12 Spinal Cord Injury Nursing Care Plans – Nurseslabs

Discuss injury process, current prognosis, and future expectations. Provide common knowledge base necessary for making informed choices and commitment to the therapeutic regimen.Note: Improvement in managing effects of SCI has increased life expectancy of patients to only about 5 yr below norm for specific age group. Provide information and demonstrate: Positioning Promotes circulation; reduces tissue pressure and risk of complications. Use of pillows, supports, splints Keeps spine aligned and prevents or limits contractures, thus improving function and independence. Encourage continued participation in daily exercise and conditioning program and avoidance of fatigue and chills. Reduces spasticity, risk of thromboembolic (common complication). Increases mobility, muscle strength and tone for improving organ and body functionsuch assqueezing 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 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 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, checking 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 risk of injury and complications. Instruct caregiver in techniques to facilitate cough as appropriate. Quad coughing is performed to facilitate 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 safety belt and adequate number of people during bed-to-wheelchair transfers. Reduces pooling of blood in 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 importance of regularly monitoring 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 misuse can reduce risk of pressure ulcer formation. Discuss necessity of preventing excessive diaphoresis by using tepid bath water, providing comfortable environment (fans), 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, prevent complications (constipation, abdominal distension and gas formation). Review pain management techniques. Discuss the potential for future pain management therapies if pain becomes chronic. Recommend avoidance of over-the-counter (OTC) drugs without approval of healthcare provider. Enhances patient safety and may improve cooperation with specific regimen.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 level of injury). Dysesthetic pain (distal to 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. Patient 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. Identify symptoms to report immediately to 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. Stress importance of continuing with rehabilitation team to achieve specific functional goals and continue long-term monitoring of therapy needs. No matter what the level of injury, individual may ultimately be able to exercise some independence like manipulating electric wheelchair with mouth stick (C-3, C-4); being independent for dressing, transfers 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 home layout and make pointsfor necessary changes. Identify equipment and medical supply needs and resources. Physical changes may be required to accommodate patient 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 area of spasm, using pillows for support, regular stretching and ROM exercises, appropriate medications). Concerns about individual sexuality and resumption of activity is frequently an unspoken concern that needs to be addressed. Spinal cord injury affects all areas of sexual functioning. In addition, choice of contraception is impacted by level of spinal cord injury and side effectsoradverse complications of specific method. Finally, some female patients may develop autonomic dysreflexia during intercourse or labor/delivery. Identify community resourcessuch ashealth agencies, visiting nurse, financial counselor; service organizations, 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 community may be involved in the long-term care and safety of patient, and coordination can ensure that needs are not overlooked and 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 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.

Originally posted here:
12 Spinal Cord Injury Nursing Care Plans - Nurseslabs