Nursing Care for Spinal Cord Injuries

Understanding Thromboembolism and Spinal Cord Injury

Thromboembolism in Non-Moving Clients

  • Causes of Coagulation: Clients with limited mobility may not utilize muscle action to assist blood flow back to the heart, leading to blood pooling and subsequent coagulation.

Goals of Treatment

  • The main objectives in treating spinal cord injuries involve preventing further complications and secondary injuries. Treatment approaches include:

    • Pharmacologic Therapies:

    • IV Corticosteroids: Administered to mitigate swelling that could exacerbate paralysis, particularly if spinal cord inflammation is evident.

    • Oxygen Therapy: Provided because hypoxemia can worsen the extent of the spinal injury.

    • Skeletal Fracture Management: Utilization of reduction techniques and traction to stabilize fractures.

    • Surgical Interventions: Procedures may include surgical caging, among other techniques to repair spinal cord damage.

Nursing Diagnoses and Interventions

  • Common nursing diagnoses for clients post-injury include:

    • Ineffective Breathing Patterns: Impaired or ineffective airway clearance.
    • Impaired Mobility: Difficulty with maintaining physical activity and bed mobility.
    • Impaired Urinary Elimination: May lead to complications such as increased risk of urinary tract infections or further autonomic dysreflexia.
    • Constipation: Significant in the context of autonomic dysreflexia management.
    • High Risk for Injury: Due to reduced sensation and immobility.
    • Impaired Skin Integrity: Due to limited mobility, increased pressure risk, and changes in sensation.

  • Nursing Interventions:

    • Facilitate adequate breathing and airway management.
    • Enhance physical mobility and prevent complications related to immobility.
    • Ensure skin integrity is maintained through regular assessment and interventions.
    • Promote urinary elimination and enhance bowel function as part of autonomic dysreflexia management.
    • Provide comfort measures tailored to client needs.

Diagnostics and Medical/Surgical Treatment

  • Diagnosis: Essential diagnostic tools for evaluating spinal cord injuries include:

    • Neurological Examinations: Assessment of neurological status through various imaging and testing methods, such as X-ray, CT scans, MRI, and EKG.

  • Complications of Spinal Cord Injury: Can include spinal or neurogenic shock and venous thromboembolism.

Secondary Injuries and Their Manifestations

  • Secondary injuries can arise and typically include:

    • Hemorrhage: Bleeding due to tissue disruption.
    • Ischemia: Lack of blood supply to tissues.
    • Hypovolemia: Decreased blood volume impacting circulation.
    • Impaired Tissue Perfusion: Reduction in blood flow to tissues.
    • Local Edema: Swelling that may lead to spinal shock.

  • Sensory Changes: Clients may notice either:

    • Hypoesthesia: Decreased sensation due to injury location.
    • Hyperesthesia: Increased sensitivity, depending on the injury.

Emergency Management of Spinal Cord Injuries

  • Primary Considerations: Proper handling is crucial to prevent further damage to the spinal cord, particularly in clients with injuries from various traumatic events:
    • Immobilization Protocols: Clients should be:
    • Immobilized on a back board and kept in an extended position to avoid additional injury.
    • Head and neck should be in a neutral alignment at all times.
    • Sitting up is discouraged to minimize risk.
    • Immediate transfer to a regional spinal injury or trauma center for specialized care.
    • Assessment of injury extent is essential.
    • Use of a rotating specialty bed or cervical collar to ensure ongoing spinal stability.

Clinical Manifestations by Injury Type and Level

  • Cervical Injuries (C5-C7): These individuals will typically require mechanical ventilation due to compromised respiratory function.
  • Thoracic (T12) and Lumbar (L1) Injuries:
    • Can result in complete or incomplete injuries:
    • Complete Injury: Total blockage of communication between the injury site and areas below.
    • Incomplete Injury: Partial blockage, leading to varying degrees of sensation and motor function, which may lead to paralysis or preserved sensations.

Primary and Secondary Injury Dynamics

  • Primary Injury: This refers to the initial damage caused by the traumatic event.
  • Secondary Injuries: Emerge as the spinal cord undergoes pathological changes due to swelling and inflammation following the primary injury.
  • Respiratory Complications: Serious concern as acute respiratory failure is a leading cause of mortality associated with spinal cord injuries; dysfunction correlates with the injury level.
Respiratory Function and Muscle Control

  • Key Muscles Involved in Respiration:

    • Diaphragm: Innervated at C4 - critical for breathing.
    • Intercostal Muscles: Controlled by T1-T6; facilitates thoracic expansion during inhalation.
    • Abdominal Muscles: Function under T6-T12; aids in forced expiration.

  • Ventilator Needs: Any injury at or above C4 necessitates the use of ventilator support due to compromised breathing abilities.

Overview of Spinal Cord Injuries

  • Definition: Spinal cord injury encompasses damage to the spinal cord, vertebral column, supporting soft tissue, and intervertebral discs, typically due to trauma, which may range from concussions and contusions to more severe laceration, compression, or transection.
  • Outcomes: Such injuries can lead to varying degrees of mobility impairments, including paraplegia, tetraplegia, and quadriplegia, depending on the severity and level of injury.