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Spinal Cord Injury Candida I. Marin Keiser University Nursing Karen Osbeck July 20, 2011

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Spinal cord injuries (SCIs) entail the loss of motor function, sensory function, reflexes and control of elimination, and can be very devastating to the patient and family. The prospect of catastrophic neurological injury as a result of damage is a very real possibility. It is important that the nurse be knowledgeable about the features of spinal injuries and the steps in evaluating and implementing care. Well organized initial care and identification of conditions that require immediate attention must be given top priority. Spinal cord injury (SCI) is damage to the spinal cord resulting in a change, either temporary or permanent. The International Standards for Neurological and Functional Classification of Spinal Cord Injury is a widely accepted system describing the level and extent of injury based on a systematic motor and sensory examination of neurologic function (American Spinal Injury Association 2001). Not all spinal cord injuries are created equal. For example injuries in the cervical region results in quadriplegia- paralysis/ paresis of all four extremities and truck. Yet, injuries below T-1 results in paraplegia-paralysis/paresis of the lower extremities, so the nurse must be astute to the exact location of injury. Most spinal cord injuries are caused by trauma, such as sport accidents/ injuries, motor vehicle accident or gunshot wounds. High risk activities, alcohol and acts of violence (gun shot and knife wound) account for a large amount of traumatic spinal cord injuries. Head/ neck injuries deserve special attention for their potential to affect the spinal cord, potentially resulting in death or a crippling permanent disability. The article make reference that a suspected spine injury not be moved without immobilization unless absolutely necessary to maintain the ABCs. Breathing is assessed by looking, listening

3 SPINAL CORD INJURY for respirations. C5, injury at or above these levels can result in paralysis of the diaphragm (Clifford 2009). An injury at C4 or above poses a great risk for impaired spontaneous ventilation because of the involvement of the phrenic nerve. The most important action will be to provide the patient with oxygen, suction as needed, intubation and mechanical ventilation may also be necessary. The article made reference to sport injuries in athletes but this model could be used for any spinal injury. Injuries to the cervical spine and the head often occur together and even when both are not present in a patient, they have common characteristics in the clinical presentation of these injuries. Nursing Implications is to assess consciousness by evaluating orientation, capability to follow instructions and eye opening. The patients behavior can be scored formally with the Glasgow coma scale, which correlates with prognosis for brain injuries. When regaining consciousness, the patient may be restless and may need additional support to sustain spine precaution (Ditunno 2005). The nurse must control the patients position because the patient may have lost consciousness and while awakening, routinely will attempt to move. After the stabilization of the patient within the ABCs framework, evaluation of subjective and objective assessment can take place. The nurse must remain calm and in control to better assistant the patient with critical care. The patient will most likely be admitted to the hospital to stay for weeks. If the patient is not able to move below a certain point, he may be at risk for certain complications. A spinal cord injury can be a very critical condition that commands around-the-clock care for the patient (DeWitt 2001). As a nurse, it's your responsibility not only to make sure the patient is receiving any treatments, medications, or tests the doctor orders; it's also

4 SPINAL CORD INJURY your job to see that the patient is comfortable, that he or she is taken care of mentally and emotionally as well (Sparks 2001). The complexity of a spinal cord injury requires the nurse to pay close attention to every detail the patient tells you about or that you observe, so that you can report any problems or complications quickly. The nurse will need to keep watching the patients cardiovascular and respiratory health, especially watching for blood clots, as immobilization drastically increases the risk pulmonary embolism. The nurse should ensure they are communicating effectively with the patient; they should study and research the patient type/cause of injury, so that they should fully understand what is going on with him or her physically. The patient should be given current and correct information and treatment education; this includes what the patient and family members will need to be taught pertaining to all aspects of the patient care (ADLs, transfer and medication regimen). This will allow for better communication with the patient. Be honest and upfront with him/her; don't sugarcoat any aspect because this could lead to mistrust later on. Most notably, pay attention to the patient. They just require a listening ear at some point. As they progress and starts gaining capability to do certain things on their own, support them and praise them, as this will improve their emotional well-being as a whole and could stimulate them to keep going and not to give up.

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American Spinal Injury Association. International Standards for Neurological Classifications of Spinal Cord Injury. revised ed. Chicago, Ill: American Spinal Injury Association; 2000:1-23. Ditunno JF Jr, Young W, Donovan WH, et al. The international standards booklet for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Paraplegia. Feb 2005;32(2):70-80. DeWitt Susan C. W.B. Saunders Fundamental Concepts and Skills for Nursing; June 2001. Sparks M Sheila. & Cynthia M. Taylor; Nursing Diagnosis Reference Manual; Springhouse Corporation, 2001. Clifford R. Everett, MD, MPH., Thomas L. Cesarz., MD,. Gaurav Kapur, MD Diagnosis and management of cervical spine injuries in athletes., The Journal of Musculoskeletal Medicine. Februarys 2009

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