Nursing care of spinal cord injury
- 1. NURSING CARE OF PATIENT WITH SPINAL CORD INJURIES Dr. A.Seethalakshmi Reader, Faculty of Nursing, SRIHER(DU).
- 3. INCIDENCE INDIA 20/million Jaipur Falls-66% RTA-18% Weights-15% US 32/ million 2,35,000 11,000 annually 77.8% men 38 yrs 60 yrs-11.5%
- 4. ETIOLOGY Motor vehicle accidents Falls Violence Sporting injuries
- 5. EXTENT Incomplete quadriplegia- 34.1% Complete quadriplegia - 18.3% Incomplete paraplegia - 18.1% Complete paraplegia - 23%
- 6. ETIOLOGY Mechanisms of injury Hyperextension Hyper flexion Vertical compression Rotation of the spine Vertebral injuries Acceleration Deceleration Reduction in APD of SC Deformation Traction/ shearing 際際滷 Bone, ligaments, joints Fracture/ Dislocation
- 7. CLASSIFICATION Simple fracture Compressed vertebral fracture Comminuted fracture Dislocation
- 8. COMMON SITES C-C C-C T -L
- 9. PATHOPHYSIOLOGY Microscop ic heamorrh ages-GM Edema- WM Impairs microcircu lation Ischemic Areas Cellular and subcellular alterations Tissue necrosis 4hrs myelin disruption, axonal degeneration and ischemic endothelial injury Chemical and metabolic changes Necrosis-40% of cross sectional cord in 4hrs 70% in 24 hrs Cord swelling- diaphragm and medulla oblongata Phagocytes 36-48 hrs after injury Microglia and astrocytes Resorption of hemorrhage Acellular collagenous tissue in 3-4 weeks
- 10. TYPES Concussion Contusion Compression Laceration Transection- Complete, Incomplete, preserved sensation only, preserved motor nonfunctional, preserved motor functional Hemorrhage Damage or obstruction of spinal blood supply
- 11. CLINICAL MANIFESTATIONS SPINAL SHOCK: 7-20 days up to 3 mths Skeletal muscles, bladder, bowel, sexual function and autonomic control. Paralysis and flaccidity, absence of sensation, loss of bladder and rectal control, drop in BP, Poor venous circulation SNS- Thermal control Sweating and capillary dilation
- 12. Cont.d NEUROGENIC SHOCK loss of sympathetic outflow: vasodilation, hypotension, bradycardia and hypothermia.
- 13. AUTONOMICHYPERREFLEXIA Syndrome BP at any time after spinal shock resolves. CVS response to SNS stimulation. Paroxysmal HT, pounding headache, blurred vision, sweating, flushing of skin, nasal congestion, nausea, piloerection and bradycardia Cause : Distended bladder or rectum
- 15. DIAGNOSIS Physical Radiologic- chest and spine Myelographic examination Somatosensory evoked potential PFT ABGs CT scan, MRI
- 16. MANAGEMENT Immobilization Decompression Corticosteroids Nutrition Lung function Skin integrity Bowel and bladder management
- 17. NURSING PROCESS IN REHABILITATION Ineffective breathing pattern Risk for trauma Impaired physical mobility Disturbed sensory perception Acute pain Anticipatory grieving Bowel incontinence/ constipation Impaired urinary elimination
- 18. Cont.d.. Risk for autonomic dysreflexia Risk for impaired skin/ tissue integrity Inadequate knowledge regarding condition, prognosis, complications, treatment self care and discharge needs.