Ian, Hana, Seans x 2, Rebekah

in its normal motor. y Destruction from direct trauma y Compression by bone fragments.Patho/Etiology y Spinal cord injury (SCI) is an insult to the spinal cord resulting in a change. hematoma. sensory. or disk material y Ischemia from damage or impingement on the spinal arteries . either temporary or permanent. The International Standards for Neurological and Functional Classification of Spinal Cord Injury is a widely accepted system describing the level and extent of injury based on a systematic motor and sensory examination of neurologic function. or autonomic function.

Interventions y Continually asses motor function spial shock or edema y Provide means to summon help y Assist in range of motion exercises y Plan activities to provide uninterrupted rest periods y Reposition periodically to help maintain skin integrity y Provide therapeutic level of ana.geic medication .

.Medications y Analgesics y NSAIDS if indicated y Other prescribed medications related to past or current medical history.

Consider the type of fracture most typical from this type of accident.6. He is accompanied by his fiancée and his parents.5 Spinal Cord y Ben Brown is a 21-year-old college junior who was admitted to the ICU via the ED for evaluation and treatment of a spinal cord injury (SCI) sustained in a diving accident. .

If plugged. stimulation of the skin. stroke. and assessment to determine the cause. it should be checked for kinks or folds. Contraction of the bladder or rectum. Manifestations include hypertension (up to 300 mm Hg systolic). blurred vision or spots in the visual fields. throbbing headache. The condition is a life-threatening situation that requires immediate resolution. The nurse should remove all skin stimuli. If symptoms persist after the source has been relieved. This morning Ben complained of an excruciating headache. Stool impaction can also result in autonomic dysreflexia. piloerection (erection of body hair). an -adrenergic blocker or an arteriolar vasodilator (e. . The most common precipitating cause is a distended bladder or rectum. The return of reflexes after the resolution of spinal shock means that patients with an injury level at T6 or higher may develop autonomic dysreflexia. this condition can lead to status epilepticus. although any sensory stimulation may cause autonomic dysreflexia. Since the patient already has a catheter in place. anxiety. Blood pressure should be monitored frequently during the episode. nifedipine [Procardia]) is administered. It occurs in response to visceral stimulation once spinal shock is resolved in patients with spinal cord lesions.g. or stimulation of the pain receptors may also cause autonomic dysreflexia. myocardial infarction. marked diaphoresis above the level of the lesion.1. or a new catheter may be inserted. flushing of the skin above the level of the lesion. It is important to measure blood pressure when a patient with a spinal cord injury complains of a headache.. Identify the etiologic factors that might cause these manifestations and the nursing interventions. nasal congestion. and his BP was 210/110 mm Hg. small-volume irrigation should be performed slowly and gently to open a plugged catheter. notification of the physician. A digital rectal examination should be performed only after application of an anesthetic ointment to decrease rectal stimulation and to prevent an increase of symptoms. If resolution does not occur. such as constrictive clothing and tight shoes. Autonomic dysreflexia (also known as autonomic hyperreflexia) is a massive uncompensated cardiovascular reaction mediated by the sympathetic nervous system. Careful monitoring must continue until the vital signs stabilize. Nursing interventions in this serious emergency are elevation of the head of the bed 45 degrees or sitting the patient upright. and nausea. bradycardia (30 to 40 beats/min). and even death.

chair.5: Manual WC may be used for everyday living. Identify the rehabilitation potential and priority nursing actions for each of these categories. walking may be possible w/ assistance or aids. computer use w/ mouth stick. head wand. S4 . w/ the ability to go over uneven ground. the more control over movement. ambulation w/ long leg braces.2. C4: Same as C1 ± 3. Include C1-2. vagus nerve domination of all vessels & organs below injury. blood vessels. full biceps . push WC on smooth. use of WC. computer use w/ adaptive equipment. S1-5 in your discussion. inability to roll over or use hands.6 Sympathetic innervation to heart. absence of independent respiratory function. T4 . ability to drive car w/ powered hand controls (in some pts). S1 ± 5: Variable bowel/bladder/sexual function.chair depending on upper body strength. gross elbow. respiration. Compare and contrast the sensory & motor deficits expected for various levels of SCI. C5: Ability to assist with xfer & perform some selfcare.car. full use of WC. may be able to breathe w/out a vent. weak grasp of thumb. wrist ext. flail ankles. xfer independently from bed . L1-5. ind standing in standing frame.3: Heel & middle back of leg. C4 . C5: Full neck. back of thighs. L1 ± 2: Good sitting balance. attendant care 0-6 hr/day Full independence in self-care and in WC. absence of hamstring function. & all organs below injury C4: Sensation & movement in neck & above. Rehabilitation Potential Ability to drive electric WC equipped w/ portable vent by using chin control/mouth stick. C4-6.elbow flexion. S1 . skin immediately at & adjacent to anus. respiration. 24-hr attendant care. ind. . ability to drive car adapted w/ hand controls. it may be possible to xfer from floor . perform most selfcare.3 Often fatal injury. may have total preservation of leg strength but complete bowel and bladder paralysis as well as perineal anesthesia. trunk stability. The lower the injury. based on level of injury.5 L1 ± 2: Vagus nerve domination of leg vessels. S1 . partial shoulder. L1 . ind. C6: Ability to transfer self to WC. T4-6. & chair . attendant care 6 hr/day. drive adapted van from WC. respiratory reserve.6 Vagus nerve domination of heart. respiratory reserve Full innervation of upper extremities.5 S1 . feed self w/ hand devices. flat surface. L3 ± 5: Quadriceps & hip flexors. GI & GU organs. Vagus nerve domination of heart. L1 ± 2: Varying control of legs & pelvis. L3 ± 5: Completely ind. push self on most surfaces. instability of lower back. able to instruct others. medial side of buttocks. L3 ± 5: Partial vagus nerve domination of leg vessels. essential intrinsic muscles of hand. Level of Injury C1 .5: Perineal region. Some hip. ambulation w/ short leg braces & canes. or noise control. full strength & dexterity of grasp. blood vessels. roll over & sit up in bed. inability to stand for long periods. back. headrest to stabilize head. ability to load WC into car independently. back. loss of innervation to diaphragm. knee and foot movement depending on the level of injury. ability to drive car with hand controls (in most pts). respiratory reserve C6: Shoulder and upper back abduction and rotation at shoulder. biceps. & all organs below injury Movement Remaining Movement in neck & above.

CT scan. Administer high-dose methylprednisolone if ordered. Assess for other injuries.rebreather mask. Obtain cervical spine x-rays. Control external bleeding. urine Keep warm. output. Administer oxygen via nasal canula or non. level of consciousness. or MRI. Stabilize cervical spine. all body systems must be maintained until the full extent of the damage can be evaluated. cardiac rhythm. Initial Ensure patent airway. For injury at the cervical level. Anticipate need for intubation if gag reflex absent. Systemic and neurogenic shock must be treated to maintain blood pressure. hypertension. Monitor for urinary retention. . Establish IV access with two large-bore catheters to infuse normal saline or lactated Ringer's solution as appropriate. oxygen saturation. Ongoing Monitoring Monitor vital signs. Prepare for stabilization with cranial tongs and traction.Priority Nursing Actions Priority nursing actions for these categories are to sustain life and prevent further cord damage.

such as the lips. neck. If an external catheter is used. an attendant may have to undress the patient and remove equipment. it should be removed before sexual activity and the patient should refrain from fluids. The partners should be encouraged to explore each other's erogenous areas. Sexual activities may require more planning and be less spontaneous than before the injury. Care should be taken not to dislodge an indwelling catheter during sexual activity. Can I ever be a man again? Open discussion with the patient is essential. Few demands should be made initially. and kissing is essential. Ample time for caressing. . and ears. A relaxed atmosphere with music and perfume creates an attractive environment. The male patient may pose a question such as. with the emphasis on open communication.3. Have you had an erection since your injury? and Have your menstrual periods continued since the injury? are nonthreatening ways to introduce the topic of sexual functioning. which can arouse psychogenic erection or orgasm. The woman may need a water-soluble lubricant to supplement diminished vaginal secretions and facilitate vaginal penetration. A nurse or other rehabilitation professional with such expertise works with the patient and partner to provide support. The bowel program should include evacuation the morning of sexual activity. Identify the teaching on sexual function that is necessary for clients with SCI. The nurse's educational role requires respect for every couple's personal standards of religious and cultural beliefs. When should this teaching begin. Questions such as. Sexual rehabilitation for both men and women should begin informally after the acute phase of the injury has passed. For example. fondling. This important aspect of rehabilitation should be handled by someone specially trained in sexual counseling. The partner should be informed that incontinence is always possible.

y Nursing Actions for Traction: 1) identify and know the types skeletal vs skin 2) patient teaching 3) maintaining the traction apparatus 4) assessing for complications of immobility 5) for patients with skeletal traction. .caring for and assessing the pin insertion sites.4. Identify the key nursing actions for clients in skeletal traction for cervical injuries. Compare these nursing actions with those given after treatment for these injuries.

insertion of metal rods. y Halo traction is a way of keeping your head and neck still while you get better after an accident or operation to your neck bones. The halo traction equipment is made up of three pieces: a ring around your head and then or a special vest Weights attached to the halo at head end of bed over a pulley system a set of four rods and two blocks. The halo traction vest when required will be made just for the individual. If surgery goes ahead and is successful post injury then there's usually no further need for halo traction. If surgery is ruled out then the halo traction will be used for up to two months on bed rest and then a further month to three months attached to a specially made vest so the head is kept perfectly still whilst sitting. This surgery usually requires a short stay in the hospital. The screws have to be tightened periodically to ensure the halo is fitting correctly. Halo traction is attached to the head by titanium screws which are screwed into the skull bone. removal of vertebra or disc and fusing remaining bone. One has to remember after a joint is fused one loses all movement in that joint which can affect ones ADL s. y y y y y y y y y y . Consider the risks and benefits of halo traction versus spinal fusion for the treatment of cervical injuries.5. The different methods are bone graphs. This will usually always be used in adults with broken necks if surgery is not performed immediately post injury. Cervical spinal fusion is a surgery that joins selected bones in the neck.

Rehab focuses on therapy aimed at improving neurocognitive function that has been lost or diminished by disease or traumatic injury. . y Acute care of spinal cord injury is focused on preventing further damage and trying to restore as much function as possible. Compare and contrast the nursing roles and priorities of the acute or critical care nurse and the rehabilitation nurse in caring for clients with SCI.6.

Vascular malformations. dural arteriovenous fistula (AVF). gunshots. Consider how the source of the injury may influence nursing care. or other causes. arteriosclerosis. etc. spinal hemangioma. resulting from stroke. war injuries. such as arteriovenous malformation (AVM).7. such as Friedreich's ataxia. Developmental disorders. such as spina bifida. diving accidents. Tumor such as meningiomas. and others Neurodegenerative diseases. Causes traumatic and non traumatic: Trauma such as automobile crashes. inflammation. falls. emboli. including dissecting aortic aneurysms. cavernous angioma and aneurysm. Transverse myelitis. Demyelinative diseases. Ischemia resulting from occlusion of spinal blood vessels. such as Multiple Sclerosis. astrocytomas. meningomyolcoele. spinocerebellar ataxia. ependymomas. . etc. It can cause myelopathy or y y y y y y y y y y y damage to nerve roots or myelinated fiber tracts that carry signals to and from the brain. y 7) Spinal cord injury refers to an injury to the spinal cord. Compare and contrast the traumatic and nontraumatic disorders that may result in SCI. and metastatic cancer.

References y http://www.com/doc/14009149/Nursingcribco m-Nursing-Care-Plan-Spinal-Cord-Injury .scribd.