nursing care of a patient with spinal cord injury

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NURSING CARE OF A PATIENT WITH SPINAL CORD INJURY : 

NURSING CARE OF A PATIENT WITH SPINAL CORD INJURY PROF.PUNITHAVATHI INBANATHAN.M.S (N) THANTHAI ROEVER COLLEGE OF NURSING PERAMBALUR, TRICHY TAMILNADU

SPINAL CORD INJURY : 

SPINAL CORD INJURY Spinal cord trauma is serious and sometimes fatal. SCI ranges from whiplash to complete transection with permanent quadriplegia Cervical and lumbar vertebrae are the most common sites

CAUSES OF SCI : 

CAUSES OF SCI Trauma-the most common cause Violence Falls Sports Miscellaneous causes More than half of all SCI involve cervical vertebrae

MECHANISM OF SCI : 

MECHANISM OF SCI Hyperflexion injuries in which the head strikes against steering wheel and flexion results in forward dislocation of the vertebra Hyperextension injuries in which head is thrown back and hyperextension of sc leads to transection of the cord Compression injuries caused by falls or jumps –the force of impact fractures the vertebra

PATHOPHYSIOLOGY OF SCI : 

PATHOPHYSIOLOGY OF SCI The spinal cord is injured by compression, pull or tear of tissues. Microscopic bleeding occurs in grey matter. Edema develops within the first hours and peaks within 2 to 3 days and subsides within the first 7 days after injury. Fragmentation of axonal covering, loss of myelin, tissue necrosis are the later changes. Contd..

PATHOPHYSIOLOGY CONTD.. : 

PATHOPHYSIOLOGY CONTD.. SCI also leads to bleeding, hematomaand compression of the nerve roots. The cord sever either partially or completely The client experiences motor and sensory dysfunction below the site of injury Physiologic response extends beyond SC *decreased GI perfusion, respiratory arrest spasticity of muscles.

TYPES OF SCI : 

TYPES OF SCI Complete spinal cord injury—results in total loss of sensation and movement below the level of injury. Incomplete injury *central cord syndrome *anterior cord syndrome *brown-sequad syndrome *injuries to individual nerve cells *spinal contusions

CONSEQUENCES OF SCI : 

CONSEQUENCES OF SCI C1_C3---paralysis below neck and no sensation below neck C4C5 ---ventilation support is required; no sensation below clavicle C6-8 ---possible diaphragmatic breathing; some elbow to wrist movements possible. sensation in chest is impaired T1-6 ---Paralysis below waist; no sensation below midchest. Contd…

CONTD : 

CONTD T7-12 ---Varying degrees of trunk and abdominal control; varying sensation below waist L1-2 ---Hip adduction impaired; no sensation below lower abdomen L3-5 ---Knee and ankle movement impaired; no sensation below upper thighs S1-5 ---Varying degrees of bowel and bladder control & sexual dysfunction; no sensation in perineum

OTHER MANIFESTATIONS OF SCI : 

OTHER MANIFESTATIONS OF SCI *Changes in reflexes *muscle spasms *Autonomic dysreflexia *Spinal shock

AUTONOMIC DYSREFLEXIA : 

AUTONOMIC DYSREFLEXIA Is a life threatening syndrome in which a cluster of clinical manifestations results shen multiple spinal cord autonomic responses discharge simultaneously. The manifestations results from an exaggerated sympathetic response to stimuli like bladder\bowel distention cause the blood vessels below the injury to constrict. S/S-Hypertension, headache, diaphoresis, piloerection, restlessness, nausea, blurred vision and bradycardia

Autonomic hyperreflexia cycle : 

Autonomic hyperreflexia cycle

SPINAL SHOCK : 

SPINAL SHOCK It is the immediate response to cord transection. S/S- complete loss of skeletal muscle function, bowel and bladder tone, sexual function and autonomic reflexes. Body assumes environmental temperature. It is most severe in clients with high levels of SCI and it lasts for 1-6 wks.

DIAGNOSTIC FINDINGS : 

DIAGNOSTIC FINDINGS Neurologic examination Full spinal X ray films CT scan-provide more information regarding the nature of fractures and the cord MRI –to locate the level of lesion; identifies edema and hematoma Myelography- if necesssary

MEDICAL MANAGEMENT : 

MEDICAL MANAGEMENT Immobilize head & neck in neutral Stabilize vital functions and manage shock Corticosteroids to reduce SC edema-short term high dose methyl-prednisolone within 8 hrs Other therapies-neuropeptides,thyrotropin releasing hormonesand H2 receptor antagonists; urinary antiseptics,laxatives, anticoagulants and antispasmodics

SURGICAL MANAGEMENT : 

SURGICAL MANAGEMENT Depending on the extent of injury -removal of bone fragments -repair of dislocated vertebrae -stabilization of spine -external immobilization with a brace and cast

SPINAL BRACE : 

SPINAL BRACE

SCENE OF SPINAL CORD INJURY : 

SCENE OF SPINAL CORD INJURY

IMMEDIATE MANAGEMENT : 

IMMEDIATE MANAGEMENT Move only with adequate personnel Stabilize head and neck before transfering Perform logrolling maneuver Cut off clothing Provide oxygen support Open a IV port, insert a indwelling catheter, vasoactive drugs, insertion of NG tube

NURSING PROCESS : 

NURSING PROCESS ASSESSMENT Obtain information about the injury Perform a neurologic assessment Assess vital signs with a focus to respiratory function Ongoing monitoring-neurologic, motor, sensory abilities, bowel and bladder pattern and signs of respiratory distress and spinal shock

NURSING DIAGNOSIS : 

NURSING DIAGNOSIS Ineffective breathing pattern Ineffective airway clearance Risk for impaired gas exchange Pain-neuropathic Impaired physical mobility Risk for impaired skin integrity Altered elimination Imbalanced nutrition

Respiratory support : 

Respiratory support Mechanical ventilation Chest physical therapy Suctioning Kinetic bed Tracheostomy Abdominal binder to facilitate abdominal breathing Incentive spirometry

THERMOREGULATION : 

THERMOREGULATION Rectal or core temperature monitoring Environmental control Prevention of cool draughts Top linen to protect warmth Hypothermia blanket

PHYSICAL MOBILITY : 

PHYSICAL MOBILITY Position to avoid contractures and foot drop Maintain skin integrity by 2hrly position change,massaging bony prominences, keep skin clean and dry and use pressure relieving devices Assist to perform isometric, active and passive exercises

STRYKERS FRAME : 

STRYKERS FRAME

SPINAL REHABILITATION : 

SPINAL REHABILITATION Rehabilitation begins on admission. During acute stage care should focus on prevention of infection, pressure sore and contractures facilitates rehabilitation and reduce the sufferings, disability and expense Establish functional goals and motivate client and family and involve them in all phases of rehabilitation

COLLABORATIVE MANAGEMENT : 

COLLABORATIVE MANAGEMENT

GOALS OF REHABILITATION : 

GOALS OF REHABILITATION Promote mobility Reduce spasticity Improve bladder and bowel control Prevent pressure ulcers Reduce respiratory dysfunction Promote expression of sexuality Control pain Nutritional management and weight gain control Effective health maintenance

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