Review of Spinal Cord Injuries (Nursing)

00:01 Hi. Welcome to our video series on neurological disorders.

00:05 We're gonna look at spinal cord injuries, spinal cord syndromes and autonomic dysreflexia.

00:11 All of the way that things go wrong with your spinal cord.

00:15 Now first let's start with a healthy spinal cord and talk about the functions of that special bundle of nerves.

00:21 The spinal cord is a bridge between the brain and the rest of the body.

00:27 So the primary function of the spinal cord is to facilitate the transfer of information from the brain to the rest of the body and back.

00:35 So information comes both up and down.

00:39 The spinal cord sends sensory information from the sensory receptors that are spread throughout the rest of the body to the brain.

00:46 So it takes information from the rest of the body up to the brain.

00:51 The spinal cord picks up the signals from the motor area of the brain and sends them to the target muscles and glands in the body.

00:58 So, sensory information comes up, and then the motor information goes back out to the rest of the body.

01:06 So that's the purpose of the spinal cord.

01:09 If we're gonna talk about things that happen or the results of your patients when they have damage to that spinal cord.

01:15 First, you need that quick refresher on what a healthy, normal and functioning spinal cord does.

01:21 Okay. Now you see from our graphic there.

01:23 We've kinda got it labeled for you with cervical, thoracic, lumbar, sacral and coccygeal.

01:29 Those are labeled. That's how we use -- that's a language we use to mark which part of the spinal cord we're talking about.

01:36 Those are the vertebra that are numbered.

01:38 Now if your patient has a spinal cord injury, because they've got it damaged two different sections of the spinal cord, now you can end up with paralysis.

01:47 And we're gonna talk about all different kinds of paralysis.

01:50 They might have loss of function and/or loss of sensation.

01:54 So as you'll see, I'm gonna give you some guidelines about what your patient could experience during a spinal cord injury.

02:01 But every case is very individual, depending on the severity of the spinal cord injury and the level of that spinal cord injury.

02:10 Now, if it's a nontraumatic spinal cord injury, sometimes it could be caused by things like arthritis or cancer or inflammation, maybe infections or the disk is degenerating of the spine.

02:23 So, let's talk about that for just a second.

02:26 So, most of the time when we think of spinal cords, we often think of some trauma, a motorcycle accident, a car accident, a diving accident, something that we would consider a traumatic spinal cord injury.

02:40 That's gonna happen, boom, you know exactly when that occurred.

02:44 But there's lots of other things in the aging process.

02:47 So, cancer, could be a tumor spreading, arthritis, we've got that inflammation in joints and tissues.

02:53 Again, inflammation really does significant damage.

02:57 Now the disks are the little spots in between the vertebra, they kinda help to cushion it.

03:02 As we age, sadly, as we age, those can start to degenerate or if you overuse your back.

03:09 So be very careful as future nurses to watch your back and always use the equipment the hospital provides.

03:17 So, so far we've talked about what the spinal cord does, right? Information comes up and down.

03:24 We know that it's got this vertebra around it for protection.

03:27 It's also gone some cerebrospinal fluid and some fat around there to keep it protected.

03:30 And there's ways that the spinal cord could be damage that don't involve trauma.

03:35 Some of the aging process and then certain disease processes can cause spinal cord injury.

03:40 So I want you to have a broad picture of the types of patients that you'll be working with.

03:45 These aren't just young people on a motorcycle accident.

03:48 These can also be elderly or people with other diagnosis.

03:52 So, we've talked about spinal cord injury and how important those nerves are.

03:58 But anything that damages those vertebra, those ligaments or disks in the spinal column will also indicate a possibility of a cause for a spinal cord injury.

04:07 Now, when we're talking about spinal cord injuries, let me give you two more categories kind of at the beginning of this.

04:14 It can either be a complete spinal cord injury or an incomplete spinal cord injury.

04:20 Now a complete injury is pretty severe. It's a total loss of feeling and emotion below the site of the injury.

04:28 Take a look at the picture there.

04:30 You see where we have the green highlighting that means that's where the patient has lost feeling and motion.

04:37 Now let's talk about that.

04:39 You know that the spinal cord brings information up, and send messages down.

04:45 A complete severing of that spinal cord would mean you have none of that being delivered.

04:50 So that's why you see in that first one that the hands, lower arms and then the lower half of the body is impacted.

04:58 That's a complete spinal cord injury where the site of injury was.

05:02 Now, if someone has a complete injury that's up higher, you see the picture next to that, the greenness from the neck down.

05:10 Now that's something that you may have heard called quadriplegia but it's also a newer term, it's called tetraplegia.

05:17 They mean the same thing. They all make reference to four extremities.

05:22 So you'll see that the patient in the picture next to the one with paraplegia is completely covered in green.

05:29 So the complete spinal cord injury means the one with paraplegia had a lower injury.

05:34 The one with tetraplegia had an injury to the spinal cord much higher up in their body.

05:41 And complete means, we've got nothing below that, no sensory or motion.

05:47 Now let's talk about the other category that we're introducing you to. Incomplete spinal cord injury.

05:53 Now, this is a lot more of a wildcard.

05:55 So we can see at the drawing while we have it, it doesn't go perfectly straight across like you see in the paraplegia incomplete.

06:02 You see it's got the line kind of going up diagonal on the patient's body for paraplegia.

06:06 So compare those two pictures; paraplegia in complete injury, paraplegia in incomplete injury.

06:13 You'll notice we have a lighter shade of green just to let you know this is extremely patient specific.

06:20 There could be some sensation or motion below the injury.

06:24 You're just gonna have to see how that plays out.

06:26 Now initially after the injury, it's gonna take some time, maybe 6 to 8 weeks before the healthcare team is really gonna know the extent of that patient's injury till we have the healing process start, get some of the inflammation to go down.

06:39 Then they can really see what the extent is. But also, look at the tetraplegia/quadriplegia. See that? We just gave you one example of what you might see.

06:48 You see that that left thigh could possibly have some sensation, but you've got a mix all the way around.

06:55 The most important thing is, this patient is most likely not going to be able to move their four extremities.

07:02 Okay. I don't wanna rush you through this section, so take some time. Take a look at this.

07:07 Think about, "Hey, someone might have a complete spinal cord injury, an incomplete spinal cord injury and what will that mean to you as a nurse." Well, anytime you're taking care of someone like this, it's gonna take communication.

07:20 You need to get a great report so you know exactly what the previous nurse has been involved with the patient and what they've observed the patient being able to do.

07:29 And then you're to be very careful when you're interacting with the patient to include them in care.

07:35 Don't just do things for them, make sure that you're very aware of what they're capable of doing because you wanna help this patient no matter what level of paralysis they are, stay as independent as possible.

07:48 Now I've got a tetraplegic/quadriplegic patient, they can't physically help me, but I can engage them in the decision-making process.

07:56 Ask them what -- when they would like to do something, how they would like to do something.

08:01 The point is, they've lost so much control.

08:04 As a nurse, our job is to give them as much control as possible and help them maintain as much independence as possible.