Spinal Cord Injuries

Aug 18, 2024

Spinal Cord Injuries

Causes of Spinal Cord Trauma

  • Hyperextension
  • Hyperflexion
  • Vertical compression
  • Rotational forces
  • Result: Hemorrhaging and edema, impairing circulation, leading to ischemia

Types of Spinal Cord Injuries

  • Complete Injury: Loss of all nerve function below injury level
  • Incomplete Injury: Some function remains below injury level

Signs and Symptoms

  • Loss of motor function
  • Loss of sensation
  • Loss of reflexes
  • Loss of bowel or bladder function

Based on Injury Level

  • Below T1: Paraplegia (paralysis/weakness of lower extremities)
  • Cervical Region: Quadriplegia (paralysis/weakness of all four extremities)

Muscle Tone and Bladder Function

  • Upper Motor Neurons (Above L1/L2):
    • Hypertonia (spastic muscle tone)
    • Spastic neurogenic bladder
  • Lower Motor Neurons (Below L1/L2):
    • Hypotonia (flaccid muscle tone)
    • Flaccid neurogenic bladder

Medications and Procedures

  • Medications:
    • Steroids: Decrease inflammation
    • Analgesics: Address pain
    • Muscle relaxants: For muscle spasms
  • Procedures:
    • Laminectomy
    • Spinal fusion
    • Therapeutic hypothermia: Decreases bleeding and edema, improving motor function and reducing pain

Nursing Care

  • Stabilize the spine
  • Maintain a patent airway (high risk for respiratory dysfunction if injury at C4 or above)
  • Monitor for complications: Hemorrhage, neurogenic shock, autonomic dysreflexia
  • Halo Traction Device Care:
    • Move as a unit, no pressure on rods
    • Keep a wrench or screwdriver for emergency vest removal

Complications of Spinal Cord Injury

Neurogenic Shock

  • Occurs with injury above T6
  • Loss of sympathetic nervous system activity causes unopposed parasympathetic activity
  • Symptoms: Hypotension, bradycardia, flushed and warm skin
  • Treatment: IV fluids, vasopressors, atropine

Autonomic Dysreflexia

  • Life-threatening hypertension
  • Trigger: Stimuli below injury level (e.g., distended bladder)
  • Symptoms: Extreme hypertension, severe headache, blurred vision, diaphoresis
  • Nursing Care: Sit patient up, notify provider, loosen clothing, address cause (e.g., catheterization for bladder distension)
  • Administer antihypertensive agents, monitor BP

Quiz Questions

  1. Spinal cord injury above L1 results in spastic muscle tone and a spastic neurogenic bladder. (True)
  2. Complication with hypotension and bradycardia? (Neurogenic shock)
  3. Priority action for extreme hypertension following spinal cord injury? (Sit the patient up)