SPINAL CORD

INJURIES (SCI)
Objectives
After this presentation we will able to:
1-Discuss the nursing assessment of patients
with spinal cord and/or vertebral column
trauma.
2-Identify appropriate nursing diagnoses and
expected outcomes associated with patients
with spinal cord and/or vertebral column
trauma.
3-Plan appropriate interventions for patients
with spinal cord and/or vertebra column
trauma.
SPINAL COLUMN
ANATOMY OF SPINAL CORD
Peripheral nervous system
 Spinal cord injuries

 Male 15-25 years

 Causes
Traumatic Non traumatic

MVA Tumours
Falls Congenital defects-spina
bifida
Industrial injuries
Sport injuries
Gun shot/stab
injuries
1-INCOMPLETE SPINAL CORD
injuries

incomplete structural damage.

-

-preservation of some motor or sensory

function below the level of the injury.
-Sacral sparing-Perianal sensation, anal
sphincter tone, and great toe flexor
function.
1-INCOMPLETE SPINAL CORD
LESIONS-SUBTYPES

A-Central cord syndrome

B-Anterior cord syndrome

C-Posterior cord syndrome

D-Brown-Sequard syndrome
Incomplete spinal cord
injuries
A-central cord syndrome (the
most common)

 Etiology: hyperextension injuries

Swelling in the center of the cord.
B- anterior cord
syndrome,(common).
Spinal tract involved:due to damage to
the front portion of the spinal cord
C- posterior cord syndrome (rare)

 Spinal tract involved :dorsum of spinal

cord injured
D- Brown Sequard syndrome (uncommon)

 Spinal tract involved : spinal cord is injured

on one side much more than the other
 2-complete SPINAL Cord LESION
-resultsin loss of all motor and sensory
function below the level of the lesion.
-shock is frequently the initial response
resulting in loss of motor, sensory, and
reflex function below the level the injury.
-The patient may also develop neurogenic
shock resulting in loss of autonomic
function.
Complete spinal cord
transection
 Sings AND Symptoms
 Spinal shock
 In injuries above T6
 Due to disturbance in ANS(autonomic nerves
system) function
α Occurs immediately after injury
α Last from 24-72 hrs
α Hypotension, bradycardia
α Absence of reflexes below injury
α Flaccid paralysis
α Lack of temperature control of affected areas
 Sings AND Symptoms

1. C1-C6-Quadriplegia and respiratory paralysis

2. T1-T4-Paraplegia
3. Complete cord dissection-Loss of motor
function below the level of the injury.
4. Incomplete cord injury-varying degree of
damage depending upon damage.
LOSS FUNCTION DEPENDS ON
AREA OF INVOLVEMENT
Medical management

Immobilization and maintenance of

normal spinal alignment to promote
fracture healing.
 Stryker frames-for horizontal turning
 Neck collar
Stryker stretcher
Neck collar
Stryker bed
 Management

Steroids:

Effects :limitation of cord edema ischemia,

and the prevention of cellular death.
management

Log rolling
Management
Skeletal traction
1. Cervical tongs –inserted through
burr holes. Traction is provided by a
rope extended from the centre of
the tongs over a pulley with weight
attached .
 Halo traction

 Stainless steel halo ring fits around the head

and is attached to the skill with four pins
;halo is attached to plastic body cast or
plastic vest.
 Permits early mobilization and decreases
complication related to immobility .
Halo traction
Surgery

 Decompression laminectomy
spinal fusion
 NURSINGCARE OF THE PATIENT WITH
A SPINAL CORD AND VERTEBRAL
COLUMN TRAUMA
 2-physical assessment
Prehospital transfer
1. Use of cervical collar and avoid
hyperextension of neck
2. Use spinal board for transferring
patients.
Inspection:
1. Assess breathing effectiveness and rate
of respirations.
2. Suction and clear airway Assessment of
airway ,breathing , circulation, and
disability.
Physical assessment cont…

Palpation
1. Palpate pulse rate and quality.
2. palpate skin temperature.
3. assess all four extremities for muscle
strength.
Physical assessment cont…

Assess sensory function

The use of a touch stimulus to determine
levels of sensory function.

Should begin at the area of no feeling and

proceed toward the area of feeling. This will
aid in localizing the level of injury .
Physical assessment cont…

 gentlypalpate the vertebral

column for pain, tenderness, or
step deformities between
vertebrae.
 Assess for sacral sparring.
Physical assessment cont…

Test reflexes
-In the presence of spinal shock, the
patient will present with areflexia.
-A Babinski’s sign is a pathologic
reflex, because of dysfunction of
upper motor neurons of the spinal
cord.
 DIAGNOSTIC PROCEDURES
Radiographic studies
- Vertebral column radiographs.
- CT scan ,MRI.
NURSING DIAGNOSIS

Ineffective airway clearance related to spinal cord injury

Goal: Maintain optimum respiratory function
Interventions:
 Open airway with jaw Thrust or chin lift while maintaining
cervical spine immobilization.
 suction airway.
 Administer oxygen via a high flow mask with 100% oxygen
 Monitor oxygen saturation with continuous pulse oximetry
 Assist with intubation
 Obtain blood sample for ABGs as indicated.
NURSING DIAGNOSIS
 Risk for impaired cardiac output related to spinal cord
injury
 Maintain optimum cardiovascular function
 Monitor for bradycardia, hypotension and arrhythmias
 Change position slowly
 Administration of vasopressor drugs to maintain BP
NURSING DIAGNOSIS
Fluid volume deficit related to inability to take
orally
Maintain fluid electrolyte balance and nutrition
Interventions
 Cannulate two veins with large- bore
catheters and initiate
 infusion of lactated Ringer’s solution or
normal saline; monitor rate carefully.
 Consider vasopressors as needed
 insert urinary catheter
 Monitor hemodynamics
NURSING DIAGNOSIS
Impaired mobility related to SCI
Maintain immobilization and spinal alignment
 Turn every 2 hourly using turning frame
 Maintain cervical traction at all times
NURSING DIAGNOSIS

Ineffective thermoregulation
Interventions
 -Monitor temperature
 -warm environment
 -warm IV fluids
NURSING DIAGNOSIS

Impaired urinary elimination

Maintain urinary elimination
 Intermittent clean catheterization
 Fluid 3L
 Urine alkalinizers
NURSING DIAGNOSIS

Impaired bowel elimination

Maintain bowel elimination
 Stool softeners
 Suppositories

Prevention of infection
 Pin site and tong site care
 Cleanse with antiseptics
 Measures to Prevent UTI
 NURSING DIAGNOSIS
Ineffective coping patient and family
Interventions
 Provide support to the patient and family
 Provide information and answer questions
 Make appropriate referrals for support
 NURSING DIAGNOSIS
Impaired skin integrity.
Interventions
 Remove patient from backboard as soon as
possible
 Avoid allowing a paralyzed patient to lie on
backboard for more than 2 hours
 Consider placement on special bed
Chronic care

 Neurogenic bladder

 Intermittent clean catheterization every 6hour

 Fluid 1800-2000ml
 Crede method
 Spasticity
 Physiotherapy
Chronic care

 Autonomic dysreflexia

 Fatal rise in BP
 Associated with cervical injuries
 Reflex stimulation of sympathetic nervous
system .Can be due to distended bladder,
constipation; chilling, bed sore
 S/S-severe headache; hypertension;
bradycardia; sweating; convulsions
Chronic care

 Autonomic dysreflexia
 Interventions

 Rise to sitting position to decrease BP

 Remove stimulus-catheterize ,stool
softeners; temp adjust; manage bed sore
 Administer antihypertensive
Rehabilitation

 Psychological support
 Sexual counselling
 Physiotherapy
 Vocational rehab
 Use
of braces electronic
wheelchair
THANK YOU