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NAME: Spinal Cord Injury y Any injury in which segment or the entire cord is damaged.

y Occurs more often in men than women y The most common cause is motor vehicle crashes y Vertebrae most frequently involved are the 5th, 6th and 7th cervical vertebrae, the 12th thoracic vertebrae and the 1st lumbar vertebrae OTHER NAME/ABBREVIATION: SCI ANATOMY:

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45cm (18inch) long and about the thickness of a finger, it extends from the foramen magnum at the base of the skull to the lower border of the first lumbar vertebra. Continuing to second lumbar space are the nerve roots that extend beyond the conus, which are called the cauda equine because they resemble as a horse tail. It is surrounded by meninges, dura, arachnoid and pia layers. Consist of gray mater (nerve cell body)-which found in the center and white mater (ascending and descending tract)- surrounded in all side. The white matter of the cord is composed of myelinated and unmyelinated nerve fibers Epidural space- between the dura mater and the vertebra H shaped structure. Which the lower portion is broader o Anterior horns- essentials for the voluntary and reflex activity of the muscles they innervate. o Posterior horns- relay station in the sensory/reflex pathway. o Lateral horns- in the thoracic region spinal cord has a projection from each side at the crossbar of the H shaped structure of gray mater. The bones of the vertebral column surround and protect the spinal cord and normally consist of
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7 cervical 12 thoracic 5 Lumbar 1 sacral (5 at birth) 1 coccygeal (3-5 at birth)

PATHOPHYSIOLOGY: S/SX: Manifestation is depend on the type and level of injury.

1. Incomplete spinal cord lesions-the sensory or motor fibers, or both, are preserved below the lesions. a) Central b) Lateral c) Anterior d) Peripheral Total sensory and motor paralysis Loss of bladder and bowel control Loss of sweating and vasomotor tone Marked reduction of blood pressure.

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2. Complete spinal cord lesion a) paraplegia (paralysis of the lower body) b) quadriplegia (paralysis of all four extremities). The American Spinal Injury Association (ASIA) provides another standard classification of SCI according to the degree of sensory and motor function present after injury. A _ Complete: No motor or sensory function is preserved in the sacral segments S4-S5. B _ Incomplete: Sensory but not motor function is preserved below the neurologic level, and includes the sacral segments S4-S5. C _ Incomplete: Motor function is preserved below the neurologic level, and more than half of key muscles below the neurologic level have a muscle grade less than 3. D _ Incomplete: Motor function is preserved below the neurologic level, and at least half of key muscles below the neurologic L evel have a muscle grade of 3 or greater. E _ Normal: Motor and sensory function are normal. DIAGNOSTIC EXAMS: y y y y y Bone Xray (lateral cervical spine xrays) used to examine a bone disease or fracture Bone Scan- after IV administration of radioactive material, a counter detects the gamma rays, indicating areas of increased uptake, suggesting abnormality. MRI- if ligamentous is suspected since significant spinal cord damage may exist even in the absence of bony injury. Myelography-if MRI is contraindicated. It is a radiographic examination of the spinal cord following injection of contrast medium. Continues ECG monitoring may be indicated if a spinal cord injury is suspected, because bradycardia and asystole are common in patients with acute spinal cord injuries.

MEDICAL AND SURGICAL MANAGEMENT: y Pharmacologic therapy: Administration of high dose corticosteroids specifically methylprednisolone given within 8 hours after injury. y Respiratory Therapy: Oxygen is administered to maintain a high partial pressure of oxygen, because hypoxemia can create or worsen

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Skeletal fracture reduction and traction: Management of SCI requires immobilization and reduction of dislocations and stabilization of vertebral column. Surgical management: A laminectomy (excision of the posterior arches and spinous processes of a vertebra) may be indicated in the presence of progressive neurologic deficit, suspected epidural hematoma, bony fragments, or penetrating injuries that require surgical dbridement, or to permit direct visualization and exploration of the cord.

NURSING MANAGEMENT y Promoting adequate breathing and airway clearance o It is important to ensure proper humidification and hydration to prevent secretions from becoming thick and difficult to remove even with coughing. o The patient is assessed for signs of respiratory infection (cough, fever, dyspnea). o Smoking is discouraged becauseit increases bronchial and pulmonary secretions and impairs ciliary action. o Ascending edema of the spinal cord in the acute phase may cause respiratory difficulty that requires immediate intervention. Therefore, the patients respiratory status must be monitored frequently. y Improving mobility o Proper body alignment is maintained at all times. The patient is repositioned frequently and is assisted out of bed as soon as the spinal column is stabilized. y Maintaining skin integrity o The patients position is changed at least every 2 hours. Turning not only assists in the prevention of pressure ulcers but also prevents the pooling of blood and tissue fluid in the dependent areas. o Careful inspection of the skin is made each time the patient is turned. y Maintaining urinary elimination o Intermittent catheterization is carried out to avoid overdistention of the bladder and UTI. y Improving bowel function o the patient is given a high-calorie, high-protein, high-fiber diet, with the amount of food gradually increased. o The nurse administers prescribed stool softeners. o A bowel program is instituted as early as possible.

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