Spinal Cord Injury (SCI)
Signs & Symptoms
The neurologic level refers to the lowest level of the injury of the cord.
• Total sensory and motor paralysis below the neurologic level
• Loss of bladder and bowel control (usually with urinary retention and bladder distention)
• Loss of sweating and vasomotor tone below the neurologic level
• Marked reduction of blood pressure from loss of peripheral vascular resistance
• If conscious, patient reports acute pain in back or neck; patient may speak of fear that the neck or back is broken
• Related to compromised respiratory function; severity depends on level of injury
• Acute respiratory failure is the leading cause of death in high cervical cord injury
Diagnosis of SCI is based on physical examination, radiologic examination, CT scan, MRI and myelography.
Diagnostic x-rays such as lateral cervical spine x-rays and CT scanning are usually performed initially. An MRI scan may be ordered as a further work up if a ligamentous injury is suspected, since significant spinal cord damage may exist even in the ansence of bony injury. Continuous electrocardiographic monitoring may be indicated if a cord injury is suspected since bradycardia and asystole are common in acute spinal injuries.
Promoting Adequate Breathing
- Detect potential respiratory failure by observing patient, measuring vital capacity, and monitoring oxygen saturation through pulse oximetry and arterial blood gas values.
- Prevent retention of secretions and resultant atelectasis with early and vigorous attention to clearing bronchial and pharyngeal secretions.
- Suction with caution, because this procedure can stimulate the vagus nerve, producing bradycardia and cardiac arrest.
- Initiate chest physical therapy and assisted coughing to mobilize secretions.
- Supervise breathing exercises to increase strength and endurance of inspiratory muscles, particularly the diaphragm.
- Ensure proper humidification and hydration to maintain thin secretions.
- Assess for signs of respiratory infection: cough, fever, and dyspnea.
- Discourage smoking.
- Monitor respiratory status frequently.
- Maintain proper body alignment; place patient in dorsal or supine position.
- Turn patient every 2 hours; monitor for hypotension in patients with lesions above the midthoracic level. Assist patient out of bed as soon as spinal column is stabilized.
- Do not turn patient who is not on a turning frame unless physician indicates that it is safe to do so.
- Apply splints to prevent footdrop ans trochanter rolls to prevent external rotation of the hip joint; reapply every 2 hours.
- Perform passive range-of-motion exercises within 48 to 72 hours after injury to avoid complications such as contractures and atrophy.
- Provide a full range of motion at least every four or five times daily to toes, metatarsals, ankles, knees & hips.
Maintaining Skin Integrity
- Change patient’s position every 2 hours and inspect the skin, particularly under cervical collar.
- Assess for redness or breaks in skin over pressure points; check perineum for soilage; observe catheter for adequate drainage; assess general body alignment and comfort.
- Wash skin every few hours with a mild soap, rinse well, and blot dry. Keep pressure sensitive areas well lubricated and soft with bland cream or lotion; gently perform massage using a circular motion.
- Teach patient about pressure ulcers and encourage participation in preventive measures.
Promoting Urinary Elimination
- Perform intermittent catheterization to avoid overstreatching the bladder and infection. If this is not feasible, insert an indwelling catheter.
- Show family members how to catheterize, and encourage them to participate in this facet of care.
- Teach patient to record fluid intake, voiding pattern, amounts of residual urine after catheterization, quality of urine, and any unusual feelings.
Promoting Adaptation to Disturbed Sensory Perception
- Stimulate the area above the level of the injury through touch, aromas, flavorful food, conversation, and music.
- Provide prism glasses to enable patient to see from supine position.
- Encourage use of hearing aids, if applicable.
- Provide emotional support; teach patient strategies to compensate for or cope with sensory deficits.
Improving Bowel Function
- Monitor reactions to gastric intubation.
- Provide a high-calorie, high-protein, and high-fiber diet. Food amount may be gradually increased after bowel sound resume.
- Administer prescribed stool softener to counteract effects of immobility and pain medications, and institue a bowel program as early as possible.
- Reassure patient in halo traction that he/she will adapt to steel frame.
- Cleanse pin sites daily, and observe for redness, drainage, and pain; observe for loosening; keep a torque screwdriver readily available.
- Assess skull for signs of infection, including drainage around halo-vest tongs.
- Check back of head periodically for signs of pressure. Massage at intervals, taking care not to move the neck.
- Shave hair around tongs to facilitate inspection. Avoid probing under encrusted areas.
- Inspect skin under halo vest for excessive perspiration, redness, and skin blistering, especially on bony prominences.
- Open vest at the sides to allow torso to be washed. Do not allow vest to become wet; do not use powder inside vest.
Smeltzer, S. Et Al.. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (Lippincott Williams & Wilkins. 10th edition,2004)
Huether, S. Et Al. Understanding Pathophysiology (Mosby, Inc. 2nd edition. 2000)