with paroxysmal hypertension, profuse diaphoresis, nausea, nasal congestion and bradycardia. The sudden increase in blood pressure may rupture one or more cerebral blood vessels or lead to increased ICP.

Management for Autonomic Dyreflexianervous-system

  • Place immediately in sitting position
  • Urinary catheter is immediately used in emptying the bladder
  • Rectum should be examined for fecal mass
  • Any other triggering stimulus should be removed
  • A ganglionic blocking agent is prescribed and administered slowly by the IV route

Nursing Management

  1. Ineffective breathing patterns related to weakness or paralysis of abdomen and intercostal muscles and inability to clear secretions
  • Suctioning may be indicated but with caution.
  • Assist the patient in coughing
  • Increase hydration and monitor the patient closely
  1. Impaired physical mobility related to neuromuscular impairment
  • Passive range of motion exercises should be implemented ASAP
  • Proper body alignment should be maintained at all times
  • Assist patient is moving at all times
  1. Risk for impaired skin integrity related to immobility and sensory loss.
  • Patient should be kept clean at all times and pressure-sensitive areas should be kept well lubricated
  • Turning the patient as indicated is always necessary
  • General body alignment is maintained
  1. Constipation related to presence of atonic bowel
  • High calorie, protein and fiber diet are indicated
  • Stool softeners are given
  • Increase in fluid intake

3 Spinal Cord Injury Nursing Care Plan

References

  • Dawodu, S. T. (2007). Spinal cord injury: Definition epidemiology pathophysiology
  • Doenges, M., Moorhouse, M., Murr, A. (2006) Nursing Care Plans: Guidelines for individualizing client care across the lifespan. F. A Davis Company, Philadelphia. 7th edition.
  • Hickey, J. V. (2009). The clinical practice of neurological and neurosurgical nursing (6th ed.). Philadephia: Lippincott Williams and Wilkins.
  • Huether, S, et al. (2000). Understanding Pathophysiology. 2nd edition. Mosby, Inc.
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Rina Malones is currently working as a critical care/acute stroke nurse. Besides from blogging, she's also studying International Health at University of the Philippines Open University.