Spinal cord injuries: Nursing

A spinal cord injury refers to any damage to the spinal cord, which is a bundle of nerve fibers that serves as a highway that carries information between the brain and the body.

Now, a spinal cord injury can involve primary and secondary injury. Primary injury typically involves a sudden traumatic impact on the spine that fractures or dislocates the protective vertebrae damages the spinal cord or interrupts its blood supply.

Then after the primary injury, there's usually additional damage or secondary injury that occurs due to the body's natural response to trauma.

Secondary injury begins immediately after the spinal injury and includes bleeding, inflammation and edema. This is followed by compression of the spinal cord ischemia and neuronal damage as time goes by additional neuronal cell death occurs.

Eventually specialized glial cells begin to form scar tissue at the site of injury, which creates a barrier across the injured tissue, impairing cellular regeneration, which can result in permanent nerve damage and subsequent neurologic deficit.

Now, spinal cord injuries can have several different causes including trauma like with a motor vehicle crash or falls such as falling from a ladder, penetrating trauma, like a stab wound in the back or a gunshot or recreational injuries like those caused by impact sports.

They can also be caused by medical conditions including spinal tumors, infections or degenerative diseases of the spine, like a protruding intervertebral disc.

Risk factors for developing a spinal cord injury include engaging in high risk behaviors such as not wearing safety equipment when playing sports or speeding while driving.

Lastly, a history of bone or joint disorders increases the risk since even minor trauma could damage already weakened bones and injure the spinal cord.

All right. Now, clinical manifestations of spinal cord injuries depend on the severity and location of the injury and may include partial or complete loss of sensation.

For instance, injury between C one and T one leads to tetraplegia, sometimes called quadriplegia, which can involve loss of function of the limbs, trunk and loss of innervation to the diaphragm requiring mechanical ventilation.

Next, injury between T one and L1 leads to paraplegia where upper limb function remains intact. But there's paralysis of both lower limbs.

There can also be a loss of accessory respiratory muscle function like the intercostal muscles as well as bowel and bladder dysfunction.

Moreover, severe spinal cord injuries may result in spinal shock, which is a transient condition that develops shortly after an acute injury.

It's characterized by flaccid paralysis, loss of sensation and loss of deep tendon and sphincter reflexes below the level of injury.

Neurogenic shock can also occur leading to loss of sympathetic outflow and unopposed parasympathetic activity to the heart and peripheral vessels.

This can cause peripheral vasodilation, hypotension and bradycardia diagnosis of a spinal cord injury starts with a history and physical assessment.

Motor and sensory function is tested at each dermatome level on both sides of the body and the severity of impairment is scored using the American spinal injury association or Asia scale.

In addition, imaging tests like x rays, CT scan or MRI can be used to look for the exact cause of spinal cord injury. Treatment.

For spinal cord injuries begin with supportive measures to stabilize the patient. This may include immobilizing the spinal column and addressing respiratory and cardiovascular compromise.

For example, a patient with an injury above C five will often be intubated and receive mechanical ventilation. While injuries above T six will often need fluids or vasopressors due to loss of sympathetic outflow to the heart and peripheral vasculature treatment may also involve performing decompression surgery to relieve pressure on the spinal cord.

After the acute phase, much of the treatment is geared towards rehabilitation which can involve pain management along with physical and occupational therapy.

Finally, the goal of long term care is to prevent and treat complications and promote the patient's functional independence.

All right, the nursing care you'll provide for a patient with a spinal cord injury, involves working with the health care team to stabilize the patient and prevent complications.

First, institute spinal precautions to prevent further injury to your patient's spine including applying a cervical collar to immobilize the neck, keeping their head in a neutral position.

And using the log roll technique during repositioning the respiratory care you'll provide depends on the level of injury.

So your patient could be ventilator dependent or they may need some degree of respiratory support due to weak cough, reflex, difficulty, clearing secretions or impaired lung expansion, initiate high flow oxygen as prescribed as well as continuous pulse, oximetry and capnography.

Closely monitor their lung sounds as well as their respiratory rate and depth and watch for hypoxia, hypercapnia, atelectasis and pneumonia.

Next, monitor your patient closely for hemodynamic compromise and signs of neurogenic shock including bradycardia and hypotension and administer the prescribed IV fluids and vasopressors as needed.

Finally, assess your patient for other potential complications including bowel and bladder dysfunction and temperature instability, use pressure distribution surfaces and help your patient change their position at least every two hours to prevent pressure injuries, provide parenteral or enteral nutrition to support healing.

Collaborate with physical therapy for early mobilization to prevent contractures and venous thromboembolism and administer the prescribed medications to manage pain.

A spinal cord injury refers to any damage to the spinal cord. The injury can be primary usually due to a sudden traumatic impact on the spine and secondary due to the body's natural response to trauma such as bleeding and inflammation.

Clinical manifestations depend on the severity and location of the injury. And diagnosis involves assessment of motor and sensory function as well as imaging tests.

Treatment includes spinal stabilization, addressing complications and rehabilitation. Nursing considerations are focused on providing physiological support and monitoring for complications.