Spinal Cord Injury Overview

Concussion: Full recovery is expected.
Contusion: Tissue damage within the spinal cord.
Laceration: A tear in the spinal cord.
Compression: Pressure on the spinal cord.
Complete transection: Results in paralysis below the injury site.
The primary injury is usually permanent and the result of the initial trauma.
Secondary injuries result from swelling and disintegration of nerve fibers; these are potentially reversible in the first few hours.
The 5th, 6th, and 7th cervical, 12th thoracic, and 1st lumbar vertebrae are most commonly involved in SCI due to their higher mobility.

Manifestations depend on the injury level (cervical, thoracic, lumbar, sacral).
Different types of complete and incomplete SCI can result in varying degrees of paralysis.
Chart 64-7 and 65-7 illustrate the effects of various SCI types and levels.

Complete lesion: Total loss of motor and sensory function below the injury.
Anterior cord syndrome: Loss of pain and temperature below the lesion; motor function is also impacted but to a lesser extent than sensory function.
Brown-Sequard syndrome: Loss of sensation and motor function on the opposite side of the injury, along with loss of pain and temperature on the same side; sensation and motor impairments on the same side are less affected than on the opposite side.
Central cord syndrome: Motor impairment more severe in the upper extremities than in the lower extremities.
Conus medullaris and cauda equina syndromes: Loss of motor function and sensory function in various ways, depending on the injury.

The ASIA scale is used to assess the degree of impairment.
Clients are classified using levels (A-E).
Level A represents a complete loss of function below the lesion and levels B–D show incomplete losses with varying degrees/types of lower body strength and functionality.

Emergency medical care for SCI includes immobilization and proper handling to prevent further injury.
Management during the acute phase includes pharmacologic therapy, respiratory therapy, fracture reduction and traction, and surgery.
Assessment for traumatic brain injury (TBI) includes evaluating the level of consciousness, pupils, gag reflex, corneal reflex, and vital signs.

Clinical manifestations depend on the location and level of injury within the spinal cord.
The neurologic level refers to the lowest level where sensory and motor function are normal.
Signs and symptoms of SCI include paralysis below the injury level, loss of bladder and bowel control, loss of sweating and vasomotor tone in the affected area, and blood pressure changes.
Headaches are also a possible symptom; If a conscious client describes a headache, the cause should be identified.

The severity of respiratory problems depends on the injury level.
High cervical injuries are at higher risk of respiratory failure, which is a principal cause of death in these situations.

Comprehensive evaluation of neurological status is crucial.
Imaging (MRI, and CT scans) is often used to assess spinal injury and the associated damage.
Baseline routine labs, urinalysis tests, blood tests, and ECGs.

Nursing diagnoses related to SCI may include:
Altered spinal cord tissue perfusion, ineffective airway clearance, impaired physical mobility, altered urinary elimination, impaired adjustment, and skin integrity.

Crucial aspects of non-surgical management include vital signs monitoring, positioning, and immobilization based on the injury level.
Positioning is critical to preventing further injury and impairment, particularly in cervical injuries.

Treatment may include high-dose corticosteroids (methylprednisolone), oxygen administration, strict avoidance of neck movement, and mechanical ventilation as required.
Proper immobilization and reduction of dislocations, and stabilization of the vertebral column.
Specific types of traction, like Gardner-Wells tongs and halo fixation devices, may be used.
Early surgical intervention may be considered in many cases.

Assessing and maintaining the airway is a priority.
Proper monitoring and management of secretions and breathing are critical.
Skin care is particularly important to prevent pressure ulcers.
Proper nutrition, hydration, hygiene, and monitoring bowel and bladder function.

Potential complications of SCI include deep vein thrombosis (DVT), orthostatic hypotension, spinal shock, neurogenic shock, and autonomic dysreflexia.

Autonomic dysreflexia is a potentially life-threatening complication.
It is typically triggered by stimuli below the level of injury.
Symptoms, often rapid onset, include sudden, significant increases in blood pressure, profuse sweating, and nasal stuffiness above the injury level.
Removing the stimulus and/or managing blood pressure is crucial to prevent life-threatening complications.

Assessment includes history and physical. Nurses need to understand important diagnosis.
Goals in management might include some degree of mobility, skin integrity maintenance without infection, achievement of bowel and bladder control, increased sexual expression, increased coping mechanisms, and absence of complications. The client's goals are also individualized.