describes what spinal cord injury is; causes, pathophysiology, signs and symptoms,dx and treatment

1. Spinal injury
Sultana

2. Definition
• The spinal cord contains the nerves that carry
messages btw brain and body. The cord passes
through your neck and back. A spinal cord
injury due to trauma to nerves can cause loss
of movement (paralysis) below the site of the
injury

3. Spinal cord injuries are described as either
complete or incomplete. In a complete spinal
cord injury there is complete loss of sensation
and muscle function in the body below the level
of the injury. In an incomplete spinal cord injury
there is some remaining function below the level
of the injury. In most cases both sides of the
body are affected equally.

4. Causes spinal injury
• Road traffic accident
• Electric shock
• Falling from a great height
• Head injury during sports e.g. rugby
• Bullet or being stabbed by sharp object

5. Clinical manifestation
• Head in unusual position
• Numbness along e.g. legs because of loss of
sensation
• Difficulty in movement
• Paralysis (loss of movement) of arms or legs
• Bowel/bladder incontenency
• Unconscious

6. PATHOPHYSIOLOGY
• involves the initial mechanical injury during which
failure of the spinal column (fracture and/or
dislocation) directly imparts force to the spinal
cord, disrupting axons, blood vessels, and cell
membranes. This is followed by the delayed
onset of a secondary injury phase involving
vascular dysfunction, edema, ischemia,
electrolyte shifts, free radical production,
inflammation, and delayed apoptotic cell death.
Whereas neurological deficits are present
immediately following the initial injury

7. Prevention
• The following may lower your risk of spinal injury:
• Wear seat belts.
• Do not drink and drive.
• Do not dive into pools, lakes, rivers, and other
bodies of water, particularly if you cannot
determine the depth of the water or if the water
is not clear.
• Do not tackle or dive into a person with your
head.

8. Dx
• Spinal xray.- Locates level and type of bony injury
(fracture, dislocation); determines alignment and
reduction after traction
• MRI - Identifies spinal cord lesions, edema, and
compression.
• Physical examination> sensation to touch is intact
testing muscle strength and reflexes in the arms and
legs.
• (CT) scan- Locates injury, evaluates structural
alterations. Useful for rapid screening and providing
additional information if xrays questionable for
fracture/cord status.

9. RX /MGT
• Immobilizing the patient, using neck collars to prevent
further injury. You may need traction to stabilize your spine,
to bring the spine into proper alignment or both. A special
bed also may help immobilize your body
• Medications. Intravenous (IV) methylprednisolone (A-
Methapred, Solu-Medrol) is a treatment option for an acute
spinal cord injury.It works by reducing damage to nerve
cells and decreasing inflammation near the site of injury.
However, it's not a cure for a spinal cord injury
• Surgery- to stabilize the spine. combination of metal
screws, rods and plates may be necessary to help hold the
vertebrae together and stabilize them until the bones heal.

10. Nursing dx
• Impaired physical mobility related to neuromuscular
injury as evidenced by inability to move – paralysis
• Disturbed sensory perception as evidenced by
destruction of sensory trsctd with altered sensory
reception,transmission and intergration as evidenced
by anxiety, disorientation,bizarre
thinking,exaggerated emotional responses
• Acute pain related to physical injury as evidence by
burning pain below level of injury(paraplegia)
• Anticipatory grieving related to actual loss of
physiopsychosocial well-being as evidence by
expression of distress

11. IMPLEMENTATION
• Perform and assist with full ROM exercises on all
extremities and joints, using slow, smooth movements.
Hyperextend hips periodically.
• Note presence of exaggerated emotional responses, altered
thought processes (disorientation, bizarre thinking).so as to
Indicate damage to sensory tracts and psychological stress,
requiring further assessment and intervention.
• Administration of analgesics e.g PCM,DICLOFENAC
• Note loss of interest in living, sleep disturbance, suicidal
thoughts, hopelessness. Listen to but do not confront these
expressions. Let patient know nurse is available for support.