Spinal Cord Injuries Lecture Notes

Introduction

• Presenter: Cathy from LevelUpRN
• Topic: Spinal Cord Injuries
• A quiz is provided at the end to test knowledge on key facts.
• Recommended to use LevelUpRN medical surgical nursing flashcards for reference.

Causes of Spinal Cord Trauma

• Types of Trauma:
  • Hyper extension
  • Hyper flexion
  • Vertical compression
  • Rotational forces
• Effect of Trauma:
  • Results in hemorrhaging and edema
  • Impairs circulation, leading to ischemia

Types of Spinal Cord Injuries

• Complete Spinal Cord Injury: Loss of all nerve function below the injury
• Incomplete Spinal Cord Injury: Some function remains below the injury

Signs and Symptoms

• Loss of motor function
• Loss of sensation
• Loss of reflexes
• Loss of bowel or bladder function
• Depends on injury level:
  • Below T1: Causes paraplegia (paralysis or weakness of lower extremities)
  • Cervical region: Causes quadriplegia (paralysis or weakness of all four extremities)

Muscle Tone and Bladder Function

• Injury above L1/L2: Upper motor neurons affected
  • Results in hypertonia (spastic muscle tone) and spastic neurogenic bladder
• Injury below L1/L2: Lower motor neurons affected
  • Results in hypotonia (flaccid muscle tone) and flaccid neurogenic bladder

Medications and Procedures

• Medications:
  • Steroids (reduce inflammation)
  • Analgesics (pain relief)
  • Muscle relaxants (reduce muscle spasms)
• Procedures:
  • Laminectomy
  • Spinal fusion
  • Therapeutic hypothermia (reduces bleeding and edema, improves motor function, and decreases pain)

Nursing Care

• Stabilize spine
• Maintain a patent airway
  • Injury at C4 or above increases respiratory dysfunction risk
• Monitor for complications:
  • Hemorrhage
  • Neurogenic shock
  • Autonomic dysreflexia
• Halo Traction Device:
  • Move patient as a unit
  • Ensure a wrench or screwdriver is attached for emergencies

Complications

Neurogenic Shock

• Occurs: Injury above T6
• Cause: Loss of sympathetic activity, unopposed parasympathetic activity
• Symptoms: Hypotension, bradycardia, flushed and warm skin
• Treatment: IV fluids, vasopressors, atropine

Autonomic Dysreflexia

• Life-threatening hypertension following spinal cord injury
• Cause: Stimuli (e.g., distended bladder) below injury level causes sympathetic response
• Symptoms: Extreme hypertension, severe headache, blurred vision, diaphoresis
• Nursing Care:
  • Sit patient up
  • Notify provider
  • Loosen restrictive clothing
  • Address underlying cause (e.g., catheterization for distended bladder)
  • Administer antihypertensives as prescribed

Quiz Questions

1. Question: A spinal cord injury above L1 results in spastic muscle tone and a spastic neurogenic bladder. True or False?
   • Answer: True
2. Question: Which complication of a spinal cord injury results in hypotension and bradycardia?
   • Answer: Neurogenic shock
3. Question: What is the priority action if a patient exhibits extreme hypertension following a spinal cord injury?
   • Answer: Sit the patient up

Conclusion

• Key Takeaways: Understanding the types, symptoms, complications, and nursing care for spinal cord injuries.
• Good Luck: Encouragement to continue studying.