SPINAL CORD INJURY

WHAT IS SPINAL CORD INJURY?

Spinal cord injury is damage to the spinal cord as a result of a direct trauma to the spinal cord itself or as a result of indirect damage to the bones, soft tissues, and vessels surrounding the spinal cord. The spinal cord is the major bundle of nerves carrying nerve impulses to and from the brain to the rest of the body. Rings of bone called vertebrae surround the spinal cord. These bones constitute the spinal column (back bones). Spinal cord damage results in a loss of function, such as mobility or feeling. In most people who have spinal cord injury, the spinal cord is intact. Spinal cord injury is not the same as back injury, which might result from causes such as pinched nerves or ruptured disks. Even when a person sustains a break in a vertebra or vertebrae, there might not be any spinal cord injury if the spinal cord itself is not affected.

FUNCTIONS OF SPINAL CORD

EFFECTS OF SPINAL INJURY

Predisposing factors of Spinal Cord Injury

SPINAL CORD TRAUMA CAN BE CAUSED BY A NUMBER OF INJURIES TO THE SPINE, INCLUDING:
Assault Falls Gunshot wounds Industrial accidents Motor vehicles accidents Sports injuries (particularly diving into shallow water)

A minor injury can caused spinal cord injury if the spine is weakened (such as from rheumatoid arthritis or osteoporosis) or if the spinal canal protecting the spinal cord has become too narrow (or spinal stenosis) due to the normal aging process. Direct damage also occur if the spinal cord is pulled, pressed or compressed. This may occur if the head, neck, or back are twisted abnormally during an accident or intense chiropractic manipulation. Bleeding, fluid buildup and swelling can occur inside or outside the spinal (but within the spinal canal). The buildup of blood or fluid can press on the spinal cord and damage it.

INFECTIOUS DISORDERS OF THE SPINAL CORD

Disease/Disorder: Definition

- Infectious disorders that affect the spinal cord can be divided according to their anatomic location, including the following:
Spinal column: pyogenic osteomyelitis, spondylodiscitis and discitis,1 Pott disease, and spinal fungal infections. Epidural space: epidural abscess. Meninges: arachnoiditis. Spinal cord: intramedullary abscess, neurosyphilis, and viral infections of the spinal cord.

ETIOLOGY
- Most common cause of spine and spinal cord infections are bacterial in origin. Causative organisms include the following:

Staphylococcus species Streptococcus species Salmonella in patients with sickle cell anemia E.coli, Proteus mirabilis, and Enterococcus in patients who are immunocompromised Pseudomonas aeruginosa and Brucella in intravenous (IV) drug abusers Mycobacterium tuberculosis in patients with spinal tuberculosis or Pott disorder Treponema pallidum, which causes neurosyphilis

- Immunocompromised patients are at high risk of developing viral infections that can affect the spinal cord. Causative agents include the following:

Human immunodeficiency virus Herpes simplex virus I and II Cytomegalovirus Varicella zoster virus Human T-cell lymphotrophic virus

- Fungal infections are extremely rare. However, these may also occur in immunosuppressed individuals. Common fungal species include the following:

Candida Cryptococcus Aspergillus Coccidioides Blastomyces

- Epidemiology including risk factor Risk factors that may contribute to developing infections within the spinal cord or surrounding structures include the following:

Age (pediatric and geriatric populations) Poor nutritional status Immunosuppression IV drug use Spine surgery and/or instrumentation Hemodialysis

DIAGNOSTIC TEST:

Spinal cord injury is a medical emergency that needs immediate medical attention.

HEALTH CARE PROVIDER They will perform a physical exam, including a brain and nervous system (neurological) exam. This will help identify the exact location of the injury, if it is not already known. Some of the reflexes may be abnormal or missing. Once swelling goes down, some reflexes may slowly recover.

THE FOLLOWING TESTS MAY BE ORDERED:

CT scan or MRI of the spine Myelogram (an x-ray of the spine after injecting dye) Somatosensory evoked potential (SSEP) testing or magnetic stimulation Spine x-rays

SPINAL CORD INJURY

Nursing Process (Nursing Responsibilities)

PATIENT WITH ACUTE SPINAL CORD INJURY

Assessment
Breathing Pattern Cord Edema Motor and sensory system Temperature Spinal Shock

Diagnosis
Ineffective airway clearance related to weakness of the intercostal space Acute pain and discomfort related to treatment and prolonged immobility

Based on the assessed data, potential complications may develop:

DVT Orthostatic Hypotension Autonomic Dysreflexia

Planning and goals

Improved breathing pattern and airway clearance Improved mobility Improved sensory awareness Promotion of comfort Absence of complication

Nursing Interventions
Promoting adequate breathing and airway clearance Improving mobility Promoting adaptation to sensory and perceptual alterations Maintaining skin identity Maintaining urinary elimination Improving bowel function Providing comfort measures: the patient Halo Traction Monitoring and managing potential complications

PATIENT WITH TETRAPLEGIA OR PARAPLEGIA

Assessment
Cephalocaudal Skin redness or breakdown Sensation Vasomotor control Sexual function Bladder and bowel control

Diagnosis
Impaired bed and physical mobility related to loss of motor function Impaired urinary elimination related level of injury

Potential complications that may develop:

Spasticity Infection and Sepsis

Maintenance of health Bladder mgt wihtout infection Bowel control Sexual expression Strengthen coping mechanism Absence of complications

Planning and Goals

Nursing Invertions
Increasing Mobility Preventing Disuse Syndrome Promoting skin integrity Improving balder management Establishing bowel control Counseling on sexual expression Enhancing coping mechanisms Monitoring and managing potential complications

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