14 - Spinal Cord Injury.pptx

Basic Medical Surgical Nursing Care of the Patient with a Spinal Cord Injury  Spinal Cord Injuries (SCIs) Complete vs Incomplete Types of Injuries Primary Related to the initial injury Secondary Worsens the injury Can be: Hemorrhage Ischemia Impaired tissue perfusi...

Basic Medical Surgical Nursing Care of the Patient with a Spinal Cord Injury  Spinal Cord Injuries (SCIs) Complete vs Incomplete Types of Injuries Primary Related to the initial injury Secondary Worsens the injury Can be: Hemorrhage Ischemia Impaired tissue perfusion from shock Hypovolemia Local Edema  Risk Factors Young males Educate patients to: not engage in risk-taking Trauma behaviors Motor Vehicle Crashes Wear protective (MVCs) gear/equipment for Falls potentially traumatic sports Acts of Violence (gunshot or recreational activities wounds) Wear seatbelts while Sports operating a motor vehicle Recreational activities Avoid impaired driving (including alcohol, (alcohol or illicit drug use) marijuana, and other impairing substances) Avoid diving in shallow Importance of water (water must be at prevention least 9 ft)  Level of Injury Level of injury  depends on where the injury occurred -plegia vs -paresis Tetra- (aka quadri-) Para- C3-C5 Respiratory compromise Sensation Complete loss vs hyper-/hypoesthesia  Signs & Symptoms Cardiovascular: Neuromuscular: Bradycardia, hypotension, hypothermia Loss of movement (plegia vs paresis) Must keep SBP > 90 mm Hg to keep adequate Numbness , tingling or loss/change to perfusion to the spinal cord sensation in extremities Potential for cardiac dysrhythmias Immobility Unsteady Gait Respiratory: Difficulty breathing related to paresis or plegia ofPain or pressure in the head, neck or the diaphragm (C3-5) back Difficulty clearing secretions Psychosocial: Changes in sexual function Gastrointestinal: Loss of bowel control Genitourinary: Loss of bladder control  Diagnosis CT or MRI of the spine X-ray of spine CMP (or BMP) and CBC For baseline Initial Care of SCIs ABCs are the priority Spinal precautions C3-5 Log roll patients Respiratory assessment Keep cervical collar on Cervical collar on ALL suspected or until cleared by confirmed SCIs healthcare provider Evaluate: HR, BP & peripheral perfusion Helps keep patients' (pulse strength and capillary refill) spine in neutral Assess for hemorrhage (hypovolemia) alignment Frequent Glasgow Coma Scale (GCS) Cognitive impairment can be indication of other injuries or substance use Assess patient’s sensory perception Spinal Shock Syndrome  Treatments Medications Surgical Atropine sulfate (Isopto Atropine): given to Surgical: many different types of spinal surgeries  treat a patient with symptomatic bradycardia Priority is to stabilize the spine IV medications to raise BP: can be used to Post-operative care will depend on level of injury and specifc surgery completed treat severe hypotension Patient will need to wear a specific orthosis (brace) Midodrine (ProAmatine): oral (PO) med while the body heals that can be used to treat mild hypotension Proton pump inhibitors (ex: pantoprazole, Non-Surgical omeprazole, lansoprazole): can be given to help prevent stress ulcers Immobilization of the spine with a specific orthosis Muscle relaxers (ex: baclofen (Lioresal) or (brace) methocarbamol (Robaxin)): may be given to Examples of orthotics: cervical collar, halo crown, help prevent muscle spasticity or pain thoracic-lumbar sacral orthosis (TLSOs) Fluids (IV or PO hydration): goal is to Regardless of the orthosis, must monitor skin maintain adequate hydration. integrity  SCI Complications Respiratory Autonomic Dysreflexia Potentially life-threatening hypertensive Mobility emergency Cardiovascular Severe, sudden increase in BP puts patient at risk of hemorrhagic stroke Integumentary Signs & Symptoms: Genitourinary Flushing & Profuse sweating above level of injury Gastrointestinal Blurred vision, spotty vision Nasal congestion Venous thromboembolisms Severe, throbbing headache Bradycardia  Autonomic Dysreflexia Causes: Gynecological-urological (GU), gastrointestinal (GI) or vascular stimulation Examples: urinary tract infection, full bladder, fecal impaction, bowel distention, irritation of hemorrhoids, pain, circumferential constriction of the body (i.e., tight clothing), excess pressure, sharp or hard objects Treatment: Sit patient upright Remove the stimulus (Ex: straight cath patient with full bladder) Treat the patient’s blood pressure  Questions?