Spinal Cord Injury free essay sample

Spinal Cord Injury Spinal cord injuries (SCIs) most commonly occur as a result of falls, motor vehicle accidents, violence, sports injuries, or any other form of impact directed to the spinal cord. Over half of SCIs occur in the adolescent or young adult age group, although the elderly population is at increased risk for SCI because of normal degeneration of the delicate spinal cord (Nayduch, 2010). These injuries can be fatal, cause permanent damage, or have temporary or no effect to the individual at all. Spinal cord injuries occur when there is damage to the neurons of the spinal cord (Huether, 2008). They are usually classified by the type of injury and where it occurs along the spinal cord. Fractures of the bones along the spinal cord or dislocations or partial dislocations of the bony structures most commonly cause SCI. The patient can experience many types of SCI including: * Concussion- short term disruption of the normal anatomy of the spinal cord * Compression- pressure on the spinal cord * Contusion- bruising or local short term damage to the spinal cord * Laceration- a tear in the spinal cord tissue Transection- a complete severing of the spinal cord * Hemorrhage- bleeding into or around the spinal cord causing pressure and irritation on the cord itself or surrounding tissues * Damage to the blood vessels surrounding the spinal cord causing local damage where the bleeding occurs (Nayduch, 2010). We will write a custom essay sample on Spinal Cord Injury or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page All of these types of injury to the spinal cord can cause swelling, bruising, nerve damage, localized bleeding, inflammation, and/or tissue necrosis. These injuries can also be classified as complete or incomplete. A complete SCI indicates no motor function below the site of injury while incomplete SCIs can have some remaining level of sensory and/or motor function below the level of injury. Most vertebral injuries occur along the most mobile areas of the spinal cord, including C1-C2, C4-C7, and T10-L2 (Huether, 2010). All of these injuries have the potential to be devastating. Spinal shock can occur, resulting in complete loss of function. This is a temporary occurrence and usually lasts up to 3 months after injury. It involves paralysis, loss of reflex, loss of bladder/bowel control and sexual dysfunction. It can also cause systemic changes, such as loss of temperature control, decrease in blood pressure, and poor venous circulation. When function returns, it is usually demonstrated by return of movement, reflexes, and bowel/bladder control (Heuther, 2008). As function returns, an uncompensated cardiovascular response can occur called autonomic hyperreflexia. This is a life threatening emergency and must be treated immediately. If left untreated, the result is death. Autonomic hyperreflexia displays as a dramatic rise in blood pressure, pounding headache, excessive diaphoresis (sweating), nausea and bradycardia. This is caused by â€Å"stimulation of the skin or pain receptors† such as delayed bowel or bladder emptying and can be treated by first fixing the cause of stimulation (Huether, p. 379). Quick but thorough evaluation, diagnostic testing and treatment determined by findings is essential to sustain life in most patients with SCI. Airway, breathing and circulation must first be assessed followed promptly by full spinal immobilization including a cervical collar and long backboard. Immobilization can help decrease the chance of secondary injury (Nayduch, 2010). Continuous monitoring of blood pressure and temperature regulation must also occur. Nurses can also conduct a thorough neurologic exam which must be reassessed often to monitor for a change or worsening in condition. Movement including flexion and extension of body parts, pupil exam, muscle tone and vital signs must all be assessed to determine the extent of injury. Diagnostic evaluation leading to diagnosis includes physical exam, CT scan, MRI, radiologic studies and myelogram (Heuther, 2008). Treatment is aimed at reducing initial injury and preventing secondary damage. The patient must be closely monitored for spinal shock and automonic hyperreflexia. Patient education is a necessary nursing intervention for patients with SCI. All spinal cord injuries require close monitoring and therefore should be in an intensive care setting. Early stabilization (either in the field or in the ED) is key in treating SCI, and must continue on through the patient’s admission to the ICU and thereafter. Surgery to repair boney injury, decompress nerves and tissue, or insert long-term stabilization devices may be necessary. Some patients will need external stabilization devices that they wear for any amount of time up to one year. SCI patients are usually bedridden or severely limited in their activities, therefore the nurse must always be aware of the risk for skin breakdown, pneumonia, and deep vein thrombosis (DVT) or pulmonary emboli (PE) (Nayduch, 2010). Nursing interventions for these patients include frequent turning and change of position, instituting cough/deep breathing exercises, applying compression stockings, and monitoring any infusion of anticoagulants. Again, patient education is key in these patients.