Spinal Cord Injury

Introduction:

Injury to the spinal cord results in compression, twisting, severing, or pulling on the
spinal cord. The damage to the cord may involve the entire thickness of the cord
(complete), or only a partial area of the spinal cord (incomplete). The most com-
mon cause of spinal cord injury is trauma. Any level of the spinal cord may have
been affected by the injury. Loss of sensation, motor control, or reflexes may occur
below the level of injury or within 1 to 2 vertebrae or spinal nerves above the level
of injury. The loss may be unilateral or bilateral. Damage to the vertebrae may
have occurred at the same time as the spinal cord injury. Swelling due to the ini-
tial trauma may make the injury seem more severe than it actually is. When the
initial swelling resolves, the actual degree of permanent injury can be more accu-
rately assessed.


PROGNOSIS
The level of injury will determine the degree of disability the patient is likely to sus-
tain.Ahigh-level injury, such as a cervical injury, will more likely result in quadra-
plegia (paralysis of all four extremities) and compromise of the respiratory drive.
A complete spinal cord injury will result in greater disability than an incomplete
injury. Spinal cord tissue does not regenerate after an injury. Swelling that occurs
immediately following an injury may be controlled with medications and some
clinical improvement may occur, but the damage to the cord cannot be undone.

SIGNS AND SYMPTOMS

• Loss of motor control due to damage to the anterior horn of the spinal cord
• Loss of reflexes due to damage of the spinal cord, the point of synaptic trans-
mission of sensory impulse to motor response
• Flaccid paralysis
• Lack of bowel and bladder control
• Altered sensation (tingling—paresthesia; diminished—hypoesthesia; in-
creased—hyperesthesia)
• Bradycardia, hypotension, hypothermia due to problems with the autonomic
nervous system

TREATMENT

• Immobilize the affected area of the spinal cord to decrease chance of further
irritation.
• Place the patient in a flat position to avoid flexion or misalignment of the
spine.
• Monitor traction or collar to prevent skin irritation.
• Administer corticosteroid to decrease inflammation at point of injury:
• methylprednisolone
• prednisone
• dexamethasone
• Administer dextran, a plasma expander, which increases blood flow in the
spinal cord, increasing oxygenation to the tissue.
• Assist respirations if indicated.
• Administer H2 receptor antagonists to protect stomach from stress ulcer formation:
• cimetidine, ranitidine, famotidine, nizatidine
• Administer gastric mucosal protective agent to coat stomach lining:
• sucralfate
• Place patient in a rotation bed for repositioning to prevent pressure on skin.
• Surgical repair of vertebral fracture or decompression may be necessary.


NURSING DIAGNOSES

• Impaired physical mobility
• Powerlessness

NURSING INTERVENTION

• Monitor respiratory status—assess for changes in rate, effort, use of acces-
sory muscles, cyanosis, altered mental status, and pulse oximetry reading.
• Monitor neurologic status for changes—assess sensation, temperature, touch,
position sense, comparing right to left.
• Monitor for spinal shock:
• Flaccid paralysis, loss of reflexes below the level of injury, hypotension,
bradycardia, possible paralytic ileus.
• Monitor pulse and blood pressure for changes—change in heart rate, hypo-
tension, or hypertension.
• Assess skin for signs of pressure (redness) or breakdown.
• Assess abdomen and listen for bowel sounds.
• Explain to the patient:
• Importance of regular bowel and bladder function to avoid autonomic
dysreflexia due to distension: severe headache, hypertension, bradycardia,
flushing, nasal congestion, sweating, nausea.
• Use of incentive spirometer.
• Need for turning and positioning or special rotating bed to decrease pressure.
• Monitor intake and output.
• Home care needs—accessibility, equipment needs.
• Proper way to transfer from bed to wheelchair.
• Care of pin sites for cervical traction devices (e.g. halo traction).