Xavier University Ateneo de Cagayan

College of Nursing

S.Y. 2016 2017

A Presentation on the Concept Map of Spinal Cord Injuries

In Partial Fulfillment of the Requirements of Nursing Care Management 104.1

Submitted to:

Maam Jesusa Gabule, RN, MN

Maam Jesseca P. Monsanto, RN, MAN

Sir Dexter Dave Orginies, RN, MN

Sir Philip Eli Nalzaro, RN, MN

Level III Clinical Instructors

Submitted By:

Karen Mae Donaire

Diane Marie Estandarte

BSN 3 NB

December 16, 2016

 I. Describe briefly the disease condition

A spinal cord injury usually begins with a sudden, traumatic blow to the spine that
fractures or dislocates vertebrae. The damage begins at the moment of injury when displaced
bone fragments, disc material, or ligaments bruise or tear into spinal cord tissue. Most injuries
to the spinal cord don't completely sever it. Instead, an injury is more likely to cause fractures
and compression of the vertebrae, which then crush and destroy axons -- extensions of nerve
cells that carry signals up and down the spinal cord between the brain and the rest of the
body. An injury to the spinal cord can damage a few, many, or almost all of these axons.
Some injuries will allow almost complete recovery. Others will result in complete paralysis.

II. Determine the Predisposing and Precipitating Factors and discuss

Predisposing Factors

o Being male. Spinal cord injuries affect a disproportionate amount of men. In

fact, females account for only about 20 percent of traumatic spinal cord injuries
in the United States.

o Being between the ages of 16 and 30. You're most likely to suffer a traumatic
spinal cord injury if you're between the ages of 16 and 30.

o Being older than 65. Falls cause most injuries in older adults.

o Having a bone or joint disorder. A relatively minor injury can cause a spinal
cord injury if you have another disorder that affects your bones or joints, such as
arthritis or osteoporosis.

Precipitating Factors

o Engaging in risky behavior. Diving into too-shallow water or playing sports

without wearing the proper safety gear or taking proper precautions can lead to
spinal cord injuries.. Such behaviors can result in:

Motor Vehicle Crashes

Gunshot Wounds
 Falls

Injury from Recreational Sporting Activities

o Alcohol and Drug Use. Substances that can hinder sensory perception and
motor function can increase the risk of injury due to lack of awareness of
surroundings or behavior.

III. Discuss briefly the pathologic process

Damage in SCI ranges from transient concussion (from which the patient fully
recovers), to contusion, laceration, and compression of the spinal cord substance (either
alone or in combination), to complete transection (severing) of the spinal cord (which renders
the patient paralyzed below the level of the injury). The vertebrae most frequently involved are
the 5th, 6th, and 7th cervical vertebrae (C5 to C7), the 12th thoracic vertebra (T12), and the
1st lumbar vertebra (L1). These vertebrae are most susceptible because there is a greater
range of mobility in the vertebral column in these areas (Sherwood, Crago, Spiro, et al.,
2007). SCIs can be separated into two categories: primary injuries and secondary injuries.
Primary injuries are the result of the initial insult or trauma and are usually permanent.
Secondary injuries are usually the result of a contusion or tear injury, in which the nerve fibers
begin to swell and disintegrate. A secondary chain of events produces ischemia, hypoxia,
edema, and hemorrhagic lesions, which in turn result in destruction of myelin and axons. The
secondary injury is of primary concern for critical care nurses. Experts believe secondary
injury is the principal cause of spinal cord degeneration at the level of injury and that it is
reversible during the first 4 to 6 hours after injury. Methods of early treatment are essential to
prevent partial damage from becoming total and permanent (Sherwood, et al., 2007).

IV. Identify the different clinical manifestations as the disease progresses

Manifestations of SCI depend on the type and level of injury (Chart 63-7). The type of
injury refers to the extent of injury to the spinal cord itself. Incomplete spinal cord lesions
(the sensory or motor fibers, or both, are preserved below the lesion) are classified according
to the area of spinal cord damage: central, lateral, anterior, or peripheral. The American
Spinal Injury Association (ASIA) provides classification of SCI according to the degree of
sensory and motor function present after injury (Chart 63-8). Neurologic level refers to the
lowest level at which sensory and motor functions are normal. Below the neurologic level,
there is total sensory and motor paralysis, loss of bladder and bowel control (usually with
urinary retention and bladder distention), loss of sweating and vasomotor tone, and marked
reduction of blood pressure from loss of peripheral vascular resistance. A complete spinal
cord lesion (total loss of sensation and voluntary muscle control below the lesion) can result
in paraplegia or tetraplegia. If conscious, the patient usually complains of acute pain in the
back or neck, which may radiate along the involved nerve. However, absence of pain does
not rule out spinal injury, and a careful assessment of the spine should be conducted if there
has been a significant force and mechanism of injury (ie, concomitant head injury). Often the
patient speaks of fear that the neck or back is broken. Respiratory dysfunction is related to
the level of injury. The muscles contributing to respiration are the abdominals and intercostals
(T1 to T11) and the diaphragm (C4). In high cervical cord injury, acute respiratory failure is the
leading cause of death. Functional abilities by level of injury are described in Table 63-3.
V. What are the diagnostic studies and its relevance to the disease condition

Diagnosis of SCI is based on

o Physical examination. Used to identify all the physical injuries that the
patient may have acquired which can greatly help in identifying the type of
injury the Spinal Cord may have.

o Radiologic examination

CT scan (Computed Tomography). A CT Scan is used to help

define bone, from disc, and other properties in order to locate the
problem.

MRI (Magnetic Resonance Imagery). An MRI scan may be ordered

as a further work up if a ligamentous injury is suspected, since
significant spinal cord damage may exist even in the absence of bony
injury.

Myelography. Used to see spinal nerves more clearly with the use of
an injected dye.

Diagnostic x-rays such as lateral cervical spine x-rays and CT scanning are
usually performed initially.

Continuous electrocardiographic monitoring may be indicated if a cord injury is

suspected since bradycardia and asystole are common in acute spinal injuries.
VI. What are the surgical/medical management and discuss briefly

Medical Management

o IV Corticosteroid (Methylprednisolone Sodium Succinate)- Used to

lessen the Swelling and pain of the patients with SCI and improving their
neurological status through the Spinal Cord Decompression.
o O2 Therapy- To assist with the Respiratory Dysfunction of patients with
affected Lung function.
 o Mechanical Ventilator- To assist with the Respiratory Dysfunction of
patients with affected Lung function.

Surgical Management

o Skeletal Fracture Traction- A Halo or Cervical Traction may be used to

straighten the Spinal Column to prep for surgery and to immobilize the
problematic area.
o Spinal Reduction- a surgical procedure to restore a fracture or dislocation
to the correct alignment.
o Skeletal Decompression (Laminectomy)- is surgery that creates space by
removing the lamina the back part of the vertebra that covers your spinal
canal. Also known as decompression surgery, laminectomy enlarges your
spinal canal to relieve pressure on the spinal cord or nerves.

VII. Determine the Nursing Diagnoses based on the clinical manifestations

Ineffective Breathing Pattern Related to Weakness or Paralysis of Abdominal and

Intercostal Muscles and Inability to Clear Secretions
Ineffective Airway Clearance Related to Weakness of Intercostal Muscles
Impaired Bed and Physical Mobility Related to Motor and Sensory Impairments
Disturbed Sensory Perception Related to Motor and Sensory Impairments
Risk for Impaired Skin Integrity Related to Immobility and Sensory Loss
Impaired Urinary Elimination Related to Inability to Void Spontaneously
Constipation Related to Presence of Atonic Bowel as a Result of Autonomic Disruption
Acute Pain and Discomfort Related to Treatment and Prolonged Immobility

VIII. Bibliography

Andrew T Raftery, et al. Applied Basic Science for Basic Surgical Training. Second edition
2008;8:219-223

ATLS, et al. Student Course Manual. 7th Edition 2004;7:177-204

Huether, S. Et Al. Understanding Pathophysiology (Mosby, Inc. 2nd edition. 2000)

Keith L Moore et al. Clinically Orientated Anatomy. 3rd Edition1992;4:359-369

K Frielingsdorf, R N Dunn et al. SAMJ. March 2007,Vol. 97,No. 3

Mayo Clinic Staff. (2014). Diseases and Conditions, Spinal Cord Injury. Retrieved on
December 15, 2016. From http://www.mayoclinic.org/diseases-conditions/spinal-cord-
injury/basics/risk-factors/con-20023837
Segun T Dawodu et al. eMedicine Specialities. March 2009

Smeltzer, S. Et Al.. Brunner & Suddarths Textbook of Medical-Surgical Nursing (Lippincott

Williams & Wilkins.10th edition,2004)