Spinal Cord Injuries

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Spinal Cord Injuries

• Cheryl McConnell RN MSN

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Incidence of SCI

• 250,000 people in US
• 11,000 new injuries yearly
• 15 30 year old single males
• Warm weather
• 50 of injuries involve
• substance abuse

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Causes of SCI

• TRAUMA
• Diseases
• Results in fracture, dislocation, or subluxation
• Hyperextension Hyperflexion
• Axial loading Rotation

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Classifications of SCI

• Complete
• Severed spinal cord
• No sensory or motor function below injury
• Incomplete
• Some function below injury

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Level of Injury

• Paraplegia
• Paraparesis
• Quadraplegia
• Quadraparesis

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Diagnosis

• Cross table C-spine
• CT scan of spine
• MRI of spine
• Complete neuro exam
• ABG, CMP, CBC, UA

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Emergent Care

• Airway NG Tube
• Immobilization Foley
• Vital Signs IV fluids
• Hemorrhage Solu Medrol
• Surgery

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Spinal Shock

• AKA Neurological shock
• Most common in first 24 hours after injury
• Usually with high level injuries
• Can last 7 10 days
• Flacid paralysis
• No reflexes below injury level
• Bradycardia, hypotension
• Paralytic ileus, neurogenic bladder

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Treatment of Spinal Shock

• Maintain body systems
• Atropine
• Dextran
• Dopamine, Dobutrex
• Continued Solu Medrol

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Ongoing Nursing Care

• RESPIRATORY
• Pulmonary toilet Assisted coughing
• Turning
• Incentive spirometry Aspiration risk
• Chest PT Pulse oximetry
• Tital Volumes/Capacity

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Autonomic Dysreflexia

• Caused by uncontrolled sympathetic nervous system
  stimulation from noxious stimulus
• Common causes distended bladder, constipation
• Is a neurological emergency will result in a
  hypertensive stroke if not treated

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Signs and Symptoms of Autonomic Dysreflexia

• Sudden, severe, throbbing headache
• Severe hypertension
• Bradycardia
• Flushing above level of injury, pale below injury
• Stuffy nose
• Sweating
• Blurred vision
• Nausea
• Feeling of apprehension

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Immediate Nursing Care for Autonomic Dysreflexia

• Raise HOB to high Fowlers position
• Frequent vital signs
• Palpate bladder check Foley for kinks
• Assess for fecal impaction
• Loosen tight clothing
• Ensure comfortable environmental temperature
• Prepare for administration of vasodilators
• Calming affect

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Ongoing Nursing Care

• CARDIAC OUTPUT
• Cardiac monitoring
• Hemodynamic monitoring
• Ongoing vasopressors
• Hydration
• Orthostatic hypotension
• Pneumatic stockings, TEDs
• ROM

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Ongoing Nursing Care

• SKIN INTEGRITY/IMMOBILITY
• Prophylactic treatment
• Speciality bed
• Weight shifts, ROM
• Nutrition
• Foot board
• Gel pads
• Mobility

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Ongoing Nursing Care

• GASTROINTESTINAL
• Abdominal Assessment
• Nutritional support
• Bowel training
• Timing Suppository
• Stool softener Manual disimpaction

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Ongoing Nursing Care

• GENITAL/URINARY
• Palpate bladder
• Bladder training
• Intermittent catheterization
• Creade method
• Urecholine (bethanechol)
• Accurate I O
• Sexual counseling
• Reflexogenic erection
• Vaginal lubrication

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Ongoing Nursing Care

• NUTRITION
• Enteral feedings
• Daily weights
• Calorie count
• High protein, high carbohydrate,
• high calorie diet
• Feeding aids

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Ongoing Nursing Care

• HOME MAINTENANCE
• Change in physical layout of home
• Transportation
• Accessibility
• Chair Skills
• Halo Device Care
• Health Promotion

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Ongoing Nursing Care

• PSYCHOLOGICAL
• Role in the Family
• Body Image
• Self Esteem
• Financial Concerns
• Coping Techniques