SPINAL CORD INJURY
D/T trauma
CLASSIFICATION
Mechanisms of Injury:
1. Hyperfelxion
2. Hyperextension
3. Felxion rotation
4. Compression
Level of Injury:
1. Cevical: quadraplegia
2. below C4: diaphragmatic breathing
3. Thoracic
4. Lumbar
Degree of Injury:
1. Complete
2. Incomplete
Pathophysiology:
- Spinal cord tough; rarely torn
- edema, bleeding, metabolytes; leads to ischemia and
necrosis
Upper Motor Neuron Disorder VS Lower Motor Disorder:
UMD:
- paralysis, spasticity, hyperactive reflexes
LMD:
- flaccidity, atrophy, decreased or absent reflexes
Spinal Shock:
- complete transection of cord:
- loss vascular tone; bradycardia
Medical/nursing management:
- ABCs, stabalize, assess baseline motor movement
Prehospital and Acute/Emergency management:
Respiratory:
- above C4: mechanical ventilation
- below C4: can breathe
- assess and maintain patency airway
- continuous asessment respiratory status
- at risk for atelectasis
- quad-assist coughing; suctioning
Cardiovascular:
- above T5: bradycardia and hypotension
- atropine
- hemorrhage
- dependent edema and DVT: elevate limb, ROM, anti-embolic
stockings
Immobilization/Mobilization:
- immobilize head and neck
- skeletal traction
- Stryker Frame or Rotorest bed
- ROM
- extended immobilization
- advance mobility slowly
- elevate HOB
Medications:
CORTICOSTEROID!
GI/Nutrition:
- GI tract may stop functioning
- when bowel sounds or flatus return, begin oral feeding
- stress ulcer: H2 receptor antagonists
- depression
Muscles:
- spasm
- benefits spasm: maintains muscle bulk, promotes venous
return, useful for boel, blaader, and sexual retraining
- disadvantages spasm: pain
Bowel and Bladder:
- urinary retention is common: catheter
- assess for retention, incontinence, reflexive voiding
- risk for UTIs, renal calculi
Management:
- cutaneous stimulation (tap abdomen, pull pubic hair, stroke
inner thigh)
- Crede (downward pressure of bladder with pumping
motion)
- Valsalva maneuver
- Combine valsalva with rectal stretch
- intermittent catheters
Bowel:
- constipation
- valsalva for UMD
- manual disimpaction for LMD
Temperature control:
- loss temperature control; pt assumes temperature of
surrounding air
- monitor pt's temperature
Sexuality:
- use pt's terminology
- communication is very NB
- Sexual disfunction is variable:
- UMD: reflective erections/no orgasm or ejaculation
- LMD (complete): no erections/ejacualtion
- LMD (incomplete): highest possibility of
erection/ejaculation; 10% are fertile
- women are fertile but no orgasm
- explore alternative sexual satisfaction
Emotional support:
- overwhelming sense of loss
- need emotional support+++; include family
AUTONOMIC DYSREFELXIA
- potentially life-threatening
- results from exaggerated response of sympathetic nevous
system
- symptoms are severe: hypertension (up to 300 systolic);
therefore: H/A, bradycardia, iloerection, flushing,
diaphoresis, blurred vision
- most common: bladder irritation
NEW RESEARCH:
Regeneration Therapy via transplantation of fetal tissue into the injured spinal cord!