Immobility – Nursing Interventions for Acute Spinal Cord Injury

by Rhonda Lawes, PhD, RN

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    00:01 Now, immobility is a risk for anyone but it's a particular risk for somebody with a spinal cord injury.

    00:06 Now think about emboli or clots, that's just a fancy word for clots. DVT means deep vein thrombosis.

    00:15 Now normally, these will form like in a patient's calf, right? Deep vein thrombosis, a common place it forms is in a patient's calf.

    00:23 PE is a pulmonary embolism.

    00:26 So emboli, clots, DVT, PE -- those are just all ways of saying that we've got a clot big enough that it's impairing circulation.

    00:36 Now, these are really common in patients with a spinal cord injury particularly in the first three months.

    00:43 We're still getting on healing and moving again so we know as nurses when I have somebody with a spinal cord injury I have to really be on alert for somebody with for possibility for embolism.

    00:54 In fact, pulmonary embolus is a leading cause of death in a spinal cord injury so it's not unusual for somebody with a spinal cord injury to survive the injury but then they end up with a secondary problem and it could cause their death.

    01:11 So, we're watching for clots, we know they're really at risk for it, but something that's not as dramatic but can also be extremely problematic is skin breakdown.

    01:20 Anywhere the patient has a -- we call it a bony prominence, but think of someone laying on a bed, you're gonna have pressure points over bony prominences like the heel, the elbow, they can even have them on the back of their head.

    01:35 There's gonna be areas that diminish sensory and motor, like normally, when you're sleeping, your body senses like, "Wow, I need to move, I need to turn over, I need to move this or that." But somebody with a spinal cord injury, you remember those messages aren't making up and down that information highway to tell your body what to do so they don't sense that, they may not feel that and so what they normally would do to keep themselves from developing this injury they're not able to do.

    02:03 So people with a spinal cord injury are at a high, high, high risk for skin breakdown and that is completely on us as nurses.

    02:12 Our job is to make sure that never happens on our watch.

    02:16 So you're gonna do great skin care and assess that skin regularly.

    02:21 You will look at that patient top to bottom, side to side, front to back; so you do it ever you need to do to make the patient feel comfortable but you do need to look at every square inch of their body. Got socks on, they need to come off, you need to clean those feet and make sure you did a really good job assessing them.

    02:40 You wanna make sure the patient is turned appropriately on a minimum as of every two hours.

    02:46 Now, the patient has paralysis, we talked about in our other videos, how you can turn the patient appropriately to protect that paralyzed side.

    02:53 Advocate for your patient to get a specialized therapeutic bed.

    02:57 We have the coolest kind of beds that can help especially in the early phases of recovery for a spinal cord injury.

    03:05 They can get a specialized therapeutic bed.

    03:08 They have all kinds of beds from airbeds, that they will deflate and inflate and change the pressure points on the patient, and so they don't have to literally be turned as often and they get excellent care on those.

    03:20 Now, you wanna make sure that you administer and monitor anticoagulant therapy as prescribed because we know there are risk for clots, you wanna make sure that the patients on some type of therapy as prescribe by the health care provider and that we give it on time and regularly like we do it with all of our medications.

    03:38 Now, last one, this isn't real fancy but compression stockings will help with that pooling, will help keep that extra blood from hanging out down there in the lungs, I'm sorry, from hanging out down there in the legs, the other L word, so use those compression stockings.

    03:53 Make sure that you don't have a lot of extra pooling blood in the legs because pooling blood can also put you at risk for clot development.

    04:01 So compression stockings and anticoagulant or antiplatelet therapy will help with clot development.

    About the Lecture

    The lecture Immobility – Nursing Interventions for Acute Spinal Cord Injury by Rhonda Lawes, PhD, RN is from the course Spinal Cord Injuries and Syndromes (Nursing) .

    Included Quiz Questions

    1. Emboli
    2. Skin breakdown
    3. Muscle atrophy
    4. Impaired nutrition
    5. Urinary incontinence
    1. Regular skin assessments
    2. Frequent turning
    3. Administration of anticoagulants
    4. More frequent bathing
    5. Use of extra sheet over the bed mattress

    Author of lecture Immobility – Nursing Interventions for Acute Spinal Cord Injury

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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