Spinal Cord Injuries: Anatomy, Function & Actions

Spinal Cord Injuries: Anatomy and Function

• Cervical spinal cord controls movement and sensation in the arms and legs
• Injuries in the cervical area can result in tetraplegia/quadriplegia
• Motor vehicle accidents are the leading cause of spinal cord injuries, accounting for approximately half of all cases
• A T4 spinal cord injury results in paraplegia, affecting the lower body, but spares arm function
• Complete spinal cord injuries cause a total loss of motor and sensory function below the level of injury
• The spinal cord transmits signals between the brain and body for movement and sensation
• The C1-C4 region controls the diaphragm and accessory muscles for respiration, making injuries in these areas particularly dangerous

Immediate Actions and Monitoring

• Spinal immobilization prevents further injury and neurological damage
• Injuries at or above C6 can impair respiratory function, necessitating close monitoring
• Airway and breathing are the primary concerns in spinal cord injuries, particularly in cervical injuries

Autonomic Dysreflexia and Neurogenic Shock

• Autonomic dysreflexia is a life-threatening condition characterized by a sudden rise in blood pressure, bradycardia, and flushed skin above the injury.
• Autonomic dysreflexia is most common in patients with injuries at T6 or above.
• Neurogenic shock presents with hypotension, bradycardia, and warm, dry skin due to loss of sympathetic tone

Prevention and Care

• Deep vein thrombosis (DVT) prevention requires a combination of anticoagulants, mobility exercises, and compression therapy
• Patients with high cervical spinal cord injuries have weakened respiratory muscles and require interventions to maintain airway clearance
• Patients with lumbar spinal cord injuries need education on bladder and bowel management, as well as skin care to prevent complications
• Loss of sensory function leads to decreased awareness of pressure, increasing the risk of skin breakdown
• Patients with spinal cord injuries are at risk for orthostatic hypotension due to loss of sympathetic nervous system function, leading to impaired vasoconstriction
• Key nursing interventions for autonomic dysreflexia: check the patient's blood pressure, identify and remove the noxious stimulus and administer an antihypertensive medication if needed
• The inability to regulate temperature occurs due to loss of sympathetic control and reduced mobility
• Urinary retention is a major risk factor for autonomic dysreflexia in spinal cord injury patients
• Teaching to prevent pressure ulcers should include Repositioning every 2 hours, maintaining proper skin hygiene, and using pressure-relieving devices

Patient Independence and Rehabilitation

• A wheelchair is the most suitable mobility aid for patients with lower limb paralysis
• Airway management is crucial in ventilator-dependent patients to prevent infections and maintain airway patency in C3 spinal cord injuries requiring ventilation.
• T12 injuries affect lower limb function but do not impair cognition, so cognitive rehabilitation is unnecessary
• Patients with C6 injuries may be able to use assistive devices for some activities of daily living.
• Key discharge teaching topics for T12 spinal cord injuries: Bladder self-catheterization, pressure ulcer prevention, and assistive devices for mobility
• A successful bowel program results in regular, predictable bowel movements without dependence on daily laxatives
• Encouraging independence with upper body movements is the most appropriate intervention for a patient with a T10 spinal cord injury