Spinal Cord Injuries
“What are the assessment findings associated with injuries of the spinal cord at the thoracic level?” The signs and symptoms associated with a thoracic spinal cord injury may range from respiratory, cardiovascular, gastrointestinal, and urinary complications. If the thoracic vertebrae experience any trauma, during assessment the patient may exhibit a loss of physical sensation, paraplegia or weakness in the legs, bradycardia, hypotension, or orthostatic hypotension. The patient may also experience hypoactive bowel sounds or paralytic ileus, abdominal distention, constipation, or uncontrollable bowels. In continuing, the patient may also display urinary signs and symptoms such as, urinary retention or urinary incontinence. (Lewis, 2014)
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2. “Identify limitations that a patient with a T6 and below injury may experience.”
Due to paraplegia or paralysis the patient will be immobilized and limited to routine activities of daily living. The patient is limited to wheel chair accessible buildings in which will impact selection of travel and social interaction. The patient limitations may also reindeer them with out transportation. Psychosocial issues may impact social interactions because of spinal cord injury. Sexual health may be affected and reduce social or romantic interactions. Weight gain may be a result of spinal cord injury due to lack of or less activity. Risk for infection may increase due to limited ROM to provide proper hygiene. In continuing, due to limitations associated with spinal cord injury, depression and hopelessness may occur as related to reduced social interactions. The patient may develop pressure ulcers from limited range of motion. There are many things that a patient must adapt and readjust activities of daily living, but can resolve or eliminate associated limitations of spinal cord injury
3. “Explain the measures that are performed to manage bladder and bowel elimination for a patient with spinal cord injury.” To manage bladder and bowel elimination for a patient with spinal cord injury, the administering of assistive devices is used to aid in the elimination process. Signs and symptoms of spinal cord injury is distended or retained bladder. By administering a Foley catheter as a result of this debilitating injury will prevent urine retention and prevent possible acute kidney injury. Also, with impaired sensation of the bladder, possible eruption or infection of the bladder may occur. Large fluid intake or intravenous solution therapy are needed to assist in bladder or bowel elimination. For bowel elimination management, constipation is a common symptom of spinal cord injury. Because of the impaired autonomic sensory, the bowels cannot process or pass feces. To combat this issue, suppositories or enemas are used to stimulate bowel activity. If the patient experience constipation, manual evacuation must be applied. In addition, bladder and bowel rehabilitation process will be initiated.
4. “Define autonomic dysreflexia including the etiology, risk factors, preventative measures and acute medical and nursing care.”
The term autonomic dysreflexia is defined by Stedman's Medical Dictionary for the Health Professions and Nursing as “a syndrome occurring in some people with spinal cord lesions resulting from functional impairment of the autonomic nervous system” (Stedman's Medical Dictionary for the Health Professions and Nursing, 7th Edition, 2011, p. 171). This is exhibited by patients with T6 spinal injuries or higher. This manifestation is evoked by stimulus below the injury area. Common stimulants are complications of the bowels, bladder, or intact pain sensory. These stimulants evoke an arteriolar vasoconstriction reflex that asa a result increase blood pressure. As the body tries to counteract the effect, the heart rate is reduced. The associated symptoms are exhibited as hypertension, bradycardia, severe headaches, pallor skin tone below the spinal cord injury, and muscle spasms.
Preventative measures that will reduce the risk of autonomic dysreflexia are the proper management of bladder and bowel function and reducing trauma below the spinal cord injury. A Foley catheter will be administered to reduce risk for bladder distention or trauma. Suppositories, enemas, and bowel elimination management are administered to reduce bowel obstructions or constipation that might stimulate an autonomic dysreflexia reaction. To prevent any pain sensory stimulant that may evoke dysreflexia, remove any stimuli that may agitate the skin. Provide rotation of the body every two hours and pillows or wedges to prevent painful pressure ulcers. “Remove any constrictive clothing or shoes”. In acute care, raise the head of the bed by 45 degrees or sit the patient up. Assess blood pressure and vitals and contact the attending physician. Continue an assessment to determine stimulant or complication that may exacerbated the autonomic reaction. In addition, administer prescribed vasodilators.
5. “Describe the nursing interventions to prevent and to manage the various stages of pressure ulcers.” The interventions that will be takin to prevent pressure ulcers for patients with spinal cord injuries will provide a better quality of life and aid in rehabilitation.
The first intervention will be to rotate the patient with caution every two hours. In continuing, pillows or foam wedges may be applied to bony prominences to relieve pressure on the skin. This practice will also be applied to wheel chairs and various types of seating. The next intervention is to maintain skin integrity through intravenous medication therapy to balance electrolytes and a protein rich diet. Obesity or malnutrition can promote skin breakdown. By balancing electrolytes, promotes proper hydration to the integumentary system to maintain skin integrity. The rich protein diet will provide the essential building blocks for muscle and skin growth and repair. If pressure ulcers are developed, prescribed ointments and lotions are applied to the pressure ulcer and dry dressings. Then the dry dressing will be wrapped in dry gauzes to add additional relief of pressure. Furthermore, proper teaching of diet and medication regiment will support skin health and prevent pressure …show more content…
ulcers.
(Lewis, Dirksen, Heitkemper, Bucher, 2014)
6. “Describe measures to promote adaptation to loss for patients with spinal cord injury.”
Patients with a spinal cord injury may experience many psychosocial issues.
The patient may exhibit anger, frustration, hopelessness, and depression as a result of the loss of everyday activities. They may also perceive themselves as a burden to others. The measures that are used to help the patient to adjust to their altered lifestyle are to be supportive and provide encouragement. By involving the patient in the planning stage will contribute to the patient’s self-esteem and rehabilitation process. The nurse must exhibit tolerance for the patient because the individual may experience transitional stages of emotional regression during the rehabilitation stage (Lewis, Dirksen, Heitkemper, Bucher, 2014) . In the rehabilitation stage, patients may develop an altered independent lifestyle but, still experience psychosocial
issues.
In the shock and denial stage, provide honest information and encourage the patient to begin the rehabilitation process. Through the anger stage, include the patient in the planning stage and allow emotional outbursts. Also, include family to build support group and assist in grieving process. During the depression stage, “avoid sympathy” and use “firm kindness” (Lewis, Dirksen, Heitkemper, Bucher, 2014). In addition, involve a social worker and provide resources for support groups, organizations that aid in transforming housing conditions that aid in altered lifestyle, and transportation needs for work or medical appointments. (Lewis, Dirksen, Heitkemper, Bucher, 2014)
2. “Identify limitations that a patient with a T6 and below injury may experience.”
Due to paraplegia or paralysis the patient will be immobilized and limited to routine activities of daily living. The patient is limited to wheel chair accessible buildings in which will impact selection of travel and social interaction. The patient limitations may also reindeer them with out transportation. Psychosocial issues may impact social interactions because of spinal cord injury. Sexual health may be affected and reduce social or romantic interactions. Weight gain may be a result of spinal cord injury due to lack of or less activity. Risk for infection may increase due to limited ROM to provide proper hygiene. In continuing, due to limitations associated with spinal cord injury, depression and hopelessness may occur as related to reduced social interactions. The patient may develop pressure ulcers from limited range of motion. There are many things that a patient must adapt and readjust activities of daily living, but can resolve or eliminate associated limitations of spinal cord injury
3. “Explain the measures that are performed to manage bladder and bowel elimination for a patient with spinal cord injury.” To manage bladder and bowel elimination for a patient with spinal cord injury, the administering of assistive devices is used to aid in the elimination process. Signs and symptoms of spinal cord injury is distended or retained bladder. By administering a Foley catheter as a result of this debilitating injury will prevent urine retention and prevent possible acute kidney injury. Also, with impaired sensation of the bladder, possible eruption or infection of the bladder may occur. Large fluid intake or intravenous solution therapy are needed to assist in bladder or bowel elimination. For bowel elimination management, constipation is a common symptom of spinal cord injury. Because of the impaired autonomic sensory, the bowels cannot process or pass feces. To combat this issue, suppositories or enemas are used to stimulate bowel activity. If the patient experience constipation, manual evacuation must be applied. In addition, bladder and bowel rehabilitation process will be initiated.
4. “Define autonomic dysreflexia including the etiology, risk factors, preventative measures and acute medical and nursing care.”
The term autonomic dysreflexia is defined by Stedman's Medical Dictionary for the Health Professions and Nursing as “a syndrome occurring in some people with spinal cord lesions resulting from functional impairment of the autonomic nervous system” (Stedman's Medical Dictionary for the Health Professions and Nursing, 7th Edition, 2011, p. 171). This is exhibited by patients with T6 spinal injuries or higher. This manifestation is evoked by stimulus below the injury area. Common stimulants are complications of the bowels, bladder, or intact pain sensory. These stimulants evoke an arteriolar vasoconstriction reflex that asa a result increase blood pressure. As the body tries to counteract the effect, the heart rate is reduced. The associated symptoms are exhibited as hypertension, bradycardia, severe headaches, pallor skin tone below the spinal cord injury, and muscle spasms.
Preventative measures that will reduce the risk of autonomic dysreflexia are the proper management of bladder and bowel function and reducing trauma below the spinal cord injury. A Foley catheter will be administered to reduce risk for bladder distention or trauma. Suppositories, enemas, and bowel elimination management are administered to reduce bowel obstructions or constipation that might stimulate an autonomic dysreflexia reaction. To prevent any pain sensory stimulant that may evoke dysreflexia, remove any stimuli that may agitate the skin. Provide rotation of the body every two hours and pillows or wedges to prevent painful pressure ulcers. “Remove any constrictive clothing or shoes”. In acute care, raise the head of the bed by 45 degrees or sit the patient up. Assess blood pressure and vitals and contact the attending physician. Continue an assessment to determine stimulant or complication that may exacerbated the autonomic reaction. In addition, administer prescribed vasodilators.
5. “Describe the nursing interventions to prevent and to manage the various stages of pressure ulcers.” The interventions that will be takin to prevent pressure ulcers for patients with spinal cord injuries will provide a better quality of life and aid in rehabilitation.
The first intervention will be to rotate the patient with caution every two hours. In continuing, pillows or foam wedges may be applied to bony prominences to relieve pressure on the skin. This practice will also be applied to wheel chairs and various types of seating. The next intervention is to maintain skin integrity through intravenous medication therapy to balance electrolytes and a protein rich diet. Obesity or malnutrition can promote skin breakdown. By balancing electrolytes, promotes proper hydration to the integumentary system to maintain skin integrity. The rich protein diet will provide the essential building blocks for muscle and skin growth and repair. If pressure ulcers are developed, prescribed ointments and lotions are applied to the pressure ulcer and dry dressings. Then the dry dressing will be wrapped in dry gauzes to add additional relief of pressure. Furthermore, proper teaching of diet and medication regiment will support skin health and prevent pressure …show more content…
ulcers.
(Lewis, Dirksen, Heitkemper, Bucher, 2014)
6. “Describe measures to promote adaptation to loss for patients with spinal cord injury.”
Patients with a spinal cord injury may experience many psychosocial issues.
The patient may exhibit anger, frustration, hopelessness, and depression as a result of the loss of everyday activities. They may also perceive themselves as a burden to others. The measures that are used to help the patient to adjust to their altered lifestyle are to be supportive and provide encouragement. By involving the patient in the planning stage will contribute to the patient’s self-esteem and rehabilitation process. The nurse must exhibit tolerance for the patient because the individual may experience transitional stages of emotional regression during the rehabilitation stage (Lewis, Dirksen, Heitkemper, Bucher, 2014) . In the rehabilitation stage, patients may develop an altered independent lifestyle but, still experience psychosocial
issues.
In the shock and denial stage, provide honest information and encourage the patient to begin the rehabilitation process. Through the anger stage, include the patient in the planning stage and allow emotional outbursts. Also, include family to build support group and assist in grieving process. During the depression stage, “avoid sympathy” and use “firm kindness” (Lewis, Dirksen, Heitkemper, Bucher, 2014). In addition, involve a social worker and provide resources for support groups, organizations that aid in transforming housing conditions that aid in altered lifestyle, and transportation needs for work or medical appointments. (Lewis, Dirksen, Heitkemper, Bucher, 2014)