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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
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
Neurologic Level
The neurologic level refers to the lowest level of the injury of the cord.
• Loss of bladder and bowel control (usually with urinary retention and bladder distention)
• If conscious, patient reports acute pain in back or neck; patient may speak of fear that the neck or back
is broken
Respiratory Problems
• 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
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.
• Discourage smoking.
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
• 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
• Assess for redness or breaks in skin over pressure points; check perineum for soilage; observe catheter for adequate
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.
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,
• Provide emotional support; teach patient strategies to compensate for or cope with sensory deficits.
• 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
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
• 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)