Spinal Cord Injury (SCI)

DEFINITION OF THE DISEASE

Injuries affecting the spinal cord commonly results from trauma, gunshot wounds and motor vehicle

accidents. Many cases of SCI are caused by falls, sports-related injury and minor trauma. The principal risk

factors for SCI include age, gender, and alcohol and drug use. Males are affected four times more often than

females. Over half of the victims are 16 to 30 years of age.

The most common vertebrae involved in SCI are the 5th, 6th and 7th cervical, the 12th thoracic, and

the 1st lumbar. These vertebrae are the most vulnerable because there is a greater range of mobility in the

vertebral column in these areas. Damage to the spinal cord ranges from transient concussion, to contusion,

laceration and compression of the cord substance, to complete transection of the cord.

Injury can be categorized as primary which is usually permanent or secondary wherein nerve fibers

swell and disintegrate as a result of ischemia, hypoxia, edema, and hemorrhagic lesions. The type of injury on

the other hand, refers to the extent of injury to the spinal cord itself. Incomplete spinal cord lesions are

classified according to the area of spinal cord damage: central, lateral, anterior, or peripheral. A

complete spinal cord injury can result in paraplegia, which is paralysis of the lower body or quadriplegia which

is the paralysis of all four extremities.

Signs & Symptoms

Neurologic Level

The neurologic level refers to the lowest level of the injury of the cord.

• Total sensory and motor paralysis below the neurologic level

• Loss of bladder and bowel control (usually with urinary retention and bladder distention)

• Loss of sweating and vasomotor tone below the neurologic level

• Marked reduction of blood pressure from loss of peripheral vascular resistance

• If conscious, patient reports acute pain in back or neck; patient may speak of fear that the neck or back

is broken

Respiratory Problems

• Related to compromised respiratory function; severity depends on level of injury

• Acute respiratory failure is the leading cause of death in high cervical cord injury
 PATHOPHYSIOLOGY

DIAGNOSTIC EXAM

Diagnosis of SCI is based on physical examination, radiologic examination, CT scan, MRI and myelography.

Diagnostic x-rays such as lateral cervical spine x-rays and CT scanning are usually performed initially. An MRI

scan may be ordered as a further work up if a ligamentous injury is suspected, since significant spinal cord

damage may exist even in the ansence of bony injury. Continuous electrocardiographic monitoring may be

indicated if a cord injury is suspected since bradycardia and asystole are common in acute spinal injuries.

NURSING CARE

Promoting Adequate Breathing

• Detect potential respiratory failure by observing patient, measuring vital capacity, and monitoring oxygen saturation

through pulse oximetry and arterial blood gas values.

• Prevent retention of secretions and resultant atelectasis with early and vigorous attention to clearing bronchial and

pharyngeal secretions.
• Suction with caution, because this procedure can stimulate the vagus nerve, producing bradycardia and cardiac

arrest.
• Initiate chest physical therapy and assisted coughing to mobilize secretions.

• Supervise breathing exercises to increase strength and endurance of inspiratory muscles, particularly the diaphragm.
• Ensure proper humidification and hydration to maintain thin secretions.

• Assess for signs of respiratory infection: cough, fever, and dyspnea.

• Discourage smoking.

• Monitor respiratory status frequently.

Improving Mobility
• Maintain proper body alignment; place patient in dorsal or supine position.

• Turn patient every 2 hours; monitor for hypotension in patients with lesions above the midthoracic level. Assist

patient out of bed as soon as spinal column is stabilized.

• Do not turn patient who is not on a turning frame unless physician indicates that it is safe to do so.

• Apply splints to prevent footdrop ans trochanter rolls to prevent external rotation of the hip joint; reapply every 2

hours.
• Perform passive range-of-motion exercises within 48 to 72 hours after injury to avoid complications such as

contractures and atrophy.

• Provide a full range of motion at least every four or five times daily to toes, metatarsals, ankles, knees & hips.

Maintaining Skin Integrity

• Change patient’s position every 2 hours and inspect the skin, particularly under cervical collar.

• Assess for redness or breaks in skin over pressure points; check perineum for soilage; observe catheter for adequate

drainage; assess general body alignment and comfort.

• Wash skin every few hours with a mild soap, rinse well, and blot dry. Keep pressure sensitive areas well lubricated

and soft with bland cream or lotion; gently perform massage using a circular motion.
• Teach patient about pressure ulcers and encourage participation in preventive measures.

Promoting Urinary Elimination

• Perform intermittent catheterization to avoid overstreatching the bladder and infection. If this is not feasible, insert

an indwelling catheter.
• Show family members how to catheterize, and encourage them to participate in this facet of care.

• Teach patient to record fluid intake, voiding pattern, amounts of residual urine after catheterization, quality of urine,

and any unusual feelings.

Promoting Adaptation to Disturbed Sensory Perception

• Stimulate the area above the level of the injury through touch, aromas, flavorful food, conversation, and music.

• Provide prism glasses to enable patient to see from supine position.

• Encourage use of hearing aids, if applicable.

• Provide emotional support; teach patient strategies to compensate for or cope with sensory deficits.

Improving Bowel Function

• Monitor reactions to gastric intubation.

• Provide a high-calorie, high-protein, and high-fiber diet. Food amount may be gradually increased after bowel sound

resume.
• Administer prescribed stool softener to counteract effects of immobility and pain medications, and institue a bowel

program as early as possible.

Providing Comfort
• Reassure patient in halo traction that he/she will adapt to steel frame.

• Cleanse pin sites daily, and observe for redness, drainage, and pain; observe for loosening; keep a torque

screwdriver readily available.

• Assess skull for signs of infection, including drainage around halo-vest tongs.

• Check back of head periodically for signs of pressure. Massage at intervals, taking care not to move the neck.

• Shave hair around tongs to facilitate inspection. Avoid probing under encrusted areas.

• Inspect skin under halo vest for excessive perspiration, redness, and skin blistering, especially on bony prominences.
• Open vest at the sides to allow torso to be washed. Do not allow vest to become wet; do not use powder inside

vest.

REFERENCE

Smeltzer, S. Et Al.. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (Lippincott Williams & Wilkins.

10th edition,2004)

Huether, S. Et Al. Understanding Pathophysiology (Mosby, Inc. 2nd edition. 2000)

 University of Pangasinan
College of Nursing
Dagupan City, Philippines

NURSING CARE PLAN

Alias/age: Date Handled:
Medical Dx: Date Submitted:
 Assessment Nursing Nursing Analysis Expected Nursing Interventions Rationale Evaluation
Diagnosis Outcome
SUBJECTIVE: Impaired Spinal cord After 8 hours Independent: • Evaluates status of After 8 hours of
“Hindi ako physical injury may result of • Continually asses individual situation nursing
makagalaw” (I mobility related from trauma, nursing motor function (as (motor-sensory interventions, the
can’t move) as to vascular interventions, spinal shock or edema impairment may be patient was able
verbalized by the neuromascular disruption, the resolves) by mixed and/ or not to demonstrate
patient. impairment. infection, tumor, patient will requesting patient to clear) for a specific techniques or
OBJECTIVE: and other insults. demonstrate perform certain level of injury, behaviors that
Paralysis The injury may be techniques or actions. affecting type and enable
Muscle partial or behaviors that • Provide means to choice of intervention. resumption of
atrophy complete and enable summon help. • Enables patient to activity.
Irritability vary from a mild resumption of • Assist in range of have sense of control,
V/S taken as cord concussion activity. motion exercises on all and reduces fear of
follows: with transient extremities and joints, being left alone.
T: 37.3 numbness to using slow, smooth • Enhances circulation,
P: 92 complete cord movements. restores or maintains
R: 19 transaction
• Plan activities to muscle tone and joint
BP: 120/80 causing mobility, and prevent
provide uninterrupted
immediate and disuse contractures
rest periods.
permanent and muscle atrophy.
Encourage
tetraplegia. The
involvement within • Prevents fatigue,
most common
individual tolerance or allowing opportunity
sites of injury are
ability. for maximal efforts or
the cervical areas
• Reposition periodically participations by
C5, C6, and C7,
even when sitting in patient.
and the junction
chair. Teach patient • Reduces pressure
of the thoracic
and lumbar how to use weightshifting areas, promotes
vertebrae, T12 techniques. peripheral circulation.
and L1. Clinical • Inspect the skin daily. • Altered circulation,
manifestations Observe for pressure loss of sensation, and
vary with the areas, and provide paralysis potentiate
location and meticulous skin care. pressure sore
severity of cord Collaborative: formation.
damage. In • Consult with physical • Helpful in planning
general, complete or occupational and implementing
Transaction therapist. individualized
causes loss of all • Administer muscle exercise program and
function below relaxants or identifying or
the level of lesion, antispasticity as developing assistive
and incomplete prescribed. devices to maintain
cord damage function, enhance
results in a mobility and
variety of regional independence.
deficits. • May be useful in
Complications limiting or reducing
include shock, pain associated with
________________________ Paul Christian P. Santos
Clinical Instructor/Agency UPCN-SN/Shift