Spinal Cord Injury Case Studies

The following paper will examine the etiology, mechanisms, and manifestations of spinal cord injuries, as well as how they relate to the case study. Given A.D.’s status, spinal shock can be suspected. Spinal shock is defined as “a sudden and complete transection of the spinal cord that results in complete loss of motor, sensory, reflex, and autonomic function below the level of injury,” and is often the immediate response to an acute spinal cord injury (Hung, 2009). After A.D. was ejected from his vehicle, he suffered a C5-C6 cervical subluxation (or misalignment), causing spinal cord damage. In the case of A.D., a severe drop in blood pressure was noted, dropping from 110/72 to 90/60, as well as a decreased heart rate, from 86 to 54 beats per minute. As damage to the spinal nerve tracts occur, system vasomotor tone is often loss, leading to vasodilation, and a decrease in the venous return rate (Hung, 2009). These factors decrease cardiac output, thus decreasing the blood pressure and heart rate (Young, 2010). A drop in the heart rate and blood pressure is known collectively as neurogenic shock (Hung, 2009). A decrease in cardiac
output can also cause an increase in the respiratory rate, another manifestation seen with A.D. (Charkoudian, Hart, Joyner, Wallin, & Wehrewin. 2010). Because the spinal injury occurred at the level of C5, the diaphragm may be paralyzed because of the lack of innervation occurring, further effecting his respiratory system. According to the definition of a spinal cord injury, which is stated above, it is noted that all reflex function below the point of injury will be loss (Hung, 2009). This explains why A.D. shows no deep tendon reflexes in both his arms and legs: the injury occurred above his extremities at the cervical level.
Although A.D.
is already presenting many manifestations related to a severe spinal cord injury, there are other complications that can be anticipated as well. For example, skin breakdown can occur, due to the lack of mobility occurring during the injury (Hung, 2009). The nurses caring for A.D. need to be sure to move him often and use protective measures, such as skin prep, to prevent pressure ulcers from forming. The BRADEN scale should be utilized to further identify A.D.’s risk for impaired skin integrity (Ayello & Lyder, 2008). A.D. is also at a higher risk for developing edema or deep vein thrombosis (DVT) due to his injury, decreased vasomotor tone, and impaired mobility. To prevent these complications, compression stockings, binders, or other compression devices should be utilized to help increase the venous return (Hung,
2009).
Initially, with spinal shock, bowel and bladder function will be completely lost, due to the lost of autonomic nervous system function below the injury. However, after the shock subsides, the return of bladder and bowel function depends on where the spinal injury occurred. In A.D.’s case (injury at C5-C6), gastrointestinal and genitourinary function will not fully return. The higher brain centers for communication and coordination of the sphincters found within these systems are damaged. A.D. will, unfortunately, be unable to voluntarily control when defecation occurs, and become incontinent. Patients with upper spinal cord injuries often lack awareness of bladder filling and tone, and become unable control their bladder function (Hung, 2009). Losing control of the GI/GU systems functions is one of the most embarrassing and devastating consequences that occur with spinal cord injuries, especially in someone as young as A.D.
Overall, it can be stated that A.D. is suffering spinal shock related to his C5-C6 cervical subluxation. His changes in blood pressure, heart rate, and respiratory rate, as well as his lack of deep tendon reflexes, provide evidence for this claim. Spinal cord injuries can have severe complications both during and after treatment, and theses injuries should be taken care of seriously to prevent these difficulties from occurring.