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12 Spinal Cord Injury Nursing Care Plans

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By Matt Vera BSN, R.N.

Use this nursing care plan and management guide to help care for patients with spinal cord injury (SCI). Enhance your understanding of nursing assessment, interventions, goals, and nursing diagnosis, all specifically tailored to address the unique needs of individuals facing spinal cord injury. This guide equips you with the necessary information to provide effective and specialized care to patients dealing with spinal cord injuries.

Table of Contents

What is Spinal Cord Injury?

A spinal cord injury (SCI) is damage to any part of the spinal cord or nerves at the end of the spinal canal. The condition often causes permanent changes in strength, sensation, and other body functions below the site of the injury.

Motor vehicle accidents, acts of violence, and sporting injuries are the common causes of spinal cord injury (SCI). The mechanism of injury influences the type of SCI and the degree of neurological deficit. Spinal cord lesions are classified as a complete (total loss of sensation and voluntary motor function) or incomplete (mixed loss of sensation and voluntary motor function).

Physical findings vary, depending on the level of injury, degree of spinal shock, and phase and degree of recovery, but in general, are classified as follows:

  • C-1 to C-3: Tetraplegia with total loss of muscular/respiratory function.
  • C-4 to C-5: Tetraplegia with impairment, reduced pulmonary capacity, complete dependency for ADLs.
  • C-6 to C-7: Tetraplegia with some arm/hand movement allowing some independence in ADLs.
  • C-7 to T-1: Tetraplegia with limited use of thumb/fingers, increasing independence.
  • T-2 to L-1: Paraplegia with intact arm function and varying function of intercostal and abdominal muscles.
  • L-1 to L-2 or below Mixed motor-sensory loss; bowel and bladder dysfunction.

Nursing Care Plans & Management

Nursing care planning and goals for patients with spinal cord injuries include: maximizing respiratory function, preventing injury to the spinal cord, promoting mobility and/or independence, preventing or minimizing complications, supporting the psychological adjustment of patient and/or SO, providing information about the injury, prognosis, and treatment, and facilitating the patient’s transition to home or a supportive care setting.

Nursing Problem Priorities

The following are the nursing priorities for patients with spinal cord injuries:

  1. Ensure airway, breathing, and circulation stability.
  2. Prevent complications such as pressure ulcers, urinary tract infections, and respiratory infections.
  3. Provide pain management and optimize comfort.
  4. Facilitate rehabilitation and mobility interventions to maximize independence.
  5. Address psychosocial needs and promote emotional well-being.
  6. Educate the patient and their caregivers about self-care, adaptive techniques, and prevention of secondary complications.
  7. Coordinate interdisciplinary care and facilitate a smooth transition to home or a supportive care setting.

Nursing Assessment

Assess for the following subjective and objective data:

  • Reports of pain, numbness, or tingling sensation
  • Complaints of loss of sensation or motor function in limbs
  • Descriptions of difficulty with bladder or bowel control
  • Expressions of emotional distress, such as feelings of frustration, sadness, or anxiety
  • Statements about changes in sexual function or fertility concerns
  • Loss of sensation or altered sensation below the level of injury
  • Loss of motor function or weakness in the limbs
  • Difficulty or inability to move or control limbs
  • Spasticity or exaggerated reflexes
  • Changes in bladder or bowel control, such as urinary or fecal incontinence
  • Respiratory difficulties, including shortness of breath or difficulty breathing
  • Pain or intense pressure in the neck, back, or head
  • Numbness or tingling in the extremities
  • Difficulty maintaining balance or coordination
  • Sexual dysfunction or changes in sexual function
  • Changes in blood pressure or heart rate
  • Autonomic dysreflexia, characterized by a sudden increase in blood pressure accompanied by severe headache, sweating, and flushing

Assess for factors related to the cause of spinal cord injury:

  • Impairment of innervation of the diaphragm (lesions at or above C-5)
  • Complete or mixed loss of intercostal muscle function
  • Reflex abdominal spasms; gastric distension
  • Temporary weakness/instability of the spinal column
  • Neuromuscular impairment
  • Immobilization by traction

Nursing Diagnosis

A nursing diagnosis follows a standardized approach in identifying, prioritizing, and addressing specific client needs and responses to actual and high-risk problems. These diagnoses encompass actual or potential health problems that can be effectively managed or prevented through independent nursing interventions. After conducting a thorough assessment, it is crucial to formulate nursing diagnoses that comprehensively reflect the patient’s existing and potential health concerns. These diagnoses then serve as a guiding framework for developing and implementing focused nursing interventions.

Nursing Goals

Goals and expected outcomes may include:

  • The patient will maintain adequate ventilation as evidenced by the absence of respiratory distress and ABGs within acceptable limits.
  • The patient will demonstrate appropriate behaviors to support the respiratory effort.
  • The patient will maintain proper alignment of the spine without further spinal cord damage.
  • The patient will maintain a position of function as evidenced by the absence of contractures and foot drop.
  • The patient will increase the strength of unaffected/compensatory body parts.
  • The patient will demonstrate techniques/behaviors that enable the resumption of activity.
  • The patient will identify behaviors to compensate for deficits.
  • The patient will verbalize awareness of sensory needs and the potential for deprivation/overload.
  • The patient will report relief or control of pain/discomfort.
  • The patient will identify ways to manage pain.
  • The patient will demonstrate the use of relaxation skills and diversional activities as individually indicated.
  • The patient will maintain balanced I&O with clear, odor-free urine, free of bladder distension/urinary leakage.
  • The patient will verbalize/demonstrate behaviors and techniques to prevent retention/urinary infection.
  • The patient will participate in the level of ability to prevent skin breakdown.
  • The patient will verbalize behaviors/techniques for individual bowel programs.
  • The patient will reestablish a satisfactory bowel elimination pattern.
  • The patient will recognize signs/symptoms of the syndrome.
  • The patient will identify preventive/corrective measures.
  • The patient will not experience episodes of dysreflexia.
  • The patient will begin to progress through recognized stages of grief, focusing on 1 day at a time.
  • The patient will verbalize acceptance of self in the situation.
  • The patient will recognize and incorporate changes into self-concept in an accurate manner without negating self-esteem.
  • The patient will develop realistic plans for adapting to new role/role changes.
  • The patient will verbalize understanding of the condition, prognosis, and treatment.
  • The patient will correctly perform necessary procedures and explain the reasons for the actions.
  • The patient will initiate necessary lifestyle changes and participate in the treatment regimen.

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients with spinal cord injury may include:

1. Promoting Effective Breathing Pattern

Spinal cord injury can disrupt the normal functioning of the respiratory system, leading to ineffective breathing patterns. This can result in reduced oxygenation and ventilation, as well as an increased risk of complications such as pneumonia. Improving breathing can be achieved by optimizing respiratory support, such as ensuring a patent airway, providing mechanical ventilation if necessary, and implementing strategies for respiratory muscle training and breathing exercises.

Assess respiratory function by asking the patient to take a deep breath. Note the presence or absence of spontaneous effort and quality of respirations (labored, using accessory muscles).
C-1 to C-3 injuries result in complete loss of respiratory function. Injuries at C-4 or C-5 can lead to variable loss of respiratory function, depending on phrenic nerve involvement and diaphragmatic function, but generally cause decreased vital capacity and inspiratory effort. For injuries below C-6 or C-7, respiratory muscle function is preserved; however, weakness or impairment of intercostal muscles may impair the effectiveness of cough and the ability to sigh, and deep breathe.

Auscultate breath sounds. Note areas of absent or decreased breath sounds or development of adventitious sounds (rhonchi).
Hypoventilation is common and leads to the accumulation of secretions, atelectasis, and pneumonia (frequent complications). Note: Respiratory compromise is one of the leading causes of mortality, especially during the acute stage as well as later in life.

Note the strength or effectiveness of the cough.
The level of injury determines the function of intercostal muscles and the ability to cough spontaneously or move secretions.

Observe skin color for developing cyanosis, and duskiness.
This may reveal impending respiratory failure, and a need for immediate medical evaluation and intervention.

Assess for abdominal distension and muscle spasm.
Abdominal fullness may impede diaphragmatic excursion, reducing lung expansion and further compromising respiratory function.

Monitor and limit visitors as indicated.
General debilitation and respiratory compromise place patients at increased risk for acquiring URIs.

Monitor diaphragmatic movement when the phrenic pacemaker is implanted.
Stimulation of the phrenic nerve may enhance respiratory effort, decreasing dependency on the mechanical ventilator.

Measure or graph vital capacity (VC), tidal volume (VT), inspiratory force, serial ABGs, and pulse oximetry.
See Laboratory and Diagnostic Procedures

Elicit concerns and questions regarding mechanical ventilation devices.
Acknowledges the reality of the situation.

Provide honest answers.
Future respiratory function needs will not be totally known until spinal shock resolves and the acute rehabilitative phase is completed. Even though respiratory support may be required, alternative devices and techniques may be used to enhance mobility and promote independence.

Maintain patent airway: keep head in a neutral position, elevate the head of the bed slightly if tolerated, and use airway adjuncts as indicated.
Patients with high cervical injury and impaired gag and cough reflexes require assistance in preventing aspiration and maintaining the patient’s airway.

Assist the patient in “taking control” of respirations as indicated. Instruct in and encourage deep breathing, focusing attention on the steps of breathing.
Breathing may no longer be a totally voluntary activity but require conscious effort, depending on the level of injury and involvement of respiratory muscles.

Assist with coughing as indicated for the level of injury (have the patient take a deep breath and hold for 2 sec before coughing, or inhale deeply, then cough at the end of a slow exhalation). Alternatively, assist by placing hands below the diaphragm and pushing upward as the patient exhales (quad cough).
Adds volume to cough and facilitates expectoration of secretions or helps move them high enough to be suctioned out. Note: Quad cough procedure is generally reserved for patients with stable injuries once they are in the rehabilitation stage.

Suction as necessary. Document the quality and quantity of secretions.
If the cough is ineffective, suctioning may be needed to remove secretions, enhance gas exchange, and reduce the risk of respiratory infections. Note: “Routine” suctioning increases the risk of hypoxia, bradycardia (vagal response), and tissue trauma. Therefore, suctioning needs are based on the inability to move secretions.

Reposition and turn periodically. Avoid and limit prone position when indicated.
Enhances ventilation of all lung segments, and mobilizes secretions, reducing the risk of complications such as atelectasis and pneumonia. Note: Prone position significantly decreases vital capacity, increasing the risk of respiratory compromise and failure.

Encourage fluids (at least 2000 mL per day).
Aids in liquefying secretions, promoting mobilization and expectoration.

Administer oxygen by an appropriate method (nasal prongs, mask, intubation, ventilator).
The method is determined by the level of injury, degree of respiratory insufficiency, and amount of recovery of respiratory muscle function after the spinal shock phase.

Assist with the use of respiratory adjuncts (incentive spirometer, blow bottles) and aggressive chest physiotherapy (chest percussion).
Preventing retained secretions is essential to maximize gas diffusion and reduce the risk of pneumonia.

Refer and consult with respiratory and physical therapists.
Helpful in identifying exercises individually appropriate to stimulate and strengthen respiratory muscles and effort. For example, glossopharyngeal breathing uses muscles of the mouth, pharynx, and larynx to swallow air into the lungs, thereby enhancing VC and chest expansion.

2. Improving Physical Mobility

Spinal cord injury can lead to impaired physical mobility due to the disruption of motor function and sensation. Depending on the level and severity of the injury, patients may experience varying degrees of paralysis, muscle weakness, and loss of sensation. This can significantly impact their ability to perform daily activities and require careful monitoring, interventions, and assistive devices to promote optimal physical mobility and prevent further complications.

Continually assess motor function (as spinal shock or edema resolves) by requesting the patient to perform certain actions such as shrugging the shoulders, spreading fingers, squeezing, release the examiner’s hands.
Evaluates the status of the individual situation (motor-sensory impairment may be mixed or not clear) for a specific level of injury, affecting the type and choice of interventions.

Measure and monitor BP before and after activity in acute phases or until stable. Change position slowly. Use a cardiac bed or tilt table and CircOlectric bed as the activity level is advanced.
Orthostatic hypotension may occur as a result of venous pooling (secondary to loss of vascular tone). Side-to-side movement or elevation of the head can aggravate hypotension and cause syncope.

Inspect skin daily. Observe pressure areas, and provide meticulous skin care. Teach the patient to inspect skin surfaces and to use a mirror to look at hard-to-see areas.
Altered circulation, loss of sensation, and paralysis potentiate pressure sore formation. This is a lifelong consideration.

Investigate sudden onset of dyspnea, cyanosis, and other signs of respiratory distress.
Development of pulmonary emboli may be “silent” because pain perception is altered and DVT is not readily recognized.

Assess for redness, swelling, and muscle tension of calf tissues. Record calf and thigh measurements if indicated.
In a high percentage of patients with cervical cord injury, thrombi develop because of altered peripheral circulation, immobilization, and flaccid paralysis. Risk is greatest during the 2 wk immediately following injury and on through the next 3 mo.

Provide means to summon help (special sensitive call light).
Enables patient to have a sense of control, and reduces fear of being left alone. Note:  Quadriplegic on ventilator requires continuous observation in early management.

Perform and assist with full ROM exercises on all extremities and joints, using slow, smooth movements. Hyperextend hips periodically.
Enhances circulation, restores and maintains muscle tone and joint mobility, and prevents disuse contractures and muscle atrophy.

Position arms at a 90-degree angle at regular intervals.
Prevents frozen shoulder contractures.

Maintain ankles at 90 degrees with a footboard, high-top tennis shoes, and so on. Place trochanter rolls along thighs when in bed.
Prevents footdrop and external rotation of hips.

Elevate lower extremities at intervals when in a chair, or raise the foot of the bed when permitted in the individual situation. Assess for edema of feet and ankles.
Loss of vascular tone and “muscle action” results in the pooling of blood and venous stasis in the lower abdomen and lower extremities, with an increased risk of hypotension and thrombus formation.

Plan activities to provide uninterrupted rest periods. Encourage involvement within individual tolerance and ability.
Prevents fatigue, allowing the opportunity for maximal efforts and participation by the patient.

Reposition periodically even when sitting in a chair. Teach the patient how to use weight-shifting techniques.
Reduces pressure areas, and promotes peripheral circulation.

Prepare for weight-bearing activities like the use of a tilt table for an upright position, and strengthening and conditioning exercises for unaffected body parts.
Early weight bearing reduces osteoporotic changes in long bones and reduces the incidence of urinary infections and kidney stones. Note: Fifty percent of patients develop heterotopic ossification that can lead to pain and decreased joint flexibility

Encourage the use of relaxation techniques.
Reduces muscle tension and fatigue, and may help limit the pain of muscle spasms and spasticity.

Assist and encourage pulmonary hygiene like deep breathing, coughing, and suctioning.
Immobility and bedrest increase the risk of pulmonary infection.

Place the patient in a kinetic therapy bed when appropriate.
Effectively immobilizes unstable spinal columns and improves systemic circulation, which is thought to decrease complications associated with immobility.

Apply an anti-embolic hose or leotard or sequential compression devices (SCDs) to the legs as appropriate.
Limits pooling of blood in lower extremities or abdomen, thus improving vasomotor tone and reducing the incidence of thrombus formation and pulmonary emboli.

Administer muscle relaxants and antispasticity agents as indicated.
See Pharmacologic Management

Consult with physical and occupational therapists and the rehabilitation team.
Helpful in planning and implementing individualized exercise programs and identifying or developing assistive devices to maintain function, and enhance mobility and independence.

3. Promoting Safety and Preventing Trauma and Injury

Patients with spinal cord injury are at increased risk for trauma due to impaired motor function and sensation. The inability to move or feel certain body parts can lead to accidental injuries such as falls, pressure ulcers, and burns. Spinal cord injury can also cause disturbed sensory perception due to the disruption of sensory pathways. This can result in a range of sensory deficits, including numbness, tingling, and loss of sensation. Patients may also experience alterations in proprioception and kinesthesia, which can affect the ability to perceive the position and movement of their limbs.

Check weights for ordered traction pull (usually 10–20 lb).
Weight pull depends on the patient’s size and the amount of reduction needed to maintain vertebral column alignment.

Check the external stabilization device (Gardner-Wells tongs or skeletal traction apparatus).
These devices are used for the decompression of spinal fractures and stabilization of the vertebral column during the early acute phase of injury to prevent further spinal cord injury.

Elevate the head of the traction frame or bed as indicated. Ensure that traction frames are secure, pulleys aligned, and weights hanging free.
Creates safe, effective counterbalance to maintain both patient’s position and traction pull.

Maintain bed rest and immobilization devices (s) such as sandbags, traction, halo, hard or soft cervical collars, and brace.
Body rest prevents vertebral column instability and aids healing. Note: Traction is used only for cervical spine stabilization.

Reposition at intervals, using adjuncts for turning and support (turn sheets, foam wedges, blanket rolls, pillows). Get at least three staff members when turning and logrolling patients. Follow special instructions for traction equipment, kinetic bed, and frames once the halo is in place.
Maintains proper spinal column alignment, reducing the risk of further trauma. Note: Grasping the brace and halo vest to turn or reposition the patient may cause additional injury.

Assist with preparation and maintain skeletal traction via tongs, calipers, halo, or vest, as indicated.
Reduces vertebral fracture and dislocation.

Prepare for internal stabilization surgery (spinal laminectomy or fusion) if indicated.
Surgery may be indicated for spinal stabilization and cord decompression or removal of bony fragments.

Assess and document sensory function or deficit (by means of touch, pinprick, hot or cold, etc.), progressing from the area of deficit to a neurologically intact area.
Changes may not occur during the acute phase, but as spinal shock resolves, changes should be documented by dermatome charts or anatomical landmarks (“2 in above nipple line”).

Note the presence of exaggerated emotional responses, and altered thought processes (disorientation, bizarre thinking).
Indicative of damage to sensory tracts and psychological stress, requiring further assessment and intervention.

Protect from bodily harm (falls, burns, positioning of arm or objects).
The patient may not sense pain or be aware of body position.

Assist the patient to recognize and compensate for alterations in sensation.
May help reduce the anxiety of the unknown and prevent injury.

Explain procedures before and during care, identifying the body part involved.
Enhances patient perception of the “whole” body.

Provide tactile stimulation, touching the patient in intact sensory areas (shoulders, face, head).
Touching conveys caring and fulfills a normal physiological and psychological need.

Position the patient to see surroundings and activities. Provide prism glasses when prone on the turning frame. Talk to patients frequently.
Provides sensory input, which may be severely limited, especially when the patient is in a prone position.

Provide diversional activities (television, radio, music, liberal visitation). Use clocks, calendars, pictures, bulletin boards, and so on. Encourage SO and family to discuss general and personal news.
Aids in maintaining reality orientation and provides some sense of normality in the daily passage of time.

Provide uninterrupted sleep and rest periods.
Reduces sensory overload, enhances orientation and coping abilities, and aids in reestablishing natural sleep patterns.

4. Managing and Relieving Acute Pain

Spinal cord injury can cause acute pain due to the trauma and tissue damage that occurs during the injury. Managing and relieving pain in patients with spinal cord injury involves a multimodal approach, including pharmacological interventions (such as analgesics and neuropathic pain medications), non-pharmacological techniques (such as physical therapy, heat/cold therapy, and transcutaneous electrical nerve stimulation), and addressing any underlying causes or contributing factors to the pain.

Assess for the presence of pain. Help the patient identify and quantify pain (location, type of pain, intensity on a scale of 0–10).
The patient usually reports pain above the level of injury such as the chest and back or headache possibly from the stabilizer apparatus. After the spinal shock phase, the patient may also report muscle spasms and radicular pain, described as a burning or stabbing pain (associated with injury to peripheral nerves and radiating in a dermatomal pattern). The onset of this pain is within days to weeks after SCI and may become chronic.

Evaluate increased irritability, muscle tension, restlessness, and unexplained vital sign (VS) changes.
Nonverbal cues are indicative of pain and discomfort requiring intervention.

Assist the patient in identifying precipitating factors.
Burning pain and muscle spasms can be precipitated and aggravated by multiple factors (anxiety, tension, external temperature extremes, sitting for long periods, bladder distension).

Provide comfort measures (position changes, massage, ROM exercises, warm or cold packs, as indicated).
Alternative measures for pain control are desirable for emotional benefit, in addition to reducing pain medication needs and undesirable effects on respiratory function.

Encourage the use of relaxation techniques (guided imagery, visualization, deep-breathing exercises). Provide diversional activities (television, radio, telephone, unlimited visitors) as appropriate.
Refocuses attention, promotes a sense of control, and may enhance coping abilities.

Administer medications as indicated: muscle relaxants: dantrolene (Dantrium), baclofen (Lioresal); analgesics; antianxiety agents: diazepam (Valium).
May be desired to relieve muscle spasms and pain associated with spasticity or to alleviate anxiety and promote rest. See Pharmacologic Management

5. Promoting Effective Urinary Elimination

Promoting effective urinary elimination for patients with spinal cord injury involves implementing a regular bladder management program, which may include techniques such as intermittent catheterization, timed voiding, or the use of an indwelling catheter, while maintaining adequate fluid intake and addressing any bladder dysfunction through medication or other interventions to optimize bladder function and prevent urinary retention or incontinence.

Assess the voiding pattern (frequency and amount). Compare urine output with fluid intake. Note specific gravity.
Identifies characteristics of bladder function (effectiveness of bladder emptying, renal function, and fluid balance). Note: Urinary complications are a major cause of mortality.

Palpate for bladder distension and observe for overflow.
Bladder dysfunction is variable but may include loss of bladder contraction and inability to relax the urinary sphincter, resulting in urine retention and reflux incontinence. Note: Bladder distension can precipitate autonomic dysreflexia.

Observe for cloudy or bloody urine and foul odor. Dipstick urine as indicated.
Signs of the urinary tract or kidney infection that can potentiate sepsis. Multistrip dipsticks can provide a quick determination of pH, nitrite, and leukocyte esterase suggesting the presence of infection.

Encourage intake (2–4 L per day), including acid ash juices (cranberry).
Helps maintain renal function, and prevents infection and the formation of urinary stones. Note: Fluid may be restricted for a period during the initiation of intermittent catheterization.

Begin bladder retraining per protocol when appropriate (fluids between certain hours, digital stimulation of trigger area, contraction of abdominal muscles, Credé’s maneuver).
Timing and type of bladder program depend on the type of injury (upper or lower neuron involvement). Note: Credé’s maneuver should be used with caution because it may precipitate autonomic dysreflexia.

Cleanse the perineal area and keep it dry. Provide catheter care as appropriate.
Decreases risk of skin irritation or breakdown and development of ascending infection.

Urinary Catheterization:

  • Monitor BUN, creatinine, and white blood cell (WBC) count.
    Reflects renal function, and identifies complications.
  • Administer medications as indicated such as vitamin C, or urinary antiseptics like methenamine mandelate (Mandelamine).
    Maintains an acidic environment and discourages bacterial growth.
  • Refer for further evaluation for bladder and bowel stimulation.
    Clinical research is being conducted on the technology of electronic bladder control. The implantable device sends electrical signals to the spinal nerves that control the bladder and bowel. Early results look promising.
  • Keep the bladder deflated by means of an indwelling catheter initially. Begin intermittent catheterization program when appropriate.
    An indwelling catheter is used during the acute phase for the prevention of urinary retention and for monitoring output. Intermittent catheterization may be implemented to reduce complications usually associated with the long-term use of indwelling catheters. A suprapubic catheter may also be inserted for long-term management.

Measure residual urine via postvoid catheterization or ultrasound.
Helpful in detecting the presence of urinary retention and the effectiveness of bladder training programs. Note: The use of ultrasound is noninvasive, reducing the risk of colonization of the bladder.

6. Wound Care and Maintaining Skin Integrity

Wound care and maintaining skin integrity are part of the care for patients with spinal cord injuries to prevent the development of pressure ulcers, which are common complications. Regular assessment of skin, frequent repositioning to relieve pressure, proper hygiene, adequate nutrition, and the use of pressure-relieving devices are essential in preventing and managing wounds, while specialized dressings, topical treatments, and collaboration with wound care specialists may be necessary for effective wound healing.

Inspect all skin areas, noting capillary blanching and refill, redness, and swelling. Pay particular attention to the back of the head, the skin under the halo frame or vest, and folds where skin continuously touches.
Skin is especially prone to breakdown because of changes in peripheral circulation, inability to sense pressure, immobility, and altered temperature regulation.

Observe halo and tong insertion sites. Note swelling, redness, and drainage.
These sites are prone to inflammation and infection and provide a route for pathological microorganisms to enter the cranial cavity. Note: New style of halo frame does not require screws or pins.

Encourage continuation of regular exercise program.
Stimulates circulation, enhancing cellular nutrition and oxygenation to improve tissue health.

Elevate lower extremities periodically, if tolerated.
Enhances venous return. Reduces edema formation.

Avoid and limit injection of medication below the level of injury.
Reduced circulation and sensation increase the risk of delayed absorption, local reaction, and tissue necrosis.

Massage and lubricate the skin with bland lotion or oil. Protect pressure points by use of heel or elbow pads, lamb’s wool, foam padding, and egg-crate mattress. Use skin hardening agents (tincture of benzoin, Karaya, Sween cream).
Enhances circulation and protects skin surfaces, reducing the risk of ulceration. Tetraplegic and paraplegic patients require lifelong protection from decubitus formation, which can cause extensive tissue necrosis and sepsis.

Reposition frequently, whether in bed or in a sitting position. Place in a prone position periodically.
Improves skin circulation and reduces pressure time on bony prominences.

Wash and dry skin, especially in high-moisture areas such as the perineum. Take care to avoid wetting the lining of the brace or halo vest.
Clean, dry skin is less prone to excoriation and breakdown.

Keep bedclothes dry and free of wrinkles, and crumbs.
Reduces or prevents skin irritation.

Cleanse halo or tong insertion sites routinely and apply antibiotic ointment per protocol.
Helpful in preventing local infection and reducing the risk of cranial infection.

Provide kinetic therapy or an alternating-pressure mattress as indicated.
Improves systemic and peripheral circulation and decreases pressure on the skin, reducing the risk of breakdown.

7. Managing Constipation and Improving Bowel Function

Patients with spinal cord injury are at increased risk of constipation due to the disruption of neural pathways that control bowel function. The resulting decreased motility and altered sensory perception in the lower bowel can lead to decreased peristalsis, increased transit time, and fecal impaction. Nurses must closely monitor bowel function and implement interventions such as bowel management programs, adequate fluid and fiber intake, and proper positioning to prevent constipation and related complications.

Auscultate bowel sounds, noting location and characteristics.
Bowel sounds may be absent during the spinal shock phase. High tinkling sounds may indicate the presence of ileus.

Observe for abdominal distension if bowel sounds are decreased or absent.
Loss of peristalsis (related to impaired innervation) paralyzes the bowel, creating ileus and bowel distension. Note: Overdistension of the bowel is a precipitator of autonomic dysreflexia once spinal shock subsides.

Note reports of nausea and onset of vomiting. Check vomitus or gastric secretions (if the tube is in place) and stools for occult blood.
GI bleeding may occur in response to injury (Curling’s ulcer) or as a side effect of certain therapies (steroids or anticoagulants).

Record frequency, characteristics, and amount of stool.
Identifies degree of impairment and dysfunction and level of assistance required.

Check for the presence of impaction (no formed stool for several days, semiliquid stool, restlessness, increased feelings of fullness or distension of the abdomen).
Early intervention is necessary to effectively treat constipation and retained stool and reduce the risk of complications.

Establish a regular daily bowel program (digital stimulation, prune juice, warm beverage, and use of stool softeners and suppositories at set intervals. Determine the usual time and routine of post-injury evacuations.
A lifelong program is necessary to routinely evacuate the bowel because the ability to control bowel evacuation is important to the patient’s physical independence and social acceptance. Note: Bowel movements in patients with upper motor neuron damage are generally regulated with suppositories or digital stimulation. The lower motor neurogenic bowel is more difficult to regulate and usually requires manual disimpaction. Incorporating elements of the patient’s usual routine may enhance cooperation and the success of the program. Note: Many patients prefer the morning program rather than the evening schedule often practiced in acute and rehab settings.

Encourage a well-balanced diet that includes bulk and roughage and increased fluid intake (at least 2000 mL per day), including fruit juices.
Improves consistency of stool for transit through the bowel. Note: A mixture of prune juice, applesauce, and bran often provides adequate fiber for effective bowel management.

Assist and encourage exercise and activity within the individual ability and up in a chair as tolerated.
Improves appetite and muscle tone, enhancing GI motility.

Observe for incontinence and help the patient relate incontinence to changes in diet or routine.
Patients can eventually achieve fairly normal routine bowel habits, which enhance independence, self-esteem, and socialization.

Restrict intake of grapefruit juice and caffeinated beverages (coffee, tea, cola, chocolate).
The diuretic effect can reduce fluid available in the bowel, increasing the risk of dry and hard-formed stool.

Provide meticulous skin care.
Loss of sphincter control and innervation in the area potentiates the risk of skin irritation and breakdown.

Insert and maintain the nasogastric tube and attach it to suction if appropriate.
May be used initially to reduce gastric distension and prevent vomiting (reduces the risk of aspiration).

Insert rectal tube as needed.
Reduces bowel distension, which may precipitate autonomic responses.

Administer medications as indicated.
See Pharmacologic Management

Consult with a dietitian and nutritional support team.
Aids in creating a dietary plan to meet individual nutritional needs with consideration of the state of digestion and bowel function.

8. Recognizing and Managing Autonomic Dysreflexia

Patients with spinal cord injury are at risk of developing autonomic dysreflexia, a potentially life-threatening condition, due to the disruption of autonomic reflexes that regulate blood pressure and other bodily functions below the level of injury. Triggers for autonomic dysreflexia can include noxious stimuli such as bladder distention or bowel impaction. Early recognition and intervention are critical to prevent complications such as seizures, stroke, or cardiac arrest, and to promote better patient outcomes. Nurses must closely monitor patients with spinal cord injury for signs and symptoms of autonomic dysreflexia and implement appropriate interventions promptly.

Identify and monitor precipitating risk factors (bladder and bowel distension or manipulation; bladder spasms, stones, infection; skin/tissue pressure areas, prolonged sitting position; temperature extremes or drafts).
Visceral distention is the most common cause of autonomic dysreflexia, which is considered an emergency. Treatment of acute episodes must be carried out immediately (removing stimulus, treating unresolved symptoms), then interventions must be geared toward prevention.

Observe for signs and symptoms of a syndrome such as changes in VS, paroxysmal hypertension, tachycardia or bradycardia; autonomic responses: sweating, flushing above the level of the lesion; pallor below the injury, chills, (gooseflesh) piloerection, nasal stuffiness, severe pounding headache, especially in occiput and frontal regions. Note associated symptoms like chest pains, blurred vision, nausea, metallic taste, Horner’s syndrome (contraction of the pupil, partial stasis of eyelid, enophthalmos [recession of eyeball into the orbit], and sometimes loss of sweating over one side of the face).
Early detection and immediate intervention are essential to prevent serious consequences and complications. Note: Average systolic BP in tetraplegic patients is 120mmHg, therefore readings of 140+ may be considered high.

Monitor BP frequently (every 3–5 min) during acute autonomic dysreflexia and take action to eliminate stimulus. Continue to monitor BP at intervals after symptoms subside.
Aggressive therapy and removal of stimulus may drop BP rapidly, resulting in a hypotensive crisis, especially in those patients who routinely have low BP. In addition, autonomic dysreflexia may recur, particularly if a stimulus is not eliminated.

Obtain urinary culture as indicated.
The presence of infection may trigger autonomic dysreflexia episodes.

Stay with the patient during an episode.
This is a potentially fatal complication. Continuous monitoring and intervention may reduce the patient’s level of anxiety.

Elevate the head of the bed to a 45-degree angle or place the patient in a sitting position.
Lowers BP to prevent intracranial hemorrhage, seizures, or even death. Note: Placing a tetraplegic in a sitting position automatically lowers BP.

Eliminate causative stimulus as able such as bladder, bowel, and skin pressure (including loosening tight leg bands or clothing, removing abdominal binder or elastic stockings); temperature extremes.
Removing noxious stimulus usually terminates the episode and may prevent more serious autonomic dysreflexia (in the presence of sunburn, topical anesthetic should be applied). Removal of constrictive clothing and vascular support also promotes venous pooling to help lower BP. Note: Removal of bowel impaction must be delayed until the cardiovascular condition is stabilized.

Inform the patient and SO of warning signals and how to avoid the onset of the syndrome (gooseflesh, sweating, piloerection may indicate full bowel; sunburn may precipitate episode).
This lifelong problem can be largely controlled by avoiding pressure from overdistension of visceral organs or pressure on the skin.

Administer medications as indicated (IV, parenteral, oral, or transdermal), and monitor response.
See Pharmacologic Management

Apply local anesthetic ointment to the rectum; remove impaction if indicated after symptoms subside.
Ointment blocks further autonomic stimulation and eases later removal of impaction without aggravating symptoms.

Prepare the patient for a pelvic or pudendal nerve block or posterior rhizotomy if indicated.
Procedures may be considered if autonomic dysreflexia does not respond to other therapies.

9. Enhancing Effective Coping and Self-Esteem

Patients with spinal cord injury may experience grief and low self-esteem due to the significant impact of the injury on their physical and emotional well-being. The resulting changes in body image, self-perception, and self-efficacy can be challenging to manage and may contribute to feelings of inadequacy and reduced self-esteem. Promoting effective coping and self-esteem for patients with spinal cord injury involves providing psychological support, counseling, and education to help them adapt to their new circumstances, develop resilience, and engage in activities that enhance their sense of self-worth.

Identify signs of grieving (shock, denial, anger, depression).
The patient experiences many emotional reactions to the injury and its actual or potential impact on life. These stages are not static, and the rate at which the patient progresses through them is variable.


  • Note lack of communication or emotional response, absence of questions.
    Shock is the initial reaction associated with overwhelming injury. Primary concern is to maintain life, and patient may be too ill to express feelings.
  • Provide simple, accurate information to the patient and SO regarding diagnosis and care. Be honest; do not give false reassurance while providing emotional support.
    The patient’s awareness of surroundings and activity may be blocked initially, and attention span may be limited. Little is actually known about the final outcome of a patient’s injuries during the acute phase, and lack of knowledge may add to the frustration and grief of the family. Therefore, the early focus of emotional support may be directed toward SO.
  • Encourage expressions of sadness, grief, guilt, and fear among patients, SO, and friends.
    The knowledge that these are appropriate feelings that should be expressed may be very supportive to the patient and SO.
  • Incorporate SO into problem-solving and planning for patient care.
    Assists in establishing therapeutic relationships. Provides some sense of control over situations of many losses and forced changes, and promotes the well-being of patients.


  • Assist patient and SO to verbalize feelings about the situation, avoiding judgment about what is expressed.
    The important beginning step to deal with what has happened. Helpful in identifying the patient’s coping mechanisms.
  • Note comments indicating that the patient expects to walk shortly and is making a bargain with God. Do not confront these comments in the early phases of rehabilitation.
    The patient may not deny the entire disability but may deny its permanency. The situation is compounded by actual uncertainty of outcome, and denial may be useful for coping at this time.
  • Focus on present needs (ROM exercises, skin care).
    Attention to the “here and now” reduces frustration and hopelessness of an uncertain future and may make dealing with today’s problems more manageable.


  • Identify the use of manipulative behavior and reactions to caregivers.
    The patient may express anger verbally or physically (spitting, biting). Patient may say that nothing is done right by caregivers and SO or may pit one caregiver against another.
  • Encourage the patient to take control when possible (establishing care routines, dietary choices, and diversional activities).
    Helps reduce anger associated with powerlessness, and provides patients with some sense of control and expectation of responsibility for own behavior.
  • Accept expressions of anger and hopelessness. Avoid arguing. Show concern for the patient.
    The patient is acknowledged as a worthwhile individual, and nonjudgmental care is provided.
  • Set limits on acting out and unacceptable behavior when necessary (abusive language, sexually aggressive, or suggestive behavior).
    Although it is important to express negative feelings, patients and staff need to be protected from violence and embarrassment. This phase is traumatic for all involved, and the support of family is essential.


  • Note the loss of interest in living, sleep disturbance, suicidal thoughts, and hopelessness. Listen to but do not confront these expressions. Let the patient know the nurse is available for support.
    The phase may last weeks, months, or even years. Acceptance of these feelings and consistent support during this phase are important to a satisfactory resolution.
  • Arrange visits by individuals similarly affected, as appropriate.
    Talking with another person who has shared similar feelings and fears and survived may help the patient reach acceptance of the reality of the condition and deal with perceived and actual losses.

Consult with and refer to a psychiatric nurse, social worker, psychiatrist, or pastor.
The patient and SO need assistance to work through feelings of alienation, guilt, and resentment concerning lifestyle and role changes. The family (required to make adaptive changes to a member who may be permanently “different”) benefits from supportive, long-term assistance and counseling in coping with these changes and the future. Patient and SO may suffer great spiritual distress, including feelings of guilt, deprivation of peace, and anger at God, which may interfere with the progression through and resolution of the grief process.

Acknowledge difficulty in determining the degree of functional incapacity and the chance of functional improvement.
During the acute phase of injury, long-term effects are unknown, which delays the patient’s ability to integrate the situation into self-concept.

Listen to the patient’s comments and responses to the situation.
Provides clues to the view of self, role changes, and needs and is useful for providing information at the patient’s level of acceptance.

Assess dynamics of patient and SOs (patient’s role in family, cultural factors).
The patient’s previous role in the family unit is disrupted or altered by injury, adding to the difficulty in integrating self-concept. In addition, issues of independence and dependence need to be addressed.

Be alert to sexually oriented jokes, flirting, or aggressive behavior. Elicit concerns, fears, and feelings about the current situation and future expectations.
Anxiety develops as a result of perceived loss, and changes in masculine or feminine self-image and role. Forced dependency is often devastating, especially in light of changes in function and appearance.

Be aware of own feelings and reaction to the patient’s sexual anxiety.
Behavior may be disruptive, creating conflict between patient and staff, further reinforcing negative feelings, and possibly eliminating the patient’s desire to work through the situation and participate in rehabilitation.

Encourage SO to treat the patient as normally as possible (discussing home situations, and family news).
Involving patients in the family unit reduces feelings of social isolation, helplessness, and uselessness and provides an opportunity for SO to contribute to the patient’s welfare.

Provide accurate information. Discuss concerns about prognosis and treatment honestly at the patient’s level of acceptance.
The focus of information should be on present and immediate needs initially and incorporated into long-term rehabilitation goals. Information should be repeated until the patient has assimilated or integrated information.

Discuss the meaning of loss or change with the patient and SO. Assess interactions between patient and SO.
An actual change in body image may be different from that perceived by the patient. Distortions may be unconsciously reinforced by SO.

Accept the patient, and show concern for the individual as a person. Encourage the patient, identify and build on strengths, and give positive reinforcement for progress noted.
Establishes a therapeutic atmosphere for patients to begin self-acceptance.

Include the patient and SO in care, allowing the patient to make decisions and participate in self-care activities as possible.
Recognizes that the patient is still responsible for their own life and provides some sense of control over the situation. Sets the stage for future lifestyle, patterns, and interactions required in daily care. Note: The patient may reject all help or may be completely dependent during this phase.

Arrange visits by a similarly affected person if the patient desires or the situation allows.
May be helpful to patients by providing hope for the future and a role model. Can be a vital post-discharge resource during the difficult period of adjustment after injury.

Refer to counseling and psychotherapy as indicated (psychiatric clinical nurse specialist, psychiatrist, social worker, sex therapist).
May need additional assistance to adjust to changes in body image and life.

10. Initiating Health Teachings and Patient Education

Patients with spinal cord injuries may have insufficient knowledge regarding the disease condition, treatment, and self-care. The injury can be complex, and patients may require extensive education on topics such as bowel and bladder management, skincare, and mobility. Nurses play an important role in providing education and resources to promote patient understanding and empowerment, leading to better self-management.

Discuss the injury process, current prognosis, and future expectations.
Provide a common knowledge base necessary for making informed choices and commitment to the therapeutic regimen. Note: Improvement in managing the effects of SCI has increased the life expectancy of patients to only about 5 yr below the norm for the specific age group.

Identify symptoms to report immediately to the healthcare provider such as infection of any kind, especially urinary, respiratory; skin breakdown; unresolved autonomic dysreflexia; suspected pregnancy.
Early identification allows for intervention to prevent or minimize complications.

Provide information and demonstrate:

  • Positioning
    Promotes circulation; reduces tissue pressure and risk of complications.
  • Use of pillow supports, and splints
    Keeps the spine aligned and prevents or limits contractures, thus improving function and independence.

Encourage continued participation in daily exercise and conditioning programs and avoidance of fatigue and chills.
Reduces spasticity, and risk of thromboembolic (common complication). Increases mobility, muscle strength, and tone for improving organ and body function such as squeezing a rubber ball, arm exercises enhance upper body strength to increase independence in transfers or wheelchair mobility; tightening or contracting rectum or vaginal muscles improves bladder control; pushing abdomen up, bearing down, contracting abdomen strengthens trunk and improves GI function (paraplegic).

Identify energy conservation techniques and stress the importance of pacing activities and adequate rest. Review drug regimen note use of baclofen (Lioresal), diazepam (Valium), tizanidine (Zanaflex).
Fatigue is common and limits patients’ ability to participate in and manage care, decreasing quality of life and increasing feelings of helplessness or hopelessness. Medications used to treat spasticity can exacerbate fatigue, necessitating a change in drug choice/dosage. Note: Amantadine (Symmetrel) and fluoxetine (Prozac) may decrease a sense of fatigue by potentiating the action of dopamine or selectively inhibiting serotonin uptake in the CNS.

Have SO and caregivers participate in patient care and demonstrate proper procedures such as applications of splints, braces, suctioning, positioning, skin care, transfers, bowel and bladder program, and checking the temperature of bath water and food.
Allows home caregivers to become adept and more comfortable with the care tasks they are called on to provide, and reduces the risk of injury and complications.

Instruct caregiver in techniques to facilitate cough as appropriate.
“Quad coughing” is performed to facilitate the expectoration of secretions or to move them high enough to be suctioned out.

Recommend applying abdominal binder before arising (tetraplegic) and remind to change position slowly. Use a safety belt and an adequate number of people during bed-to-wheelchair transfers.
Reduces pooling of blood in the abdomen and pelvis, minimizing postural hypotension. Protects patient from falls and injury to caregivers.

Instruct in proper skin care, inspecting all skin areas daily, using adequate padding (foam, silicone gel, water pads) in bed and chair, and keeping skin dry. Stress the importance of regularly monitoring the condition and positioning of support surfaces (cushions, mattresses, and overlays).
Reduces skin irritation, decreasing incidence of decubitus (patient must manage this throughout life). Timely recognition of product fatigue, improper orientation, or other misuses can reduce the risk of pressure ulcer formation.

Discuss the necessity of preventing excessive diaphoresis by using tepid bath water, providing a comfortable environment (fans), and removing excess clothes.
Reduces skin irritation and possible breakdown.

Review dietary needs, including adequate bulk and roughage. Problem-solve solutions to alterations in muscular strength and tone and GI function.
Provides adequate nutrition to meet energy needs and promote healing, and prevent complications (constipation, abdominal distension, and gas formation).

Review pain management techniques. Discuss the potential for future pain management therapies if the pain becomes chronic. Recommend avoidance of over-the-counter (OTC) drugs without the approval of the healthcare provider.
Enhances patient safety and may improve cooperation with specific regimens. Note: Pain often becomes chronic in patients with spinal cord injury and may be mechanical (overuse syndrome involving joints); radicular (from injury to peripheral nerves); or cervical (burning, aching just below the level of injury). Dysesthetic pain (distal to the site of injury) is extremely disabling (similar to phantom pain). Treatment for these painful conditions may include a team pain management approach, medications (Neurontin, Klonopin, Elavil), or electrical stimulation.

Discuss ways to identify and manage autonomic dysreflexia.
Patients may be able to recognize signs, but caregivers need to understand how to prevent precipitating factors and know what to do if autonomic dysreflexia occurs.

Stress the importance of continuing with the rehabilitation team to achieve specific functional goals and continue long-term monitoring of therapy needs.
No matter what the level of injury, the individual may ultimately be able to exercise some independence like manipulating an electric wheelchair with a mouth stick (C-3, C-4); being independent in dressing, transferring to bed, car, toilet (C-7); or achieving total wheelchair independence (C-8 to T-4). Over time, new discoveries continue to modify equipment or therapy needs and increase patients’ potential.

Evaluate the home layout and make points for necessary changes. Identify equipment and medical supply needs and resources.
Physical changes may be required to accommodate patients and support equipment. Prior arrangements facilitate the transfer to the home setting.

Discuss sexual activity and reproductive concerns. Review alternative sexual activities and positions, and spasticity management as indicated (opposing pressure on the area of spasm, using pillows for support, regular stretching and ROM exercises, and appropriate medications).
Concerns about individual sexuality and resumption of activity are frequently unspoken concern that needs to be addressed. Spinal cord injury affects all areas of sexual functioning. In addition, the choice of contraception is impacted by the level of spinal cord injury and side effects or adverse complications of a specific method. Finally, some female patients may develop autonomic dysreflexia during intercourse or labor/delivery.

Identify community resources such as health agencies, visiting nurses, financial counselors; service organizations, and Spinal Cord Injury Foundation.
Enhances independence, assisting with home management and providing respite for caregivers.

Coordinate cooperation among community and rehabilitation resources.
Various agencies, therapists, and individuals in the community may be involved in the long-term care and safety of patients, and coordination can ensure that needs are not overlooked and an optimal level of rehabilitation is achieved. Note: Individuals with SCI are living longer, and more injuries are occurring at advanced ages, creating new challenges in care as SCI patients deal with the effects of aging.

Arrange for a transmitter and emergency call system.
Provides for safety and access to emergency assistance and equipment.

Plan for alternate caregivers as needed.
May be needed to provide respite if regular caregivers are ill or other unplanned emergencies arise.

11. Administering Medications and Pharmacologic Support

Medications for patients with spinal cord injury may include pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids, to manage pain, while other medications like muscle relaxants, antispasmodics, anticonvulsants, or antidepressants may be prescribed to address specific symptoms like muscle spasms, neuropathic pain, spasticity, or mood disorders, aiming to improve comfort and function.

Diazepam (Valium), baclofen (Lioresal), dantrolene (Dantrium)
May be useful in limiting or reducing pain associated with spasticity. Note: Baclofen may be delivered via an implanted intrathecal pump on a long-term basis as appropriate.

Tizanidine (Zanaflex)
Centrally acting [alpha]2-adrenergic agonist reduces spasticity. A short duration of action requires careful dosage monitoring to achieve maximum effect. May have an additive effect with baclofen (Lioresal) but needs to be used with caution because both drugs have similar side effects.

Opioids (morphine, oxycodone, and fentanyl)
They are given for moderate to severe pain. These medications act on the central nervous system to provide pain relief. However, these medications should be used judiciously and under close medical supervision due to the risk of dependence, respiratory depression, and other side effects.

Anticonvulsants (gabapentin and pregabalin)
These medications are often used to treat neuropathic pain, which can occur in patients with spinal cord injury. These drugs help alleviate nerve-related pain by stabilizing abnormal electrical activity in the nervous system.

Antidepressants (amitriptyline and duloxetine)
These medications are effective in managing chronic pain. They work by altering neurotransmitter levels in the brain, which can help decrease pain perception.

Mandelate (Mandelamine)
Methenamine mandelate works by breaking down into formaldehyde and ammonia in the urine, creating an environment that inhibits the growth of bacteria. This helps prevent the development of UTIs by reducing bacterial colonization in the urinary tract.

Stool softeners, laxatives, suppositories, enemas (eg, Therevac-SB)
Stimulates peristalsis and routine bowel evacuation when necessary. Suppositories should be warmed to room temperature and lubricated before insertion. Therevac-SB is a 4cc mini enema of docusate and glycerin that may cut time for bowel care by as much as 1 hr.

Antacids, cimetidine (Tagamet), ranitidine (Zantac)
Reduces or neutralizes gastric acid to lessen gastric irritation and risk of bleeding.

Diazoxide (Hyperstat), hydralazine (Apresoline)
Reduces BP if severe and sustained hypertension occurs.

Nifedipine (Procardia), 2% nitroglycerin ointment (Nitrostat)
Sublingual administration is usually effective, in absence of IV access for diazoxide (Hyperstat), but may require a repeat dose in 30 to 60 min. May be used in conjunction with topical nitroglycerin.

Atropine sulfate
Increases heart rate if bradycardia occurs.

Morphine sulfate
Relaxes smooth muscle to aid in lowering blood pressure and muscle tension.

Adrenergic blockers like methysergide maleate (Sansert)
May be used prophylactically if the problem persists and recurs frequently.

Antihypertensives like prazosin (Minipress), phenoxybenzamine (Dibenzyline)
Long-term use may relax the bladder neck and enhance bladder emptying, alleviating the most common cause of chronic autonomic dysreflexia.

12. Monitoring Laboratory and Diagnostic Procedures

Laboratory procedures for patients with spinal cord injuries involve conducting blood tests to assess various parameters and providing valuable information about the patient’s overall health and any potential underlying conditions. Diagnostic procedures for spinal cord injuries typically include imaging techniques like magnetic resonance imaging (MRI) or computed tomography (CT) scans, enabling detailed visualization of the spinal cord and surrounding structures to identify the location and extent of the injury.

Vital capacity (VC), tidal volume (VT), inspiratory force
Determines the level of respiratory muscle function. Serial measurements may be done to predict impending respiratory failure (acute injury) or determine the level of function after the spinal shock phase and while weaning from ventilatory support.

Serial ABGs and pulse oximetry.
Documents status of ventilation and oxygenation; identifies respiratory problems such as hypoventilation (low Pao2 and elevated Paco2) and pulmonary complications.

Imaging studies (X-rays, CT scans, and MRI scans)
These imaging studies are commonly used to assess the extent and location of spinal cord injury. X-rays provide a basic visualization of the bony structures, while CT scans and MRI scans provide more detailed images of the spinal cord, nerve roots, and surrounding tissues.

Urodynamic testing
Urodynamic testing is done for patients with spinal cord injury to evaluate bladder function, identify abnormalities in urinary control or voiding, and determine the most appropriate management strategies to prevent complications such as urinary retention or incontinence.

Electromyography (EMG) and nerve conduction studies
These tests assess nerve and muscle function. EMG involves the insertion of a needle electrode into specific muscles to measure electrical activity and detect any abnormalities. Nerve conduction studies measure the speed and strength of electrical signals traveling along the nerves, helping to identify nerve damage or dysfunction.

Bone density scan
Osteoporosis is a common concern for individuals with spinal cord injury. A bone density scan, such as a dual-energy X-ray absorptiometry (DEXA) scan, is performed to assess bone density and determine the risk of fractures.

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care 
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health 
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

See also

Other recommended site resources for this nursing care plan:

Other nursing care plans for musculoskeletal disorders and conditions:

Other nursing care plans related to neurological disorders:

References and Sources

Recommended references and sources for this fracture nursing care plans:

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  2. Biz, C., Fantoni, I., Crepaldi, N., Zonta, F., Buffon, L., Corradin, M., … & Ruggieri, P. (2019). Clinical practice and nursing management of pre-operative skin or skeletal traction for hip fractures in elderly patients: a cross-sectional three-institution studyInternational journal of orthopaedic and trauma nursing32, 32-40.
  3. Brent, L., Hommel, A., Maher, A. B., Hertz, K., Meehan, A. J., & Santy-Tomlinson, J. (2018). Nursing care of fragility fracture patientsInjury49(8), 1409-1412.
  4. Buckley, J. (2002). Massage and aromatherapy massage: Nursing art and scienceInternational Journal of Palliative Nursing8(6), 276-280.
  5. Desnita, O., Noer, R. M., & Agusthia, M. (2021, July). Cold Compresses Effect of on Postoperative Orif Pain in Fracture Patients. In KaPIN Conference (pp. 133-140).
  6. DiFazio, R., & Atkinson, C. C. (2005). Extremity fractures in children: when is it an emergency?Journal of pediatric nursing20(4), 298-304.
  7. Griffioen, M. A., Ziegler, M. L., O’Toole, R. V., Dorsey, S. G., & Renn, C. L. (2019). Change in pain score after administration of analgesics for lower extremity fracture pain during hospitalizationPain Management Nursing20(2), 158-163.
  8. Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences. [Link]
  9. Hommel, A., Kock, M. L., Persson, J., & Werntoft, E. (2012). The Patient’s view of nursing care after hip fractureISRN nursing2012. [Link]
  10. Lin, Y. C., Lee, S. H., Chen, I. J., Chang, C. H., Chang, C. J., Wang, Y. C., … & Hsieh, P. H. (2018). Symptomatic pulmonary embolism following hip fracture: A nationwide study. Thrombosis research172, 120-127.
  11. Maher, A. B., Meehan, A. J., Hertz, K., Hommel, A., MacDonald, V., O’Sullivan, M. P., … & Taylor, A. (2012). Acute nursing care of the older adult with fragility hip fracture: an international perspective (Part 1)International Journal of Orthopaedic and Trauma Nursing16(4), 177-194.
  12. McDonald, E., Winters, B., Nicholson, K., Shakked, R., Raikin, S., Pedowitz, D. I., & Daniel, J. N. (2018). Effect of Postoperative Ketorolac Administration on Bone Healing in Ankle Fracture Surgery. Foot & Ankle International, 39(10), 1135–1140. https://doi.org/10.1177/1071100718782489
  13. McDonald, E., Winters, B., Shakked, R., Pedowitz, D., Raikin, S., & Daniel, J. (2017). Effect of Post-Operative Toradol Administration on Bone Healing After Ankle Fracture Fixation. Foot & Ankle Orthopaedics2(3), 2473011417S000288.
  14. Metsemakers, W. J., Kuehl, R., Moriarty, T. F., Richards, R. G., Verhofstad, M. H. J., Borens, O., … & Morgenstern, M. (2018). Infection after fracture fixation: current surgical and microbiological conceptsInjury49(3), 511-522.
  15. Neri, E., Maestro, A., Minen, F., Montico, M., Ronfani, L., Zanon, D., … & Barbi, E. (2013). Sublingual ketorolac versus sublingual tramadol for moderate to severe post-traumatic bone pain in children: a double-blind, randomised, controlled trial. Archives of disease in childhood98(9), 721-724.
  16. Pan, Y., Mei, J., Wang, L., Shao, M., Zhang, J., Wu, H., & Zhao, J. (2019). Investigation of the incidence of perioperative pulmonary embolism in patients with below-knee deep vein thrombosis after lower extremity fracture and evaluation of retrievable inferior vena cava filter deployment in these patientsAnnals of vascular surgery60, 45-51.
  17. Patterson, J. T., Tangtiphaiboontana, J., & Pandya, N. K. (2018). Management of pediatric femoral neck fractureJAAOS-Journal of the American Academy of Orthopaedic Surgeons26(12), 411-419.
  18. Patzakis, M. J., & Wilkins, J. (1989). Factors influencing infection rate in open fracture woundsClinical orthopaedics and related research, (243), 36-40.
  19. Resch, S., Bjärnetoft, B., & Thorngren, K. G. (2005). Preoperative skin traction or pillow nursing in hip fractures: a prospective, randomized study in 123 patientsDisability and rehabilitation27(18-19), 1191-1195.
  20. Rothberg, D. L., & Makarewich, C. A. (2019). Fat embolism and fat embolism syndromeJAAOS-Journal of the American Academy of Orthopaedic Surgeons27(8), e346-e355.
  21. Willis, L. (2019). Professional guide to diseases. Lippincott Williams & Wilkins. [Link]
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Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers.

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