SPINAL CORD INJURY

1. What is SCI? What are the clinical manifestations of a patient with SCI?
Spinal Cord Injury is an injury to the spinal cord, vertebral column, supporting soft
tissue, or intervertebral discs caused by TRAUMA. It is a damage to any part of the
spinal cord or nerves at the end of the spinal canal (cauda equina) — often causes
permanent changes in strength, sensation and other body functions below the site of
the injury.
CLINICAL MANIFESTATIONS
- Numbness, tingling, or a loss of or changes in sensation in the hands and feet.
Paralysis that may happen immediately or develop over time as swelling and
bleeding affects the spinal cord. Pain or pressure in head, neck, or back.
I. Complete Spinal Cord Lesion
- Paraplegia and Tetraplegia; due to loss of sensory and voluntary motor
communication from brain to the periphery
II. Incomplete Spinal Cord Lesion
- Sensory and motor fibers are preserved below the lesion, spinal cord can still
relay messages to the brain

2. How do you assess SCI? Include laboratory and Diagnostics tests and what
are their implications if found with problems?
ASSESSMENT
- Assess breathing pattern
- Assess for Cough
- Monitor changes in motor and sensory functions
- Assess for spinal shock
- Assess for signs of urinary retention and bladder distention
- Temperature monitoring is needed
NEUROLOGIC LEVEL
● This refers to the lowest level at which sensory and motor functions are normal.
● Signs and symptoms include:
○ Total sensory and motor paralysis below the neurologic level
 ○ Loss of bladder and bowel control
○ Loss of sweating and vasomotor tone below the neurologic level
○ Marked reduction of BP from loss of peripheral vascular resistance
○ If conscious, patient reports acute pain in back or neck; may speak of
fear that
■ the neck or back is broken.
RESPIRATORY PROBLEMS
● Respiratory dysfunction is related to the level of injury
● The muscles contributing to respiration are the diaphragm (C4), intercostal
(T1-T6), Abdominal (T6-T12)
● Injuries at C4 and above will result paralysis of the diaphragm (will require
ventilator support, acute respiratory failure is the leading cause of death in high
cervical cord damage)
LABORATORY AND DIAGNOSTIC TESTS
● Neurological Exams
● X-ray of the lateral cervical spine - It can show fractures (breaks) in the cervical
vertebrae or dislocation of the joints between the vertebrae.
● CT Scan - provides better visualization of the extent and displacement of the
fracture.
● MRI- is ordered when ligamentous injury is suspected - shows the status of
ligamentous integrity and visualizes internal derangement of the spinal cord
○ If MRI is contraindicated, MYELOGRAM is done
○ ECG monitoring if SCI is suspected. ECG will reveal bradycardia
and asystole
3. Explain in your own words the pathophysiology of SCI.
When a person suffers from a primary injury or initial traumatic event it can be cause of
Concussion, Contusion, Lacerations, Compression of Spinal Cord Tissues, SC Transection
and secondary injuries which created by a series of biological and functional changes
could cause edema and hemorrhage that can lead to ischemia and hypoxia which can
also result to paraplegia a full or partial paralysis of the lower half of the body and
quadriplegia a paralysis of both legs and both arms. The primary injury triggers
secondary injury which produces further chemical and mechanical damage to spinal
 tissues. Secondary injury begins within minutes following the initial primary injury and
continues for weeks or months causing progressive damage of spinal cord tissue
surrounding the lesion site

4. Write 3 nsg diagnosis for SCI and their corresponding interventions( include
rationale)

➔ Ineffective breathing pattern related to weakness or paralysis of the

diaphragm, abdominal and intercostal spaces
- Assess and record respiratory rate and depth at least every 4 hours.
It is important to take action when there is an alteration in breathing
patterns to detect early signs of compromise on the respiratory system.
- Place patient with proper body alignment for maximum breathing pattern.
A sitting position permits maximum lung excursion and chest
expansion.
- Encourage sustained deep breaths.
promote deep inspiration, which increases oxygenation and prevents
atelectasis.
- Provide respiratory medications and oxygen, per doctor’s orders.
Beta-adrenergic agonist medications relax airway smooth muscles and
cause bronchodilation to open air passages.
- Suction secretions, as necessary.
Suctioning helps to clear the blockages in the airway.

➔ Impaired bed and physical mobility related to motor and sensory impairments
- Present a safe environment: bed rails up, bed in a down position, important
items close by.
These measures promote a safe, secure environment and may reduce
risk for falls.
- Establish measures to prevent skin breakdown and thrombophlebitis from
prolonged immobility
 This is to prevent skin breakdown, and the compression devices
promote increased venous return to prevent venous stasis and possible
thrombophlebitis in the legs.
- Execute passive or active assistive ROM exercises to all extremities.
Exercise enhances increased venous return, prevents stiffness, and
maintains muscle strength and stamina
- Provide the patient of rest periods in between activities. Consider energy-saving
techniques.
Rest periods are essential to conserve energy
- Give medications as appropriate.
Antispasmodic medications may reduce muscle spasms or spasticity
that interferes with mobility; analgesics may reduce pain that impedes
movement.
- Turn and position the patient every 2 hours or as needed.
Position changes optimize circulation to all tissues and relieve
pressure.

➔ Acute pain related to treatment and prolonged immobility

- Provide measures to relieve pain before it becomes severe.
It is preferable to provide an analgesic before the onset of pain or
before it becomes severe when a larger dose may be required.
- Provide nonpharmacologic pain management.
Nonpharmacologic methods in pain management may include physical,
cognitive-behavioral strategies, and lifestyle pain management.
- Provide pharmacologic pain management as ordered.
Pain management using pharmacologic methods involves using opioids
(narcotics), nonopioids (NSAIDs), and co analgesic drugs.