The nurse provides education about rehabilitation for a patient with a spinal cord tumor

Spinal Injuries Unit Nursing Services

Of all the rehabilitation team members, the nursing team has the greatest contact time with patients of the Spinal Injuries Unit, providing service across three shifts of each 24 hour period. The Nurse Unit Manager (NUM), the Nurse Educator (NE) and Clinical Nurse Consultant (CNC) along with a group of Clinical Nurses (12 FTE) make up the nursing management team. This team together with a large group of Registered Nurses, Enrolled Nurses and Assistants in Nursing are responsible for facilitating the development of self care and independence within the patient group. Working in collaboration with the interdisciplinary team, nurses encourage the patient and their significant others to see possibilities, explore opportunities and assist patients to work towards their rehabilitation goals.

The nurses’ everyday role includes assisting patients with hygiene and personal cares; medication administration and education; positioning and skin care management as well as bladder and bowel management following a person’s injury.

To best assist the patient, nurses are divided into the four rehabilitation teams. Within these rehabilitation teams, smaller groups of nurses are allocated to assist with discharge planning and targeted education on managing the patient’s spinal cord injury.

The nursing team are the coordinators of “The Living with Spinal Cord Injuries” patient education series, which is offered on a weekly basis to inpatients and their families. Spinal Injuries Unit nurses promote self-determination and maximise education opportunities for patients. The Spinal Injuries Unit nurse enhances the patient’s potential for reintegration into roles in the community and assists the patient and their significant others with lifestyle adjustments.

Diagnosis

In the emergency room, a doctor may be able to rule out a spinal cord injury by examination, testing for sensory function and movement, and by asking some questions about the accident.

But if the injured person complains of neck pain, isn't fully awake, or has obvious signs of weakness or neurological injury, emergency diagnostic tests may be needed.

These tests can include:

X-rays. X-rays can reveal vertebral (spinal column) problems, tumors, fractures or degenerative changes in the spine.
CT scan. A CT scan can provide a clearer image of abnormalities seen on X-ray. This scan uses computers to form a series of cross-sectional images that can define bone, disk and other problems.
MRI. MRI uses a strong magnetic field and radio waves to produce computer-generated images. This test is helpful for looking at the spinal cord and identifying herniated disks, blood clots or other masses that might compress the spinal cord.

A few days after injury, when some of the swelling might have subsided, your doctor will conduct a more comprehensive neurological exam to determine the level and completeness of your injury. This involves testing your muscle strength and your ability to sense light touch and pinprick sensations.

Treatment

Unfortunately, there's no way to reverse damage to the spinal cord. But researchers are continually working on new treatments, including prostheses and medications, that might promote nerve cell regeneration or improve the function of the nerves that remain after a spinal cord injury.

In the meantime, spinal cord injury treatment focuses on preventing further injury and empowering people with a spinal cord injury to return to an active and productive life.

Emergency actions

Urgent medical attention is critical to minimize the effects of head or neck trauma. Therefore, treatment for a spinal cord injury often begins at the accident scene.

Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they use during transport to the hospital.

Early (acute) stages of treatment

In the emergency room, doctors focus on:

Maintaining your ability to breathe
Preventing shock
Immobilizing your neck to prevent further spinal cord damage
Avoiding possible complications, such as stool or urine retention, respiratory or cardiovascular difficulty, and formation of deep vein blood clots in the extremities

If you have a spinal cord injury, you'll usually be admitted to the intensive care unit for treatment. You might be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury.

Medications. Methylprednisolone (Solu-Medrol) given through a vein in the arm (IV) has been used as a treatment option for an acute spinal cord injury in the past. But recent research has shown that the potential side effects, such as blood clots and pneumonia, from using this medication outweigh the benefits.
Because of this, methylprednisolone is no longer recommended for routine use after a spinal cord injury.
Immobilization. You might need traction to stabilize or align your spine. Options include soft neck collars and various braces.
Surgery. Often surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery might also be needed to stabilize the spine to prevent future pain or deformity.
Experimental treatments. Scientists are trying to figure out ways to stop cell death, control inflammation and promote nerve regeneration. For example, lowering body temperature significantly — a condition known as hypothermia — for 24 to 48 hours might help prevent damaging inflammation. More study is needed.

Ongoing care

After the initial injury or condition stabilizes, doctors turn their attention to preventing secondary problems that may arise, such as deconditioning, muscle contractures, pressure ulcers, bowel and bladder issues, respiratory infections, and blood clots.

The length of your hospital stay will depend on your condition and the medical issues you face. Once you're well enough to participate in therapies and treatment, you might transfer to a rehabilitation facility.

Rehabilitation

Rehabilitation team members will begin to work with you while you're in the early stages of recovery. Your team might include a physical therapist, an occupational therapist, a rehabilitation nurse, a rehabilitation psychologist, a social worker, a dietitian, a recreation therapist, and a doctor who specializes in physical medicine (physiatrist) or spinal cord injuries.

During the initial stages of rehabilitation, therapists usually emphasize maintaining and strengthening muscle function, redeveloping fine motor skills, and learning ways to adapt to do day-to-day tasks.

You'll be educated on the effects of a spinal cord injury and how to prevent complications, and you'll be given advice on rebuilding your life and increasing your quality of life and independence.

You'll be taught many new skills, and you'll use equipment and technologies that can help you live on your own as much as possible. You'll be encouraged to resume your favorite hobbies, participate in social and fitness activities, and return to school or the workplace.

Medications

Medications might be used to manage some of the effects of spinal cord injury. These include medications to control pain and muscle spasticity, as well as medications that can improve bladder control, bowel control and sexual functioning.

New technologies

Inventive medical devices can help people with a spinal cord injury become more independent and more mobile. These include:

Modern wheelchairs. Improved, lighter weight wheelchairs are making people with spinal cord injuries more mobile and more comfortable. Some people need an electric wheelchair. Some wheelchairs can even climb stairs, travel over rough ground and elevate a user to reach high places without help.
Computer adaptations. For someone who has limited hand function, computers can be difficult to operate. Computer adaptations range from simple to complex, such as key guards and voice recognition.
Electronic aids to daily living. Essentially any device that uses electricity can be controlled with an electronic aid to daily living. Devices can be turned on or off by switch or voice-controlled and computer-based remotes.
Electrical stimulation devices. Often called functional electrical stimulation systems, these sophisticated devices use electrical stimulators to control arm and leg muscles to allow people with spinal cord injuries to stand, walk, reach and grip.

Prognosis and recovery

Your doctor might not be able to give you a prognosis right away. Recovery, if it occurs, usually relates to the severity and level of the injury. The fastest rate of recovery is often seen in the first six months, but some people make small improvements for up to 1 to 2 years.

More Information

Spinal cord injury care at Mayo Clinic
Assistive technology for spinal cord injury
Diaphragm pacing for spinal cord injury
Functional electrical stimulation for spinal cord injury
Locomotor training for spinal cord injury
Neurogenic bladder and bowel management
Sexuality and fertility management after spinal cord injury
Spinal cord injury rehabilitation
Upper extremity functional restoration for spinal cord injury

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Coping and support

An accident that results in paralysis is a life-changing event. Suddenly having a disability can be frightening and confusing, and adapting is no easy task. You'll likely wonder how your spinal cord injury will affect your everyday activities, job, relationships and long-term happiness.

Recovery takes time, but many people who are paralyzed progress to lead productive and fulfilling lives. It's essential to stay motivated and get the support you need.

Grieving

If you're newly injured, you and your family will likely experience a period of mourning. The grieving process, which is a normal, healthy part of your recovery, is different for everyone.

It's natural — and important — to grieve the loss of the way you were. But it's also necessary to set new goals and find ways to go forward.

You'll probably have concerns about how your injury will affect your lifestyle, your financial situation and your relationships. Grieving and emotional stress are normal and common.

However, if your grief is affecting your care, causing you to isolate yourself or prompting you to abuse alcohol or other drugs, you might want to talk to a social worker, psychologist or psychiatrist. Or you might find it helpful to join a support group of people with spinal cord injuries.

Talking with others who understand what you're going through can be encouraging, and you might find good advice on adapting areas of your home or work space to better meet your needs. Ask your doctor or rehabilitation specialist if there are support groups in your area.

Taking control

One of the best ways to regain control of your life is to educate yourself about your injury and your options for gaining more independence. A range of driving equipment and vehicle modifications is available today.

The same is true of home modification products. Ramps, wider doors, special sinks, grab bars and easy-to-turn doorknobs make it possible for you to live more autonomously.

The costs of a spinal cord injury can be overwhelming, but you might be eligible for economic assistance or support services from the state or federal government or from charitable organizations. Your rehabilitation team can help you identify resources in your area.

Talking about your disability

Some friends and family members might be unsure about how to act around you. Being educated about your spinal cord injury and willing to educate others can benefit all of you.

Explain the effects of your injury and what others can do to help. But don't hesitate to tell friends and loved ones when they're helping too much. Although it may be uncomfortable at first, talking about your injury can strengthen your relationships with family and friends.

Dealing with intimacy, sexuality and sexual activity

Your spinal cord injury might affect your body's sexual responsiveness. However, you're a sexual being with sexual desires. A fulfilling emotional and physical relationship is possible but requires communication, experimentation and patience.

A professional counselor can help you and your partner communicate your needs and feelings. Your doctor can provide the medical information you need regarding sexual health. You can have a satisfying future complete with intimacy and sexual pleasure.

Looking ahead

As you learn more about your injury and treatment options, you might be surprised by all you can do. Thanks to new technologies, treatments and devices, people with spinal cord injuries play basketball and participate in track meets. They paint and take photographs. They get married, have and raise children, and have rewarding jobs.

Advances in stem cell research and nerve cell regeneration give hope for greater recovery for people with spinal cord injuries. And new treatments are being investigated for people with long-standing spinal cord injuries.

No one knows when new treatments will be available, but you can remain hopeful about the future of spinal cord research while living your life to the fullest today.

Preparing for your appointment

Traumatic spinal cord injuries are emergencies, and people who are injured might not be able to participate in their care at first.

A number of specialists will be involved in stabilizing the condition, including a doctor who specializes in nervous system disorders (neurologist) and a surgeon who specializes in spinal cord injuries and other nervous system problems (neurosurgeon), among others.

A doctor who specializes in spinal cord injuries will lead your rehabilitation team, which will include a variety of specialists.

If you have a possible spinal cord injury or you accompany someone who's had a spinal cord injury and can't provide the necessary information, here are some things you can do.

What you can do

Be prepared to provide information about the circumstances of the event that caused the injury, including any that may seem unrelated.
Have another family member or friend join you when you speak with the doctors, if possible. Someone who accompanies you can help you remember the information you're given and communicate them to the person with the injury when appropriate.
Write down questions to ask the doctors.

For a spinal cord injury, some basic questions to ask the doctor include:

What's the prognosis?
What will happen in the short term? What will happen over the long term? What treatments are available, and which do you recommend?
Could surgery help?
What type of rehabilitation might help?
What research is being done to help this condition?
Do you have brochures or other printed material? What websites do you recommend?

Don't hesitate to ask other questions you have.

What to expect from the doctor

Your doctor is likely to ask questions, including:

What were the circumstances that led to your injury?
When did it occur?
What do you do for work and leisure?
With whom do you live?
Tell me about your housing situation (home, apartment, number of stairs)?
Do you or anyone in your family have a history of blood clots?
Do you have any other medical conditions?

Oct. 02, 2021

Which manifestations in a patient with AT for spinal cord injury should alert the nurse to the possibility of autonomic dysreflexia?

Symptoms of Autonomic Dysreflexia Pounding headache. Sweating above the level of your injury. Red, blotchy skin above the level of your injury. Goose bumps.

What is the main focus of nursing care for the patient with trigeminal neuralgia?

Treatment is aimed at relieving the pain and improving the client's quality of life. The medications of choice to treat trigeminal neuralgia include antiseizure medications like carbamazepine; while alternative options include phenytoin, gabapentin, and baclofen.

Which assessment does the nurse perform first in the patient with Dysreflexia?

The FIRST action the nurse should take when AD is suspected is to position the patient at 90 degree (high Fowler's) and lower the legs. This will allow gravity to cause the blood to pool in the lower extremities and help decrease the blood pressure.

Which instruction would the nurse give the patient to assess the trigeminal nerve?

Cranial Nerve V – Trigeminal Ask the patient to close their eyes, and then use a wisp from a cotton ball to lightly touch their face, forehead, and chin. Instruct the patient to say ”Now” every time they feel the placement of the cotton wisp. See Figure 6.16 for an image of assessing trigeminal sensory function.