11. Spinal cord injuries: trauma from hyperextension, hyperfleon, aal compression, lateral fleon, or shearing of the spine.
1. Types:
1. C-l and C-2 injury level - resulting deficit:
1. Phrenic nerve involvement.
2. Diaphragmatic paralysis.
3. Respiratory difficulties (require permanent ventilatory support).
4. Possible quadriplegic.
5. Possible death.
2. C-4 through T-l injury level - resulting deficit: possible quadriplegic.
3. Thoracic-lumbar injury level - resulting deficit: possible paraplegic.
2. Pathophysiology: trauma —> vertebral dislocation or fractures —>cord trauma, compression, or severance of the cord.
3. Risk factors:
1. Motor vehicle accidents.
2. Diving, surfing, contact sports.
3. Falls.
4. Gunshot wounds.
4. Assessment:
1. Subjective data:
   1. Pain at the level of injury.
   2. Numbness/weakness, loss of sensation below level of injury.
   3. Psychological distress related to severity of injury and its effects.
2. Objective data:
1. Symptoms depend on extent of injury to spinal cord/spinal nerves.
2. Paralysis: motor, sphincter.
1. Initially a period of flaccid paralysis and loss of reflexes, called spinal or neural shock.
2. Incomplete injuries may lead to loss of voluntary movement and sensory deficits below injury level (symptoms vary depending on injury).
3. Complete injury leads to loss of function and all voluntary movement below level of injury.
3. Respiratory distress.
4. Alterations in temperature control.
5. Alterations in bowel and bladder function.
6. Involved muscles become spastic and hyperreflec within days or weeks.
5. Analysis/nursing diagnosis:
1. Ineffective breathing pattern related to highlevel injury.
2. Impaired physical mobility related to injuries affecting lower limbs.
3. Fear related to uncertain future health status.
4. Anety related to loss of control over own activities of daily living.
5. Bathing/hygiene self-care deficit related to injuries above T-l.
6. Impaired home maintenance management related to possible quadriplegia and paraplegia.
7. Risk for altered body temperature related to absence of sweating below level of injury.
8. Risk for injury related to equipment necessary for daily activities.
9. Tactile sensory/perceptual alterations related to injury level.
10. Body image disturbance related to permanent change in physical status.







6. Nursing care plan/implementation:
1. Goal: maintain patent airway.
1. Suction, cough, tracheostomy care, prn.
2. Oxygen, ventilator care.
3. Monitor blood gas levels.
2. Goal: prevent further damage.
   1. Immobilize spine.
   2. Firm mattress, Stryker frame, Foster frame, CircO-electric bed, traction, braces.
   3. Skeletal traction via tongs: Crutchfield, Gardner-Wells.
   4. Halo traction.
3. Goal: relieve edema: anti-inflammatory medications, corticosteroids.
4. Goal: relieve discomfort: analgesics, sedatives, muscle relaxants.
5. Goal: promote comfort:
   1. Maintain fluid intake: PO/IV, I&O.
   2. Increase nutritional intake
   3. Prevent contractures and decubiti.
   4. Assist patient to deal with psychosocial issues, e.g., role changes.
   5. Begin rehabilitation plan.
6. Goal: prevent complications.
   1. Monitor for spinal shock during initial phase of injury.
   2. Monitor for hyperreflexia with severed spinal cord injuries.
7. Goal: health teaching.
   1. Self-care techniques for highest level of independence; include significant others in teaching.
   2. How to use ambulation assistive devices (battery-operated wheelchair controlled by mouthpiece or hand controls, depending on level of paralysis).
   3. Identify community resources for followup care and career counseling.
   4. Signs and symptoms of autonomic hyperreflexia .
   5. Methods to prevent skin breakdown, infections of respiratory, urinary tract.
   6. Bowel, bladder program.
7. Evaluation/outcome criteria:
   1. Complications avoide
   2. Accomplishes self-care to greatest level for injury.
   3. Participates in rehabilitation plan.
   4. Grieves over loss and begins to integrate self into society.