Med-Surg - Nervous System, part 10: Spinal Cord Injury
by Cathy Parkes November 02, 2021 Updated: April 05, 2022 5 min read
Hi. I'm Cathy with LevelUpRN. In this video, we are going to talk about spinal cord injuries. And at the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key facts I'll be covering in this video. So definitely stay tuned for that. And if you have our LevelUpRN medical surgical nursing flashcards definitely pull those out so you can follow along with me in this video.
Spinal cord trauma can be caused by hyper extension or hyper flexion or vertical compression or rotational forces.
So that trauma will result in hemorrhaging and edema. And this impairs circulation in the spinal cord, which results in ischemia.
So we can have a complete spinal cord injury, which causes the loss of all nerve function below the level of the injury.
Or we can end up with an incomplete spinal cord injury, which allows for some function below the level of the injury.
In terms of signs and symptoms of a spinal cord injury. This can include loss of motor function, loss of sensation, loss of reflexes, as well as loss of bowel or bladder function. Specific signs and symptoms will depend on the level of injury.
So if your patient has injury below the level of T1, then that will cause paraplegia, which is paralysis or paresis, which means weakness of the lower extremities.
If they have injury to the cervical region, that will cause quadriplegia, and that means they'll have paralysis or paresis of all four extremities. So quad means four to help you remember that.
In terms of their muscle tone and bladder function. If the patient has injury to their upper motor neurons, which occurs when they have an injury above L1 or L2, this will result in hypertonia, which means that the patient will have a spastic muscle tone and a spastic neurogenic bladder.
If they have injury to the lower motor neurons, meaning they had injury below the level of L1 or L2, that will result in hypotonia. So this means they'll have a flaccid muscle tone and a flaccid neurogenic bladder.
So we have a little cool chicken hint here on the card. So hyper means high or above. So if the injury occurs above L1 and L2, then they're going to end up with hypertonia and then hypo means low or below. So if they end up with damage below the level of L1 or L2, then they will have hypotonia.
Medications that can be used with a spinal cord injury include steroids to decrease inflammation, analgesics to address pain, and muscle relaxants for muscle spasms.
Other procedures that can help include a laminectomy, a spinal fusion, as well as therapeutic hypothermia. So this has been shown to decrease bleeding and edema, which helps to improve the patient's motor function and also decrease pain.
In terms of nursing care. We're going to want to stabilize the patient's spine. We're going to want to maintain a patent airway. So a patient who's had injury at the level of C4 or above is at high risk for respiratory dysfunction. So that's definitely something important to keep in mind.
We're also going to monitor for complications, which can include hemorrhage, neurogenic shock, as well as autonomic dysreflexia. So if your patient has injury to the cervical region, they may end up in a halo traction device. And if you look in your nursing textbook, you will likely see someone looking very unhappy in this device. And really, you can't blame them because it's pretty intense. So if your patient is in halo traction, you want to make sure you move your patient as a unit. You never want to apply pressure to these rods or move the patient by pulling on those rods. Those rods are connected to their skull. So again, you're going to move the patient as a unit. You want to make sure there is a wrench or screwdriver attached to the vest, which is part of that halo device, so that you can remove the vest in the event of emergency, like if you need to do CPR on the patient.
Let's now get into a little more detail about the complications of a spinal cord injury starting with neurogenic shock.
With neurogenic shock, we have autonomic nervous system dysregulation following a spinal cord injury. It typically occurs when the injury is above T6.
So the pathophysiology behind this complication is that the spinal cord injury causes loss of sympathetic nervous system activity. So we have unopposed parasympathetic nervous system activity, and this causes instability in heart rate, blood pressure, and temperature regulation.
So key symptoms of neurogenic shock include hypotension, bradycardia, as well as flushed and warm skin.
So treatment will include the administration of IV fluids, vasopressors, as well as atropine to try to get that heart rate back up.
The next complication I want to talk about is autonomic dysreflexia. This is where we have life threatening hypertension following a spinal cord injury.
And the pathophysiology behind this complication is that we have some kind of stimuli going on below the level of the spinal cord injury, such as a distended bladder that is initiating a sympathetic response in the body. And this is causing vasoconstriction and an increase in blood pressure, and the parasympathetic nervous system is unable to compensate.
So symptoms of autonomic dysreflexia include extreme hypertension, a severe headache, blurred vision, and diaphoresis.
So in terms of nursing care, your number one priority is to sit the patient up. And you want to notify the provider, loosen any restrictive clothing, and address the underlying cause. So if it is a distended bladder, you may need to catheterize the patient. If the patient already has an indwelling catheter in place, then you should check the tubing for any kinks, which can cause urine to back up into the bladder and cause distension.
Another example of a stimuli that can trigger autonomic dysreflexia is a fecal impaction. So if that is the case, you may need to manually dis-impact your patient.
So in addition to addressing the underlying cause, you want to administer antihypertensive agents as prescribed and closely monitor your patient's blood pressure.
All right, time for quiz. I have three questions for you. First question, a spinal cord injury above L1 will likely result in spastic muscle tone and a spastic neurogenic bladder. True or false? The answer is true question. Number two, what complication of a spinal cord injury results in hypotension and bradycardia? The answer is neurogenic shock. Question number three, if your patient exhibits extreme hypertension following a spinal cord injury, what is your priority action? The priority action is to sit the patient up. That's the first thing you do.
All right. I hope this video has been helpful. Take care and good luck with studying.
Because if there's kinks in the tubing that can cause urine to black to black up to the bladder.
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