Impact of Spinal Cord Injuries (Nursing)

by Rhonda Lawes, PhD, RN

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      Slides Spinal Cord Injuries and Syndromes.pdf
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      Reference List Medical Surgical Nursing and Pathophysiology Nursing.pdf
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    00:01 Okay, now let's take a look at the injury with the spinal cord right there.

    00:04 We're gonna talk about the levels of spinal cord injury. Now I'm giving you big categories.

    00:09 When we talk about C1 to C6, that means we've numbered the vertebra from C1; standing for cervical; C1, 2, 3, 4, 5, and 6.

    00:21 So now you'll be familiar when you see the other letters. L is lumbar. S is sacral.

    00:26 But C1 to C6, if a patient has an injury that high, remember it's all the way up here of your neck, not in your skull.

    00:35 An injury from C1 to C6 that's gonna result in likely quadriplegia or tetraplegia.

    00:43 That means won't have the same type of use of all four extremities.

    00:49 Now there might be some weird sensation things depending on what's going on, but we still call that quadriplegia or the newer term, tetraplegia.

    00:58 Now, if the patient has an injury from C6 to C8, well that's complete paralysis of the hands, probably the trunk and legs.

    01:06 And again, we're giving you references to what we've seen, but each patient is very individualized.

    01:13 But this is generally what you'll see. T1 stands for thoracic.

    01:17 So T1 to T12 injury, you're gonna be impacted the arm and hand function and will likely be paraplegic, meaning the lower half of the body.

    01:27 Now, we'll talk about some syndromes a little bit later that are unique circumstances.

    01:32 But predominantly, when you see T1 to T12 and we say paraplegia that means they've lost the use of their legs.

    01:40 Now, L1 to L5; that stands for lumbar. So we've divided the spinal cord into these columns; cervical, thoracic, lumbar, next will be sacral.

    01:52 So when you see the letter L in front of 1 that just refers to the first L1, the first lumbar vertebra.

    01:59 So L1 to L5 is likely gonna lead to paraplegia. Now, S1 to S5 refers to the sacral area.

    02:07 And that injury, most patients can walk and have some type of function.

    02:12 So this slide is taking a look at each one of the vertebra from C1 all the way down to S5 and tells you what happens with the ability of a body to move.

    02:24 Okay. So you might wanna write in on your notes, motion or movement.

    02:28 So remember, this is what we're talking about.

    02:30 Because remember, the spinal cord is both sensation and movement, it controls both of those.

    02:36 But this slide is talking about, what can we usually expect to see if you have an injury along one of these vertebra.

    02:44 And at the bottom, you've got the coccygeal.

    02:47 So let's talk about what happens from C1 to C4 and some other functions of your body.

    02:54 Now that's considered a very high injury.

    02:57 C1 to C4 will impact their breathing because it will take out their diaphragm.

    03:02 They also have problems with head and neck movement.

    03:05 So I'm giving you a broad range there but we can say absolutely, this is a life-threatening spinal cord injury on the spot.

    03:13 Because when it happens, the patient is not gonna be able to breathe on their own because of that diaphragm paralysis.

    03:19 Now C4; cervical 4 to T1, then the patient's gonna have issues with heart rate control and upper limb movement.

    03:28 Now again, I want you to see, there's a range in between these.

    03:32 And keep in mind, we're giving you guidelines but every patient could be very unique.

    03:37 Okay. So now let's look at T1 to T12. C1-4, breathing. C1-4, breathing. C1-4, breathing.

    03:46 Why am I saying that over and over again? Because that is critical that you keep that in mind.

    03:51 C4 to T1, we talked about heart rate control and upper limb movement.

    03:55 Now we're moving down to T which is the thoracic. T1 to T12.

    04:01 Now that's a pretty big space, right? T1 to T12 is the trunk of the body, temperature regulation and control of the abdominal muscles.

    04:11 Now, let me give you just a little bit of an example because that's such a big range.

    04:16 If the injury is from T1 to T11 that's gonna impact the intercostal muscles.

    04:22 We know that the higher injuries in the cervical area took out the diaphragm.

    04:27 Somewhere between T7 and T12 will also knock out the abdominal muscles.

    04:32 So in order for me to breathe and cough effectively, I need all of those.

    04:38 I need good abdominal muscles. I need my intercostal muscles.

    04:42 Remember those are what help lift my rib cage and help it to become bigger.

    04:46 And I need a diaphragm. So clearly, I'm gonna have some serious breathing problems in addition if I have T1 to T12.

    04:56 So, to keep in mind in case this hasn't been clear, if I have an injury this high, I have problems all the way down.

    05:05 Because the problems will be from the injury and below.

    05:09 So if I have an injury here then I have problems from here and below. So if you've got a T12, you still could have some issues with breathing, right? If you have C1 to C4, we know you have issues with breathing.

    05:22 But if you have T1 to T12, depending on how much it's impacted of the abdominal muscles and the intercostal muscles, they may still have some difficulty with breathing and needs some real training.

    05:33 So key point with spinal cord injury, the level of the injury, you have problems from the injury and down below.

    05:42 Now, S2 to S4/S5, they're gonna have bowel, bladder and sexual function problems.

    05:50 So this becomes a really difficult problem for some patients and have to go through bowel and bladder training.

    05:56 And I even saw a video on YouTube once.

    05:59 There is a patient who is a quadriplegic who even shared some pretty -- well you might call them graphic, but I think it's just very personal and intimate videos he shows with his bowel and bladder training process is and what he has to do to stimulate these areas.

    06:15 I was so impressed that he was willing to be that vulnerable and transparent with people.

    06:20 But obviously, that's the kind of information that people would need.

    06:24 Now, L1 to S1 is the lower limb movement. So pull back and take a look at this.

    06:31 We've done a really good job of showing you, there's the vertebra on the one side and you see the numbers.

    06:37 We've also given you the different colors so you can see the shading.

    06:41 So you can watch how that plays over the body with the overlay to see the problems that a patient would have.

    06:48 So stop and pause the video for just a moment and review back to the main categories from the first one; C1 to C4; definitely not gonna be able to control breathing and not being able to move the rest of your body, right? And then spend your time just reviewing the other major categories.

    07:07 These will be important for you to commit to memory. So pause the video and join us.

    07:13 We have a pretty solid thought process of working each one of those categories.

    About the Lecture

    The lecture Impact of Spinal Cord Injuries (Nursing) by Rhonda Lawes, PhD, RN is from the course Spinal Cord Injuries and Syndromes (Nursing) .

    Included Quiz Questions

    1. Cervical
    2. Thoracic
    3. Lumbar
    4. Sacral
    1. Lumbar
    2. Cervical
    3. Thoracic
    4. Sacral
    1. S2 to S5
    2. C1 to C4
    3. C4 to T1
    4. T1 to T12

    Author of lecture Impact of Spinal Cord Injuries (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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