______________________________________________________________ Chapter 29 Spinal Cord Injury 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 29.1
Slide 29
Preventing Further Cord Injury (cont.)
• Special beds and cushions
• Kinetic bed, such as the Roto-Rest bed, continually rotates the patient from side to
side
• Overlay air mattresses: flotation devices placed on standard hospital beds
• Air-fluidized and flotation beds may be used after the spine has been stabilized
• Stryker wedge frame: canvas and metal frame bed that may be used to help turn the
patient
• Types of cushions include those inflated with air, flotation devices, and gel pads
TALKING POINTS:
• Side-to-side rotation is especially helpful in preventing pulmonary complications by
Slide 30
Preventing Further Cord Injury (cont.)
• Drug therapy
• Methylprednisolone
Slide 31
Preserving Cord Function
• Early surgical intervention to repair cord damage
• Cord compression by bony fragments, compound vertebral fractures, and gunshot
and stab wounds
TALKING POINTS:
• A laminectomy may be done to alleviate compression of the cord or spinal nerves.
• What must occur before a patient can undergo a laminectomy or spinal fusion?
Slide 32
Question 1
• The average cost for the first year for a patient with paraplegia is ________.
A. $150,000
B. $180,000
C. $200,000
D. $280,000
TALKING POINTS:
Introduction to Medical-Surgical Nursing, 6th ed.
Slide 33
Question 2
• One of the most serious and potentially dangerous problems for the spinal cord–injured
patient is ____________.
A. spinal shock
B. tetraplegia
C. autonomic dysreflexia
D. paraplegia
Activities
Classroom Choose from below to make 30 minutes
Online
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the impact of spinal cord injury in
terms of number of serious injuries per year,
total annual cost of care, and peak
incidence.
• Discuss the anatomic components of the
spinal cord and which defects or injuries can
have an effect on the proper functioning of
the spinal cord.
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
______________________________________________________________ Chapter 29 Spinal Cord Injury 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 29.1
DISCUSS
• Discuss why the spine must be immobilized
throughout the diagnostic process.
• Discuss patient precautions that must be
taken for an MRI.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Create a list of
diagnostic tests used for a patient with a
suspected spinal cord injury. Include
DISCUSS
• Discuss quadriplegia and paraplegia in
terms of what area of the spine is affected.
• Discuss the implications of high versus low
spinal injury.
• Discuss the circumstances under which
respiratory impairment occurs.
cord injuries.
• As a class, review the potential compli-
cations of spinal cord injury. Develop a list of
potential complications and ask class
members to identify the possible cause of
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe the
conditions under which autonomic
dysreflexia occurs and why it can occur even
in patients who have old injuries.
• Post the following discussion topic online
16 Chapter 29 Spinal Cord Injury ______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 29.1
DISCUSS
• Discuss why the first priority in spinal cord
injury is establishing a patent airway.
• Discuss why immobilization is so important
in preventing further injury to the spinal cord
and the immobilization measures that can be
taken.
• Discuss common drug therapy for the
management of spinal cord injuries.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Create a table
that outlines medications used to treat spinal
cord injury.
• Post the following discussion topic online
and have students comment. What surgical
options are available for a patient with a
suspected spinal cord injury?
Critical Thinking Question
A nurse working the night shift on a medical-surgical unit looks up from the nurses’ station
to see a patient walking toward the elevator. Evidently, the patient removed the traction
device being used to treat his high cervical (C2, C3) fractures sustained in a fall off a porch.
The Gardner-Wells tongs are still attached to his skull. He insists he is leaving to “go get a
drink.” What should the nurse do?
Instructor Notes/Student Feedback
______________________________________________________________ Chapter 29 Spinal Cord Injury 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 29.2
Instructor Preparation
Textbook Objectives Covered
6. Identify nursing diagnoses, goals, interventions, and outcome criteria for the patient with a
spinal cord injury.
8. Describe the nursing care for the patient undergoing a laminectomy.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speakers: ER nurse or physician
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying spinal cord injury, including:
• The impact of spinal cord injury
• Diagnostic tests for spinal cord injury
• Acute care of spinal cord injury
• Postlaminectomy care
• Rehabilitation
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• autonomic dysreflexia
(p. 516)
• myelinated (p. 510)
• paraplegia (p. 515)
• spasticity (p. 516)
• tetraplegia (p. 515)
Student Preparation
Assignments 2 hours
5
READ – Textbook (pp. 519-522)
REVIEW
• Figure 29-9: The dermatome chart (p. 521)
• Table 29-4: Grading Scale for Muscle Strength (p. 520)
6
READ – Textbook (pp. 522-526)
ANSWER – Study Guide
• Part IIID: 1-5, 8-12 (pp. 174–175)
• Part IIIE: 1-3 (p. 175)
7
READ – Textbook (pp. 526-527)
ANSWER – Study Guide
• Part IIC: 4, 5, 7, 16–19 (pp. 172-174)
• Part IIID: 7 (p. 174)
18 Chapter 29 Spinal Cord Injury ______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 29.2
8
READ – Textbook (pp. 527-528)
REVIEW
• Box 29-5: Case Study: Spinal Cord Injury (p. 526)
• Box 29-6: Nursing Care After a Laminectomy (p. 527)
50-Minute Lesson Plan
Lecture Outline 20 minutes
6
Slide 34
Assessment
• Monitor the patient’s level of consciousness, vital signs, respiratory status, motor and
sensory function, and intake and output
Health History
• Present illness
• Event that brought the patient to the hospital
Slide 36
Medical History
• Other accidents or injuries and chronic illnesses such as diabetes, hypertension, heart
disease, cancer, or seizure disorder
• Previous hospitalizations and operations
• Obstetric history from female patient
• Identify and record current medications and allergies
Slide 37
Family History
• Routine family history taken but not considered specifically relevant to a diagnosis of
spinal cord injury resulting from trauma
Slide 38
Review of Systems
• Skin condition, headache or dizziness, vision disturbances, hearing impairment or tinnitus,
nasal or ear drainage, dyspnea, nausea and vomiting, constipation or diarrhea, fecal
incontinence, bladder dysfunction, sexual dysfunction, and impaired motor and sensory
function
Functional Assessment
• Patient’s self-care abilities
• Patient’s roles and responsibilities as a family member
______________________________________________________________ Chapter 29 Spinal Cord Injury 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 29.2
Slide 40
Physical Examination
• Record the patient’s reported height and weight
• Take vital signs
• Take the temperature
• Level of responsiveness, posture, and spontaneous movements
TALKING POINTS:
• An actual weight measurement may have to be deferred until the patient can tolerate the
procedure.
• What symptoms may accompany spinal shock?
Slide 41
Physical Examination (cont.)
• Examine pupils for size, equality, reaction to light
• Respiratory effort and breath sounds
• Inspect abdomen; auscultate for bowel sounds
TALKING POINTS:
• How is muscle strength assessed?
• Involuntary movement also may be observed in the injured patient, evidenced by the
appearance of muscle spasms.
Slide 42
Interventions
• Ineffective breathing pattern
• Risk for injury
• Disturbed sensory perception
• Risk for autonomic dysreflexia
• Risk for disuse syndrome
• Bowel incontinence
• Impaired urinary elimination
Interventions (cont.)
• Risk for infection
• Ineffective thermoregulation
7
Slide 44
Rehabilitation
• Activities that assist individual to achieve highest possible level of self-care and
independence
• Well-organized interdisciplinary team that can address all aspects of function
20 Chapter 29 Spinal Cord Injury ______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 29.2
Rehabilitation (cont.)
• Team helps the patient accomplish activities of daily living and self-care and addresses
successful adjustment to social integration and gainful employment in the workplace
8
Slide 46
Nursing Care of the Laminectomy Patient
• Preoperatively
• Assess patient’s vital signs and neurologic status to establish baselines
Slide 47
Nursing Care of the Laminectomy Patient (cont.)
• Assessment
• Vital signs, neurologic status, and breath sounds
• Frequently assess movement, strength, range of motion, and ability to localize
sensory stimulus
• Fluid intake and output
Slide 48
Nursing Care of the Laminectomy Patient (cont.)
• Interventions
• Risk for injury
• Ineffective tissue perfusion
• Acute pain
Activities
Classroom Choose from below to make 30 minutes
Online
DISCUSS
• Discuss why a review of systems is relevant
to a diagnosis of spinal cord injury.
• Discuss what aspects of the patient are
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe the
various techniques for assessing the
______________________________________________________________ Chapter 29 Spinal Cord Injury 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 29.2
DISCUSS
• Discuss techniques that can be used to
assist patients in clearing their airways.
• Discuss why any injections needed should
be administered above the level of paralysis.
• Discuss why autonomic dysreflexia is a
medical emergency, what action is required,
and how to prevent it.
• Discuss the management of bowel problems
that may occur in the postinjury period.
• Discuss ways of dealing with Ineffective
thermoregulation.
• As a class, discuss the care of a patient with
an anterior cord syndrome of the cervical
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe
several effects of immobilization on the body
of the patient with spinal cord injury. What
action should the nurse take to prevent
complications?
DISCUSS
• Discuss the various emotional and physical
aspects of rehabilitation.
• Discuss the significance of early acute care
on later rehabilitation.
• As a class, discuss a nursing care plan for a
patient with a spinal cord injury who is going
to rehabilitation. Present a patient scenario
in which nursing diagnoses such as Risk of
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Create a list of
goals you think are appropriate for a patient
with spinal cord injury during the
rehabilitation phase.
22 Chapter 29 Spinal Cord Injury ______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 29.2
DISCUSS
• Discuss nursing care measures for bowel
and bladder function following laminectomy.
• Discuss nursing care for the surgical wound
following laminectomy.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe
various measures possible for increasing
tissue perfusion following laminectomy.
Critical Thinking Question
A 32-year-old single mother of two school-age children was involved in a motor vehicle
accident and sustained an incomplete spinal cord injury at the L2 level. She has weakness
(strength 2/5) and decreased tone in the right lower extremity. She has paralysis and
flaccidity in the left lower extremity. She is in her room crying and saying that she will never
walk again or be able to care for her children. How should the nurse respond?
Discussion Guidelines: The nurse should first acknowledge the patient’s fears and realities. She
is understandably upset and must work through the stages of loss at her own pace. The nurse
Instructor Notes/Student Feedback
______________________________________________________________ Chapter 29 Spinal Cord Injury 23
Introduction to Medical-Surgical Nursing, 6th ed.
29
Assessments for
Spinal Cord Injury
CHAPTER OBJECTIVES
Lesson 29.1:
1. Explain the impact of spinal cord injury.
3. Explain the physical effects of spinal cord injury.
Lesson 29.2:
5. List the data to be included in the nursing assessment of the patient with a spinal cord injury.
7. State the goals of rehabilitation for the patient with spinal cord injury.
8. Describe the nursing care for the patient undergoing a laminectomy.
Assessments by Lesson & Objective
Lesson 29.1
1
Study Guide
• Part IA: 1-11 (pp. 171-172)
Evolve Instructor Resources
• Test Bank: 25
2
Study Guide
Evolve Instructor Resources
• Test Bank: 5, 7, 26, 27, 30
Evolve Student Resources
• NCLEX Review: 2
• Prioritization: 2
3
Study Guide
• Part IIC: 1, 6, 9, 10 (pp. 172-173)
Evolve Instructor Resources
24 Chapter 29 Spinal Cord Injury ______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
4
Study Guide
• Part IB: 2-4 (p. 172)
Evolve Instructor Resources
• Test Bank: 13-15, 19
Evolve Student Resources
• NCLEX Review: 1
• Prioritization: 4, 5
5
Evolve Instructor Resources
• Test Bank: 11
Evolve Student Resources
Evolve Instructor Resources
• Test Bank: 8, 10, 12, 17, 18, 32, 33
Evolve Student Resources
Evolve Instructor Resources
• Test Bank: 22–24, 28
Evolve Instructor Resources
Instructor’s Notes/Student Feedback