report sci

8/13/2019 Report Sci

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SPINAL

CORD

INJURY


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WHATISSPINALCORDINJURY?

Spinal cord injury is damage to the spinal cord as a result of a directtrauma to the spinal cord itself or as a result of indirect damage to thebones, soft tissues, and vessels surrounding the spinal cord. Thespinal cord is the major bundle of nerves carrying nerve impulses toand from the brain to the rest of the body. Rings of bone calledvertebrae surround the spinal cord. These bones constitute the spinalcolumn (back bones).

Spinal cord damage results in a loss of function, such as mobility orfeeling. In most people who have spinal cord injury, the spinal cord isintact. Spinal cord injury is not the same as back injury, which mightresult from causes such as pinched nerves or ruptured disks. Evenwhen a person sustains a break in a vertebra or vertebrae, theremight not be any spinal cord injury if the spinal cord itself is notaffected.


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FUNCTIONS OF

SPINAL CORD


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EFFECTS OF

SPINAL INJURY


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Predisposing

factorsof Spinal Cord

Injury


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SPINALCORDTRAUMACANBECAUSEDBYA

NUMBEROFINJURIESTOTHESPINE, INCLUDING:

Assault

Falls

Gunshot wounds

Industrial accidents Motor vehicles accidents

Sports injuries (particularly diving into shallow

water)


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A minor injury can caused spinal cord injury if the spine

is weakened (such as from rheumatoid arthritis or

osteoporosis) or if the spinal canal protecting the spinal

cord has become too narrow (or spinal stenosis) due to

the normal aging process. Direct damage also occur if the spinal cord is pulled,

pressed or compressed. This may occur if the head,

neck, or back are twisted abnormally during an accident

or intense chiropractic manipulation.

Bleeding, fluid buildup and swelling can occur inside or

outside the spinal (but within the spinal canal). The

buildup of blood or fluid can press on the spinal cord

and damage it.


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INFECTIOUSDISORDERSOFTHESPINALCORD

Disease/Disorder:Definition

- Infectious disorders that affect the spinal cord can be

divided according to their anatomic location, including thefollowing:

Spinal column: pyogenic osteomyelitis, spondylodiscitis anddiscitis,1Pott disease,and spinal fungal infections.

Epidural space: epidural abscess.

Meninges: arachnoiditis.

Spinal cord: intramedullary abscess, neurosyphilis, and viralinfections of the spinal cord.
http://now.aapmr.org/cns/sci-disorders/Pages/Infectious-disorders-of-the-spinal-cord.aspxhttp://now.aapmr.org/cns/sci-disorders/Pages/Infectious-disorders-of-the-spinal-cord.aspx


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ETIOLOGY

- Most common cause of spine and spinal cord infectionsare bacterial in origin. Causative organisms include thefollowing:

Staphylococcus species

Streptococcus species

Salmonella in patients with sickle cell anemia

E.coli, Proteus mirabilis, and Enterococcus in patients whoare immunocompromised

Pseudomonas aeruginosa and Brucella in intravenous (IV)drug abusers

Mycobacterium tuberculosis in patients with spinaltuberculosis or Pott disorder

Treponema pallidum, which causes neurosyphilis


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- Immunocompromised patients are at high risk of

developing viral infections that can affect the spinal

cord. Causative agents include the following:

Human immunodeficiency virus

Herpes simplex virus I and II

Cytomegalovirus

Varicella zoster virus Human T-cell lymphotrophic virus


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- Fungal infections are extremely rare. However,

these may also occur in immunosuppressed

individuals. Common fungal species include the

following:

Candida

Cryptococcus

Aspergillus Coccidioides

Blastomyces


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- Epidemiology including risk factor

Risk factors that may contribute to developinginfections within the spinal cord or surrounding

structures include the following:

Age (pediatric and geriatric populations)

Poor nutritional status

Immunosuppression

IV drug use

Spine surgery and/or instrumentation

Hemodialysis


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DIAGNOSTICTEST:

Spinal cord injury

is a medical emergency that needs immediate

medical attent ion .


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HEALTHCAREPROVIDER

They will perform a physical exam, including a brain

and nervous system (neurological) exam.

This will help identify the exact location of the injury,

if it is not already known. Some of the reflexes may

be abnormal or missing.

Once swelling goes down, some reflexes may

slowly recover.


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THEFOLLOWINGTESTSMAYBEORDERED:

CT scan or MRI of the spine Myelogram

(an x-ray of the spine after injecting dye)

Somatosensory evoked potential (SSEP) testing or

magnetic stimulation Spine x-rays


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SPINALCORDINJURY

Nursing Process

(Nursing Responsibilities)


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PATIENTWITHACUTESPINALCORDINJURY

Assessment

Breathing Pattern

Cord Edema

Motor and sensory system

Temperature

Spinal Shock

Diagnosis

Ineffective airway clearance related to weakness of the

intercostal space

Acute pain and discomfort related to treatment and

prolonged immobility


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Based on the assessed data, potential

complications may develop:

DVT

Orthostatic Hypotension

Autonomic Dysreflexia

Planning and goals

Improved breathing pattern and airway clearance

Improved mobility

Improved sensory awareness

Promotion of comfort

Absence of complication


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Nursing Interventions

Promoting adequate breathing and airway clearance

Improving mobility

Promoting adaptation to sensory and perceptual

alterations

Maintaining skin identity

Maintaining urinary elimination

Improving bowel function

Providing comfort measures: the patient Halo Traction Monitoring and managing potential complications


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PATIENTWITHTETRAPLEGIAORPARAPLEGIA

Assessment

Cephalocaudal

Skin redness or breakdown

Sensation

Vasomotor control

Sexual function

Bladder and bowel control

Diagnosis

Impaired bed and physical mobility related to loss of

motor function

Impaired urinary elimination related level of injury


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Potential complications that may develop:

Spasticity

Infection and Sepsis

Planning and Goals

Maintenance of health

Bladder mgt wihtout infection

Bowel control

Sexual expression

Strengthen coping mechanism

Absence of complications


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Nursing Invertions

Increasing Mobility

Preventing Disuse Syndrome

Promoting skin integrity

Improving balder management

Establishing bowel control

Counseling on sexual expression

Enhancing coping mechanisms

Monitoring and managing potential complications


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THANK

YOU!

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