Spinal Cord Injury

2 Classifications:

  • Complete: No movement or sensation below the level of injury (can’t feel anything…pain/hot/cold/touch)
  • Incomplete: Some function below level of injury and possibly some sensation

Other complications:

  • Loss of diaphragm function resulting in the need for mechanical ventilation
  • Bowel and bladder dysfunction
  • Sexual dysfunction
  • Difficulty regulating heart rate, blood pressure, body temperature, and sweating
  • Spasticity
  • Neuropathic pain
  • Muscle atrophy
  • Osteoporosis
  • Gallbladder and renal stones

Another possible emergent complication is Autonomic Dysreflexia (hyperreflexia)
Definition: over-activity of the autonomic nervous system

  • Occurs when irritating stimulus occurs in the body below level of spinal injury
  • This complication occurs in patients with spinal cord injuries at thoracic 5 and above
  • Caused by anything that would have been physically painful, uncomfortable or irritating before the injury occurred

Examples of possible causes:

  • Over filled bladder
  • Constipation
  • Skin irritations
  • Wounds
  • Other medical complications

How it Happens

  • A stimulus (such as an overfilled bladder) sends nerve impulses to the spinal cord which travel up until they are blocked by the level of the spinal cord injury. Because of the blockage, a reflex is activated that increases the activity of the sympathetic nervous system causing spasms and narrowing of the blood vessels which increases blood pressure. Nerve receptors in heart and blood vessels detect and send messages to the brain which sends a message to the heart to slow the heart rate and to dilate the blood vessels. However, the brain can’t send messages below the level of injury so only the blood vessels above the injury respond. Therefore, the blood pressure cannot be regulated.

Symptoms:

  • Pounding headache
  • Goose bumps
  • Sweating above the injury
  • Nasal congestion
  • Slow pulse
  • Blotching of the skin
  • Restlessness

How to treat:

  • Treat acute symptoms according to Plan of Care
  • Contact the on-call nurse
  • Check to if bladder is full
  • Check if bowels are full
  • Check for skin irritant (example: wrinkle in the sheets)

To prevent:

  • Monitor output: bowel and bladder
  • Routine skin assessments
  • Regular bowel program