Nursing care of spinal cord injury

Nursing cae of spinal cord injury

1. NURSING CARE OF PATIENT WITH SPINAL CORD INJURIES Dr . A.Seethalakshmi Reader, Faculty of Nursing, SRIHER(DU).

2. SPINAL NERVES

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 Slide Bone, ligaments, joints Fracture/ Dislocation

7. CLASSIFICATION Simple fracture Compressed vertebral fracture Comminuted fracture Dislocation

8. COMMON SITES C ₁ -C ₂ C ₄ -C ₇ T ₁₂-L₂

9. PATHOPHYSIOLOGY

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

14. DIAGNOSIS Physical Radiologic- chest and spine Myelographic examination Somatosensory evoked potential PFT ABG’s CT scan, MRI

15. MANAGEMENT Immobilization Decompression Corticosteroids Nutrition Lung function Skin integrity Bowel and bladder management

16. 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

17. Cont.d .. Risk for autonomic dysreflexia Risk for impaired skin/ tissue integrity Inadequate knowledge regarding condition, prognosis, complications, treatment self care and discharge needs.

18. REHABILITATION AND PATIENT EDUCATION

19. THANK YOU