Untitled Quiz

Spinal Cord Injury Overview

• Spinal cord injury (SCI) is a significant health concern.
• Approximately 86,000 Canadians live with disabilities due to SCI.
• Risk factors for SCI include age, gender, alcohol and drug use.
• Primary prevention is crucial.

Types of Spinal Cord Injuries

• Concussion: Full recovery is anticipated.
• Contusion: Injury to the spinal cord tissue.
• Laceration: Tear in the spinal cord tissue.
• Compression: Pressure on the spinal cord.
• Complete transection: Paralysis below the injury site.
• Primary injury: Resulting from initial trauma, usually permanent.
• Secondary injury: Resulting from swelling and disintegration of nerve fibers following initial injury; these are usually reversible (or preventable) during first 4 to 6 hours post-injury

Vertebrae Involved in SCI

• Most frequent vertebrae involved: 5th, 6th, and 7th cervical; 12th thoracic; and 1st lumbar.
• These areas have greater mobility in the vertebral column.

Secondary Injury

• Mechanisms of secondary injury involve ischemia, hypoxia and hemorrhage, causing nerve damage (destruction of myelin and axons).
• These damages, secondary to injury, occur as a consequence of initial trauma and are normally considered permanent.
• Treatment is crucial during the first four to six hours after the injury to prevent extensive, permanent damage.

Manifestations of Spinal Cord Injury Depend on Injury Level

• Manifestations vary depending on the specific vertebral level injured, impacting different parts of the body and affecting varying degrees of mobility.
• Diagram showing different injury levels affects cervical, thoracic, lumbar and sacral regions.

Common Spinal Cord Syndromes:

• Complete lesion: Total loss of sensory and motor function below the injury.
• Anterior cord syndrome: Loss of motor function and pain/temperature sensation.
• Brown-Sequard syndrome: Motor function and sensory function are lost on one side of the body or localized area.
• Central cord syndrome: Motor function is predominantly impaired in the upper extremities, while sensory functions may be lost or altered in both upper and lower limbs.
• Conus medullaris and Cauda equina syndromes: Usually involve lower extremities.

American Spinal Injury Association Impairment Scale (ASIA)

• The ASIA scale classifies SCI severity based on motor and sensory function.
• A scale detailing the five impairment levels (grades A through E) based on degree of preserved function.
• This scale is utilized for classifying degree of impairment.

Emergency Management and Acute Phase Management

• Emergency management: Key elements include immobilization and proper handling.
• Acute phase of SCI management: This includes pharmacologic therapy, respiratory therapy, fracture reduction, and traction, as well as surgical intervention when needed.

Assessment for Traumatic Brain Injury

• Assess for altered level of consciousness, confusion, pupillary abnormalities, altered or absent gag or corneal reflex
• Observe for sudden onset of neurologic deficits, changes in vital signs, vision and hearing impairment, sensory dysfunction, headaches, seizures.

Mechanisms of Spinal Cord Injury

• Hyperflexion: Forward bending of the neck or spinal column.
• Hyperextension: Backward bending of the neck or spinal column.
• Axial loading (vertical compression): Forces applied vertically along the spine.
• Excessive rotation: Abnormal twisting or rotation of the spinal column.
• Penetrating injuries: Injuries from penetrating objects. (Diagram illustrating these mechanisms is included.)

Spinal Cord Injury: Etiology

• Trauma: Motor vehicle accidents (MVAs) are a significant cause (around 50%), followed by falls.
• Disease: Polio, spina bifida, and Multiple Sclerosis (MS), and other disease states can sometimes impact spinal cord function.
• Tumors: Tumors can create pressure or damage the spinal cord.

Clinical Manifestations of Spinal Cord Injury

• Depend on the injury level (location within the spinal cord), usually referring to the lowest level of sensory/motor function.
• Symptoms vary, including neurologic level, and potentially paralysis in areas below the injury.
• Signs and symptoms often depend on location/type of damage.

Sign and Symptoms of Spinal Cord Injury

• Complete paralysis of both sensory and motor functions below injury level.
• Loss of bladder and bowel control (typically urinary retention and bladder distention).
• Loss of sweating and vasomotor tone below the injury level.
• Marked reductions in blood pressure and potentially life-threatening blood pressure drops.
• Pain might be experienced in the affected area by a conscious patient.

Respiratory Problems in Spinal Cord Injury

• Depending on the injury level, potential for compromised respiratory function, respiratory failure.
• Cervical cord injuries are frequently associated with respiratory failure, potentially leading to mortality.

Assessment and Diagnostic Procedures for Spinal Cord Injury

• A comprehensive neurological examination is essential.
• Imaging techniques, such as MRI, CT, radiographic scans of the lateral cervical spine, are utilized to identify problems.
• Electrocardiogram (ECG): Assessing heart rate and rhythm, particularly important in acute spinal cord injuries.

History Assessment

• Detailed medical history including accidents/traumatic incidents
• Describe position of victim after incident
• Information about prior treatment/care

Assessment Head to Toe

• Evaluating airway
• Observing for hemorrhage
• Evaluating level of consciousness (LOC)
• Assessing injury levels (tetraplegia, quadriparesis, paraplegia, paraparesis), which impact various body parts.
• Examining sensation, motor ability, cardiovascular status, respiratory status, gastrointestinal system, genitourinary system, musculoskeletal status and psychological well-being.

Laboratory Assessment (Diagnostic)

• Routine laboratory tests: Baseline tests to gather initial information.
• Urinalysis: For detecting blood in the urine.
• Arterial blood gases (ABG's): Analyzing blood oxygenation.

Nursing Diagnoses for Spinal Cord Injuries

• Impaired physical mobility
• Ineffective airway clearance
• Altered urinary elimination
• Altered spinal cord tissue perfusion
• Impaired adjustment
• Other potential diagnoses specific to injury location/severity

Non-Surgical Management of Spinal Cord Injuries

• Vital signs monitoring
• Positioning strategies
• Immobilization (e.g., cervical, thoracic/lumbar, or sacral regions)

Medical Management of Spinal Cord Injury

• High-dose corticosteroids (e.g., methylprednisolone or Prednisone): Counteracts spinal cord edema.
• Supplemental oxygen: Maintaining high arterial oxygen levels.
• Avoiding neck flexion or extension: Protecting the neck and spinal column.
• Mechanical ventilation: In cases where respiration is compromised.
• Spinal immobilization and reduction/stabilization of dislocations/fractures using skeletal traction (i.e., tongs, calipers, or halo devices).
• Surgical interventions (e.g., laminectomy).

Types of Cervical Spine Traction

• Gardner-Wells tongs
• Halo fixation device with jacket

Medical Devices

• Rotorest Bed (a specialized bed for spinal cord patients)
• Cervical Collar

Nursing Interventions: Promoting Effective Airway Clearance

• Respiratory failure detection: Closely monitoring respiratory functions and potential issues.
• Pulmonary care (including suctioning with caution): Maintaining & removing respiratory secretions & mucus in airway, while also protecting delicate tissues.
• Routine breathing exercises
• Assisted coughing techniques

Nursing Interventions: Other Important Actions

• Interventions for sensory and perceptual alterations
• Maintaining skin integrity
• Catheterization options
• Implementing high-calorie/protein/fiber diet and bowel programs.
• Traction pin care
• Proper hygiene and skin care related to traction devices and surgical interventions

Nursing Interventions: Improving Mobility

• Maintaining proper body alignment.
• Turning only when spine is stable/approved by physicians.
• Monitoring blood pressure.
• Passive range of motion (PROM) exercises.
• Using neck braces/collars as prescribed.
• Gradual repositioning/transfer in an upright position.

Complications of Spinal Cord Injuries

• Deep vein thrombosis (DVT)
• Orthostatic hypotension
• Spinal shock
• Neurogenic shock
• Autonomic dysreflexia

Nursing Interventions for DVT

• Low dose anticoagulation
• Indwelling vena cava filter (to prevent blood clots in the lungs).
• Daily monitoring of thigh/calf circumference
• Thigh-high elastic stockings/pneumatic compression devices.
• Monitor related lab results to evaluate clot formation.

Spinal Shock

• Sudden decreased reflex activity below the injured area of the spinal cord.
• Muscles below the injury become paralyzed and flaccid.

Neurogenic Shock

• Results from the loss of autonomic nervous system function; causing walls of blood vessels in affected sections of the body to relax, leading to various cascading problems.
• Decreased blood pressure, heart rate, and cardiac output.
• Venous pooling due to peripheral vasodilation.
• Reduced perspiration/sweating in paralyzed areas.
• Potentially hypothermia.

Nursing Interventions for Autonomic Dysreflexia

• Rapid assessment: Identifying the cause (e.g., full bladder, fecal impaction).
• Emptying the bladder (via catheterization), and potential irrigation to remove obstructions/impacted material.
• Evaluating the abdomen for fecal impaction.
• Assessing skin for appropriate responses to stimulation.
• Administering medications (e.g., dopamine/dobupamine to increase blood pressure) or other medications to correct abnormal responses to stimuli.
• Immediate physicians' notification
• Labeling charts/medical records related to increased risk for dysreflexia

Management of Patients with SCI (Quadriplegia or Paraplegia)

• Assessment: Comprehensive history and physical exam
• Nursing Diagnoses: Addressing relevant problems
• Collaborative problems: Spasticity, infection management
• Patient goals: Mobility, skin integrity, bladder/bowel control, sexual expression, emotional support/coping strategies, prevention of complications.

Interventions for SCI (Quadriplegia or Paraplegia)

• Increasing mobility.
• Preventing disuse syndrome.
• Promoting skin integrity
• Maintaining bladder/bowel control
• Counseling on sexual function.
• Enhancing coping mechanisms.
• Preventing spasticity and infection.

Review Questions (Sample Questions)

• Questions assessing knowledge of assessment tools (e.g., increased cardiac markers, hypotension, tachycardia, excessive sweating) relevant to complications of spinal cord injury and the most common causes of SCI.
• Questions focused on proactive interventions (e.g., fluid restriction, elastic stockings, PROM exercises, pin site care, preventing complications) to manage symptoms and reduce complications secondary to injury.
• Understanding etiology, treatment methods for related diseases and conditions.