Spinal Cord Injury M. Dubois Fennal, PhD, RN, CNS, CNS

SPINAL CORD INJURY DEFINITION: INJURY TO THE CORD CLASSIFIED ACCORDING TO AREA OF DAMAGE.

Structure and Function of Spinal Column and Cord Cervical (cord – 8) (column – 7) –Supports muscles of the head –Smallest of all vertebrae –Atlas is the first cervical vertebrae –Articulates with occipital bone superiorly, and with the axis inferiorly –Axis is the second vertebrae, articulates with the atlas and allows for rotation of the head

Thoracic (cord – 12) (Column – 12) Articulates with the ribs and supports the muscles of the chest

Lumbar (cord – 5) (column – 5) –Supports the muscles of the back. –Largest and strongest of the vertebrae –Site of most herniated disk

Sacral (cord – 5) (column – 5) –Vertebrae fused to form large triangle bone called the sacrum

Coccygeal (cord – 1) (column – 4) –Four rudimentary vertebrae with rudimentary bodies articulating facets and a transverse process.

TYPES OF SPINAL CORD INJURY COMPRESSION CONTUSION TRANSECTION DISLOCATION RUPTURE OF LIGAMENTS RUPTURE OF BLOOD VESSELS RUPTURE OF DISK

ETIOLOGY: TRAUMA AND DISEASE Motor vehicles = 35% Violence =30% Falls =19% Sports = 8%

Incidence 11,000 new injuries each year More frequent in males than females More frequent in age More frequent in AA

PATHOPHYSIOLOGY: EDEMA AND OR PRESSURE OF THE SPINAL CORD COMPRESSION OF THE SPINAL CORD DISRUPTION OF OVERSTRETCHING OF THE NEURAL TISSUES SPASMS LOSS OF MOTOR OR SENSORY ACTION

Function, Muscle Testing and Spinal Cord Segment Affected Motor Action Abduction of the arm Flexion of the arm Extension of the forearm Flexion of the digits Opposition of the digits Hip Flexion MuscleSeg DeltoidC5 BicepsC6 TricepsC7 C8 T1 L1-2

Knee extension Dorsiflexion of the ft Dorsiflexion of the big toe Plantar flexion of the foot L3 L4 L5 S1

Level of Lesion Sensory Motor Function/Loss C1-4 = Quadriplegia with loss of respiratory function C4-5 = Quadriplegia with phrenic nerve involvement (edema) loss of respiratory function C5-6 = Quadriplegia with gross movement of the arms

C6-7 =Quadriplegia with biceps intact C7-8 =Quadriplegia with biceps and triceps intact T1-L2 =Paraplegia, loss of abdominal and intercostal muscle function Below L2 = Some motor sensory lost, bowel and bladder dysfunction

Medical Management X-rays MRI CT Ekg Lab Work Immobilization Prevention of furthur damage

Respirations Heart Rate Traction Reduction of edema Steroids Special beds Traction

Nursing Management Assessment –Spinal shock –Neurogenic shock –DVT –Autonomic dysreflexia Fluid management Skin Integrity Breathing Heart rate

Nursing Diagnosis Breathing pattern Airway clearance Mobility Sensory perception Skin integrity Urinary and bowel Acute Pain