Spinal Cord Nursing Notes-Treatment
The contusion condition of the spinal cord requires careful nursing and treatment advice. Nursing of this type of patient and providing health care must allow for direct spinal cord adjustment within the spinal cord nerve housings as well as delicate avoidance of the nerves controlling respiratory action and organ failure.
The spine is one of the most challenging nursing assignments on record. The unconscious nervous system is only treated in cases of shock and failure by contact with technological machines which preserve their action. However, the physician will estimate in what cases this will bring about total recovery or dependence ultimately on machines for any wellness caliber at all.
The variety of symptoms will surprise nonmedical personnel, but to trained nurses they will signify a serious underlying condition or set of underlying spinal injuries. Lack of voluntary muscle control, and appearance of having no spinal reflexes, perception of light and perspiration as well as obvious bladder failure and bowel dysfunction will make nurses remind the physician to assess the patient using the neurological scale. The basis of total paralysis to active movement should be universally objective.
Nurses should practice making observations to test their independent ability to rate active movement and the continuum to total paralysis. These assessments will not be purely physical symptoms. Bowel dysfunction is indicative of central nerve failure the ability to control motor actions should indicate a lapse in spinal activity control overall. If the physician is so informed of any lack of active ovement, a new appraoc to patient care that involves the patient’s immobility should be udnertaken. Cervical collars, stretchers, and backboards must be used as soon as any of th attending staff observe lack of motor senrry volition.
If the EMT staff, the nurses, the physicians, and the participants in a surgery do not observe the signs of spinal cord injury, then the symptoms may be occluded by injuries and traumatic accident recoveryside effects. When the field officer makes the necessary report, a protocol spinal cord recovery program should be observed. in this way, every patient admitted to critical care for any medical trauma will be checked for lack of motor control and other spinal cord related functions.
When the SCI paralysis test is failed, this does not mean there will never be any spinal cord injury. It means that the patient as it stands currently does not show signs of spinal cord injury. However any damage suffered from lacerations, contusions, concussions, dislocations, compressions, and transections may show up later. The consequent discovery of the symptoms of central spinal cord, anterior cord, Brown-sequard, and conus medullus as well as causa equina should be immediately communicated to the physician.
Nurses for this reason must examine their patients after traumatic injury admission and not allow them to go to sleep. Nurses must check the medications for drowsiness or effect on motor neuron areas. Testing for asymmetric pain and radicular pain, however severe, should be noted on the chart. Loss of bladder control and bowel control may be common in shock and bedridden patients. Examination of natural sensory and motor reflex activity will better indicate the presence of paralysis than mere incontinence.
Nurses and attendants must review all patient symptoms for each motor deficit, sensory loss, (e.g. Pain, texture, taste, sound) or pressure or vibration that fails to register. Assessment must recur with every repositioning and 48 hour check. The spinal cord injury, or SCI, is a life changing experience for any patient and often will change a patient’s personality and challenge the patient’s family and support network.
An SCI injury will present as a sensory “deafness” that observant nurses will notice. Keep an entire rotation of CNA and mobiilty support persons on notice for these characteristics is a valid endorsement. Herniated discs and a cut cord (laterally) will evince itself in Brown-Sequard index responses such as a flinch that only includes the right maxillofacial muscles and right shoulders. Possibly there will be an attempt to stand that will display balance using muscles on the left side, left legs and left arms only.
SCI patients will orient toward close contact with the physical therapy nursing staff. Sleeping patients cannot be tested for involuntary motor control action lapses and/or paralysis. And the ability to measure the extent to which a patient has changed their SC injury status and the direction in which the change has occurred is not detectable when the patient is asleep.
Furthermore, is the patient does not awaken naturally the conditions of blood pressure, spinal cord injury, and cardiopulmonary arrest may overtake treatment of spinal cord shock episodes. Careful charting must accompany every station’s monitoring of this patient.
The spinal cord conditions must be addressed in concert with other more dramatic organ failures, skin wounds and possible bone breakage. An evaluation by the therapist must occur every so often.
The respiratory system may survey the initial incident but they may become during the recovery phase. The nursing attendants must take careful notes about the extent of the patients recovery if any during the rest stages. Patients will also exhibit great stress and reactions to great pain when they awaken or recover from surgical intervention. Nurses should calm the patient and only allow them to be informed of as much information as the physician believes is feasible.
The nature of what information to tell patients in dramatic situations of spinal cord injury is debatable. Some schools of thought hold that nurses are bound by patient wishes and should be told of the extent to brain and spine and recovery processes at once. But some physicians believe this information can cause a stress episode to the patient that can irreversibly negate a positive outcome.
Nurses should indicate the family or spouse the seriousness of the condition and ask them how they think the patient will want to deal with the decisions regarding mechanical stabilization beyond spinal cord natural involuntary muscle and nerve control. Some patients will have a living will prepared in which they treat their plans for these situations.
However, many patients do not realize the full extent of the damage and what partial or total spinal cord injury can mean. The nerve system within the spinal cord may never fully recover from shock. Furthermore, any additional trauma to the spinal cord nerves may trigger recurrences of nerve damage or activate old contusions, lacerations, hyperinflexions, and other conditions of the SC index.
If the nurse feels that the patient does not have enough information to make an informed decision and no living will is present the physician must dictate what information they are told to get the necessary qualifying advice for further treatment. Some individual health plans will stipulate the decision to not activate artificial recovery if the patient lapses voluntary respiratory control or nervous control governing neural systems, cardiac nerves and other functions. Some patients will want every last measure taken to prevent loss of life and loss of nerve activity.