13.3.1 Spinal Cord Injuries
Spinal Cord Injuries
From Medical-Surgical Nursing- Ch 17
Learning Objectives
By the end of this section, you will be able to:
- Discuss the pathophysiology, risk factors, and clinical manifestations for spinal cord injuries
- Describe the diagnostics and laboratory values in spinal cord injuries
- Describe the medical therapies that apply to the care of spinal cord injuries
- Apply nursing concepts and plan associated nursing care for the patient with spinal cord injuries
- Evaluate the efficacy of nursing care for the patient with spinal cord injuries
Spinal Cord Injuries
A spinal cord injury is damage to any area of the spinal cord, including the nerves and nerve fibers that transmit signals from the brain. Spinal cord injuries may involve the spinal cord and/or the bones and tissues that surround the spinal cord. As with TBIs, spinal cord injuries can be caused by various events, including automobile accidents, falls, sports injuries, and violence. Infections that cause abscesses on the spinal cord can also result in spinal cord injuries.
Pathophysiology
Like TBIs, spinal cord injuries may cause temporary or permanent damage to the body. Depending on the nature of a spinal cord injury, the patient may experience issues with strength, movement, feeling, and functioning in areas of the body below the injured area.
Spinal cord injuries fall into two categories—incomplete and complete. With incomplete injuries, the spinal cord retains some capability to communicate with the brain, enabling patients to maintain some functioning, muscle control, and feeling below the injured area. In complete injuries, patients lose all nerve communication below the injured area, leading to a total loss of functioning, muscle control, and feeling below the injured area.
Spinal cord injuries may also lead to paralysis. A form of paralysis from a spinal cord injury known as paraplegia affects some or all of the truck, pelvic organs, and legs. But with paraplegia, patients can still move their arms. A form of paralysis from a spinal cord injury that is known as tetraplegia, or quadriplegia, affects patients’ arms and hands, as well as their trunk, pelvic organs, and legs.
Clinical Manifestations
Typically, the symptoms of a spinal cord injury include the inability to move, pain and/or stinging sensations, muscle weakness, numbness and tingling, balance and coordination difficulties, spasms and/or exaggerated reflexes, loss of bladder and/or bowel control, decreased or lost sensations, and sexual dysfunction. Some patients also experience difficulty breathing.
Assessment and Diagnostics
To assess and diagnose a spinal cord injury, patients should undergo a physical examination that gathers information about the incident that led to the injury and the symptoms the patient is experiencing. This includes impairments, such as the patient’s range of motion, muscle weakness, and level of sensations. This also includes the patient’s sensory functions as determined by pinpricks and touching. Patients may also need tests such as x-rays, MRIs, and CTs to reveal fractures and other damage to the spine.
Nursing Care of the Patient with Spinal Cord Injury
As with patients who have TBIs, nursing care for the patient with a spinal cord injury should focus on helping the patient recover if possible. If the patient has permanent health issues as a result of the injury, nursing care should focus on helping the patient adjust and learn to manage the new health issues. If needed, the patient and their family should be provided with mental health support.
Recognizing Cues and Analyzing Cues
The cues of a spinal cord injury will be found in the patient’s physical examination and test results. In addition to the patient’s symptoms, such as pain and inability to move, the findings may include results such as bone fractures and swelling that reveal whether the patient has a spinal cord injury, and if so, the nature and severity of the injury.
Prioritizing Hypotheses, Generating Solutions, and Taking Action
Spinal cord injuries should be prioritized based on the severity of the symptoms. The nursing interventions appropriate for patients may include those in Table 17.24.
| Nursing Care | Rationale |
|---|---|
| Complete focused neurological assessments. | The patient’s pain levels and other symptoms, such as ability to move, indicate if a spinal cord injury is present and its severity. |
| Monitor vital signs. | Changes in the patient’s vital signs such as heart rate and blood pressure may indicate health issues. In particular, patients may exhibit signs of shock. |
| Provide care before and after surgery. | Some patients with spinal cord injury may need surgery. Nurses should help patients prepare for surgery and provide care after surgery, such as dressing patients’ wound(s). |
| Administer medications. | Patients may need medication to help with pain relief. |
| Assist with traction. | Some patients may need to be placed in traction to keep them immobile and help realign their spine. |
| Coordinate with therapists. | As they recover, some patients need therapy to regain skills and overcome problems incurred by spinal cord injury. This may include physical and/or occupational therapists. |
Evaluation of Nursing Care for the Patient with Spinal Cord Injuries
The desired outcome for patients with spinal cord injuries is relief of their symptoms. If their symptoms cannot be relieved, the desired outcome is to help them control and manage their symptoms.
Medical Therapies and Related Care
The medical therapies used to help patients with spinal cord injuries may include surgery, medications, and therapy. The medications that may be useful include steroid injections to reduce swelling, as well as nonsteroidal anti-inflammatory drugs, which can also relieve pain and swelling. Some patients may benefit by taking corticosteroids for swelling, and for short-term pain relief, opioids may benefit some patients. For muscle pains and spasms, patients may benefit from drugs such as tizanidine and diazepam. To deal with pain, as well as depression, some patients may find serotonin-norepinephrine reuptake inhibitors helpful. Depending on the severity of their injury and symptoms, some patients may need rehabilitation and long-term care to recover.
Next- Module 14
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