Spinal Cord Injury Nursing Management Quiz

Spinal Cord Injury Management

• Bony fragments in the spinal canal can lead to deteriorating neurologic status, requiring surgery to reduce the spinal fracture or dislocation or decompress the cord.

Nursing Management

• Ineffective breathing pattern is related to weakness/paralysis of intercoastal muscles, abdominal muscles, and inability to expectorate secretions.
• Ineffective airway clearance is related to weakness of intercoastal muscles.
• Impaired physical mobility is due to motor and sensory impairment.
• Impaired urinary elimination is due to inability to void spontaneously.
• Acute pain is related to treatment and immobility.

Assessment

• Vital signs should be monitored, including sensation, motor function, and reflexes.
• Risk for hypotension: administer IV fluids, monitor fluid resuscitation, and administer vasopressor to maintain BP.

Airway Management

• Maintain airway through chest physiotherapy, suctioning, and assisted cough, considering contraindications.
• Monitor ABG and observe for aspiration.
• Provide abdominal binder for abdominal support to facilitate diaphragmatic breathing and increase venous return.

Rehabilitation

• Focus on functional establishment, respiratory management, and self-care.
• Assist with dressing, turning self on bed, mobility, self-feeding, transferring from place to place, bathing, and bladder and bowel function.

Psychological Support

• Provide psychological counseling to allow ventilation of feelings, clarify doubts, and offer vocational rehabilitation.

Initial Care

• Stabilize the spine in emergency situations, ensuring the client's neck is in a neutral position, spine in neutral alignment, and preventing flexion.
• Use a spinal board, hard collar, self-fastening ties across the torso and legs, and log rolling maneuver for transfer.

Medical Management

• Maintain vital functions by monitoring ABG levels, administering vasoactive agents for BP, and methyl prednisolone for SCI less than 8 hours old.
• Use H2 receptor blocking agents to reduce gastric and intestinal bleeding.
• Monitor for complications, including spinal shock, atelectasis, pneumonia, hypotension, DVT, GI bleed, pressure ulcers, joint contractures, and psychological dysfunction.

Surgical Management

• Indications for surgery include compression of the cord, fragmented or unstable vertebral body, and penetrating wounds that involve the cord.