Caring for paraplegic patients?

AgentBeast, BSN, RN · Jun 21, 2011

The nerves don't work, nothing is wrong with the arteries or veins . . . 2+

The legs are atrophied because they aren't used anymore . . .

ckh23, BSN, RN · Jun 21, 2011

Doesn't affect the CV system. The legs would be atrophied. Also look for any abd distention and bladder distention.

brownbook · Jun 21, 2011

Scotte, if the muscles are atrophied because they aren't used anymore, wouldn't that affect the venous vasculature? Would their veins be ???? not as competent??? Could that lead to blood clots?

Was your reply snide??? I thought it was a valid question

dudette10, MSN, RN · Jun 21, 2011

http://www.nature.com/sc/journal/v32/n12/abs/sc1994128a.html

http://www.ncbi.nlm.nih.gov/pubmed/9344298

http://journals.lww.com/acsm-msse/Abstract/2002/09000/Hypokinetic_circulation_in_persons_with_paraplegia.1.aspx

tyvin, BSN, RN · Jun 21, 2011

It also depends on what type of para they are. For instance a complete as opposed to an incomplete. Some paras can move their legs more and do more to keep the legs in condition.

I would think that the ones that are incomplete will have a pulse more like preinjury as opposed to completes who can't move the legs at all.

ZippyGBR, BSN, RN · Jun 21, 2011

The pulses should be normal regardless of ASIA score , however some paraplegics do have vascular problems which may not show symptoms in the same way that they would in someone with normal neurology ... and often don't become apparent until the vascular problems are really quite serious.

If the person was rehabed properly in the first place they will be an Expert Patient and should be able to guide you,

Jenni811, RN · Jun 21, 2011

It should be a normal pulse. Vascular system is not affected.

signet, LPN · Jun 21, 2011

My mother was paralyzed below the waist for 37 years due to Guillian Barre Syndrone. She had no movement, but complete feeling. Her legs were severely atropied. After 3 or four hours of sitting upright in her wheelchair, her lower legs and feet would become purple. They had the appearence of being mottled. They would also be as cold as ice, with no apparent cappillary refill in the toes and no pedal pulses. This would scare the heck out of nurses unfamiliar with her case. Elevate the legs for 15 min and they would be a perfect flesh tone again. She would also get +3 edema which was easily relieved by elevating her legs. Patients who have been paraplegic for many years do not have the same vascular structure as everyone else. Another thing to take into consideration is the cause of the paralysis. Accident victims whose spine has been damaged usually have more muscle tone than say someone paralyzed from polio, GBS, ect... The people you see racing wheelchairs are usually accident victims. Their whole body hasn't been ravaged by a disease.

thehipcrip · Jun 22, 2011

While not part of the physical assessment, I had to sneak this in:

One of the most important things to remember when caring for a patient with paraplegia is to always put her wheelchair back exactly where she left it.

We understand that it's inevitable that you're going to need to move our chair out of your way at some point -- after all, you need unfettered access to us to give us proper care and bedside space is limited and tends to fill up quickly.

But if we're permitted to be ambulatory, please make certain to put the chair back where you found it when you're finished. Doing so not only enables us to be independent, it will greatly cut back on the number of times the call light gets pushed.