MEDICAL MANAGEMENT OF PATIENTS WITH COMPLICATIONS OF SPINALCORD INJURY

Tetraplegia refers to the loss of movement and sensation in all the four extremities and the trunk, associated with injury to the cervical spinal cord.
Paraplegia refers to the loss of motion and sensation in the lower extremities and all or part of the trunk as a result of damage to the thoracic or lumbar spinal cord or to the sacral root.

ETIOLOGY

These conditions are as a result of trauma such as falls, injuries and gunshot wounds, but they may be also as a result of spinal cord lesions.(intervertebral disc tumor,spinal cord lesions),
multiple sclerosis, infections and abscesses of the spinal cord and congenital disorders such as spina bifida.

NURSING PROCESS

ASSESSMENT

• A head to foot assessment has to be done.
• Proper history has to be collected from the patient.
• Patients has to be thoroughly observed for the complications like loss of motor power,deep and superficial sensation,vasomotor control,Bowel and bladder dysfunction,sexual dysfunction,immobility,skin breakdown and pressure ulcers,recurring UTI,contractures and dysfunctions.
• Psychological support has to be given.

NURSING DIAGNOSIS

• Impaired bed and physical mobility related to loss of motor function.
• Risk of diffuse syndrome.
• Risk for impaired skin integrity related to permanent sensory loss knowledge and immobility.
• Impaired urinary elimination related to level of injury.
• Constipation related to effects of spinal cord distruption.
• Sexual dysfunction related to neurological deficit.
• Innefective coping related to impact of disabilities of daily living.
• Deficient knowledge about requirement for long term management.

COMPLICATIONS

Spasticity,infection and sepsis.

PLANNING AND GOALS

The goals includes maintenance of healthy intact skin,achievement of bladder management without infection,achievement of bladder control,achievement of sexual expression,strengthening of coping mechanisms and absence of complications.

EXERCISE PROGRAMMES

The muscles of the arm,hands,shoulders,chest,spine,abdomen and neck must be strengthened for patients with paraplegia,because he or she can bear the full weight on the muscles.The triceps and the latissmusdorsi are important muscles used in crutch walking.To strengthen these muscles the client to do push ups in prone position and sit ups in sitting position.Squeezing rubber balls or crumbling news paper promotes hand strength.Alternate exercise to increase the heart arte to target levels is done.

MOBILIZATION

Ambulation using crutches requires a high expenditure of energy.

Motorized wheel chairs can be given to the patient.

Ambulation is encouraged.

PREVENTING DISUSE SYNDROME

• Range of motion exercises is encouraged.
• The patient is repositioned frequently and is maintained in proper body alignment whether in bed or in wheelchair.

PROMOTING SKIN INTEGRITY

• The patient must be taught to check the status of the skin every 2 hours.
• The patient is taught that the ulcers develop over the bony prominences, position is changed every 2 hours and the patient can be given a mirror to inspect the pressure prone areas.
• The bottom sheet must be observed for creases.
• If the patient himself cannot change the position himself the caregiver is instructed regarding the care to be given.
• Patient should be given a diet which is high in protein,vitamins and calories to ensure minimum wasting of muscles and to maintain a healthy skin.

IMPROVING BLADDER MANAGEMENT

• Fluid intake should be minimum 2.5 litres per day. The patient should empty the bladder frequently so that there is no residual urine
• Importance should be given for personal hygiene because UTI is usually caused by ascending infection.
• The perineum must be kept clean and dry attention should be given to the perianal skin after defecation.Underwear should be cotton and must be changed atleast once daily.
• If an external catheter is used the penis must be cleaned regularly.
• The nurse should emphasize on the importance of detecting the signs and symptoms of UTI(cloud urine,Foul smelling urine,hematuria,fever or chills)
• Female patients who cannot be catheterized shoud be instructed to wear water proof underwears
• Surgical intervention is indicated by urinary diversion.

ESTABLISHING BOWEL CONTROL

• The anal sphincter is massaged by inserting a gloved finger(which has been adequately lubricated)2.5-3.7cms into the rectum and moving it in a circular motion or from side to side.This is done to trigger the defecation responseThis procedure has to be performed at regular time intervals usually 48 hours after a meal and when it is convenient for the patient.
• The patient should be taught about the signs of fecal impaction(loose stools,constipation)and is cautioned to watch for the signs of haemorrhoids.
• A diet with sufficient amount of fluids is encouraged.
• Avoid constipation and decrease the risk of autonomic dysreflexia

COUNSELLING ON SEXUAL EXPRESSION

• Special techniques and positions are educated to the clients.
• For men with erectile failure penile prosthesis enables them to sustain the erection.
• Certain medications like Viagra(Sidenafil),Vardenafil(Levitra),and Tadalafil(Cialis)increases the blood flow to the penis.
• Sex education should be given to the clients

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