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Over 17,000 people sustain spinal cord injuries yearly in the United States. This severe and often life-changing condition happens when a sudden, traumatic event injures the tightly-packed bundle of neurons and nerves of the spinal column. Severe spinal injuries can cause spinal shock and may permanently change strength, sensation, and other bodily functions depending on the level of the damage.
Proper nursing diagnosis and care plans are essential for providing quality patient care for those with spinal cord injuries. In addition, nursing care plans give patients and their caregivers the knowledge and resources necessary for navigating the changes to their physical, mental, and social abilities associated with spinal cord injuries.
Table of Contents
Diagnosis of Spinal Cord InjuryThe care of the patient varies depending on the timing of the injury. A patient with acute spinal cord injury needs immediate care focused on diagnosing the severity of the damage. Once the patient stabilizes, care must change to address the longevity of the condition, and the care team must focus on helping the patient live a full and long life.
During the acute phase, determining the severity and level of the injury is of utmost importance to providing proper medical and nursing care.
Determining the level of the injury drives acute care. The American Spinal Injury Association Impairment Scale categorizes the extent of a spinal cord injury. This tool compares motor and sensory function severity before and after injury. Healthcare providers use this scale and other diagnostic tools to determine the type and severity of the injury.
Types of Spinal Cord Injuries
Types of spinal injuries can be broken down in two ways, by the level of the damage and if the injury is complete or incomplete. Let's explore both of these categorizations.
Level of Injury
There are four types of spinal cord injuries based on the location of the impact: cervical, thoracic, lumbar, and sacral.
Complete vs. Incomplete
The main differences between a complete and incomplete injury are seen in the type of remaining function the patient experiences.
Causes of Spinal Cord InjurySpinal cord injuries are usually the result of traumatic events. However, they may be related to long-term conditions too. Common causes include:
Traumatic injuries can damage the spinal cord in one of three ways. First, the trauma may damage one or more physical structures, like the vertebrae, bones, ligaments, or discs. Another cause may be extreme pressure on the vertebrae, which can compress and damage the nerves within the cord. Finally, penetrating injuries, such as those seen with gunshots, can sever or severely damage the spinal cord.
For nontraumatic incidents, patients can experience arthritis, degenerative disc disease, cancer, or infection in the CNS. In addition, a virus or injury can cause an immune response that causes a spinal cord injury. When this happens, the body's immune system attacks the nerve cells, causing neuroinflammation.
AssessmentThe most common signs of spinal cord injury are paralysis, weakness, loss of feeling, and difficulty with movement. To assess these symptoms, healthcare professionals may ask questions about the person's medical history or do a physical exam to see how well they can move or feel different body parts.
They may also examine how well the individual breathes and their responsiveness to external stimulation.
The following tests may be run to check for damage to the spine.
At-Risk PopulationsMultiple populations have an increased risk of sustaining a spinal cord injury. Risk factors include the following:
ComplicationsSince the spine plays a significant role in bodily functions, a spinal cord injury can lead to various health complications. It is the basis for nerve signals that control body movements and reflexes. If the spinal cord is damaged, it can interfere with coordination and muscle movements.
The most common complications of a spinal cord injury include:
TreatmentsMany treatments for spinal cord injuries exist. The goal of treatments after a spinal cord injury is to help the patient achieve the highest level of independence possible and minimize the risk of complications. Therefore, a multidisciplinary approach to care is essential to provide holistic treatment modalities.
Examples of common treatments include the following:
Nurse's Role Caring for a Patient With Spinal Cord InjuryA nursing diagnosis for spinal cord injury aims to do more than address medical needs. It focuses on the patient's overall well-being and seeks to improve the quality of life for the patient and their caregivers. Nurses assist with activities of daily living, manage pain, provide psychological support, and help the patient to adjust to their new life.
As a nurse, you'll work as part of an interdisciplinary team to provide care. In addition, you'll play a significant role in educating the patient and their caregivers on self-care strategies so they can return home.
Nursing Protocols for Spinal Cord Injury
Nurses follow established protocols to assess and provide evidence-based spinal cord injury care. These protocols may include monitoring vital signs, assessing neurological status, providing skin care and pressure ulcer prevention, evaluating the patient's dietary needs, and providing emotional support.
Nursing Care Plans Related to Spinal Cord InjuryA nursing diagnosis for spinal cord injury is the basis for creating a personalized care plan for each patient. The plan's goals should focus on improving the quality of life and providing emotional and psychological support. The care plan must include individualized interventions to manage pain, improve mobility, promote wound healing, and prevent further complications.
This section provides several care plans for spinal cord injury. Though these are not exhaustive, they can provide a starting point when developing individualized patient care plans.
Risk for Ineffective Breathing Pattern Care PlanAn ineffective breathing pattern for patients with spinal cord injuries may occur due to damage to the respiratory muscles that can lead to reduced oxygenation and ventilation. Respiratory failure causes alterations in normal respiratory functions such as rate, depth, timing, rhythm, and pattern.
An inefficient breathing system hinders the body from supplying cells with vital oxygen. Changes in both abdominal and thoracic patterns can indicate imminent respiratory failure.
Nursing Diagnosis: Risk for Ineffective Breathing
Potentially Related to
Evidenced By
Desired Outcomes
Risk for Ineffective Breathing Assessment
Risk for Ineffective Breathing Nursing Interventions
Rationale: Helps to open the airways and reduce shortness of breath.
Rationale: Helps to improve oxygen saturation levels.
Rationale: Slows the breathing down, eases effort, and increases oxygenation.
Rationale: Specialized therapists can educate on exercises to strengthen muscles and the effort needed to mobilize secretions.
Rationale: Allows for optimal air entry and expansion of all lung fields.
Rationale: Mobilizes secretions so they can be suctioned.
Rationale: Removes secretions and improves oxygenation.
Risk for Autonomic Dysreflexia Care PlanAutonomic dysreflexia is the result of the autonomic nervous system getting disrupted. The autonomic nervous system regulates involuntary functions such as breathing, heart rate, and digestion.
Stimuli, such as a full bladder, can cause the body to be unable to regulate itself properly. Autonomic dysreflexia is a severe condition that can cause complications such as high blood pressure, stroke, and even death.
Nurses must assess for signs of autonomic dysreflexia and administer treatment quickly. Swift actions can prevent stroke, seizures, or cardiac arrest.
Nursing Diagnosis: Risk for Autonomic Dysreflexia
Potentially Related to
Evidenced By
Desired Outcomes
Risk for Autonomic Dysreflexia Assessment
Risk for Autonomic Dysreflexia Nursing Interventions
Rationale: Promotes self-care and prevention.
Rationale: Treats condition and minimizes complications
Rationale: Helps to stop the episode.
Rationale: Reduces complications, allows quick treatment, and helps calm the patient.
Rationale: Reduces blood pressure and prevents seizures, stroke, and intracranial hemorrhage.
Risk for Impaired Skin Integrity Care PlanThe skin is a delicate yet important organ. It acts as a protective barrier that helps keep harmful substances and bacteria out. Unfortunately, spinal cord injuries cause limitations to mobility and impaired sensation, which can impact the integrity of the skin.
Nursing Diagnosis: Risk for Impaired Skin Integrity
Potentially Related to
Evidenced By
Desired Outcomes
Risk for Impaired Skin Integrity Assessment
Risk for Impaired Skin Integrity Interventions
Rationale: Promotes self-care and prevention.
Rationale: Reduces pressure and promotes circulation to affected areas.
Rationale: Relieves the pressure on bony regions and minimizes skin breakdown.
Rationale: Promotes skin health and reduces the risk of breakdown.
Rationale: Provides an opportunity to address any skin issues quickly.
Rationale: Keeps the skin hydrated and healthy, reducing the breakdown risk.
Rationale: Reduces pressure points and minimizes the risk of skin breakdown.
Impaired Physical Mobility Care PlanPhysical mobility is essential for overall health and well-being, so addressing any limitations should be captured as part of a holistic nursing care plan. Being unable to move freely can take an emotional and psychological toll on a person. Spinal cord injuries can also cause health problems due to limited movements, such as blood clots or skin ulcers.
Nursing Diagnosis: Impaired Physical Mobility
Potentially Related to
Evidenced By
Desired Outcomes
Impaired Physical Mobility Assessment
Impaired Physical Mobility Nursing Interventions
Rationale: Promotes independence and positive mental health.
Rationale: Promotes independence.
Rationale: Utilizes specialized therapists to promote physical movement and independence.
Rationale: Promotes independence while reducing fears about being unable to move or care for oneself alone.
Rationale: Enhances circulation and prevents contractures and muscle atrophy.
Rationale: Maintains proper joint alignment and reduces the risk of contractures.
Rationale: Reduces the risk of pressure ulcers.
Rationale: Reduces the risk of respiratory infection caused by immobility.
Rationale: Reduces the risk of blood clots by improving leg vasomotor tone.
Acute Pain Care PlanAcute pain is a common symptom of spinal cord injury related to tissue damage and trauma. Patients may experience pain at the spinal cord injury site, or it may be referred to other body parts. Depending on the nature of the trauma, the patient may have other injuries causing pain too.
The healthcare team must provide as much pain relief as possible. Adequate relief depends upon a thorough physical assessment and using a validated pain tool if the patient is coherent and able to rate their pain. Including pain in the nursing care plan is crucial to overall care during the acute phase of a spinal cord injury.
Nursing Diagnosis: Acute Pain
Potentially Related to
Evidenced By
Desired Outcomes
Acute Pain Assessment
Acute Pain Nursing Interventions
Rationale: Getting rest can help reduce the intensity of pain.
Rationale: Reduces pain levels.
Rationale: Reduces pressure and maintains proper body alignment, thereby reducing
pain.
Rationale: Reduces pain levels without the use of medications.
Rationale: Promotes pain relief without the use of medications.
Risk for Constipation Care PlanConstipation is a common complication of spinal cord injury, as it can lead to impaired motility and difficulty perceiving the need for a bowel movement. Slower than usual bowel motility can create the perfect condition for constipation and fecal impaction.
Monitoring the patient's bowel patterns and managing any related symptoms is essential. Nurses also play an integral part in educating patients on preventing constipation with strategies like increasing fluids, fiber intake, and activity.
Left untreated, constipation can worsen and cause other problems like nausea, vomiting, abdominal pain, or rectal bleeding. So, the nurse must continually assess and treat the signs and symptoms of constipation.
Nursing Diagnosis: Risk for Constipation
Potentially Related to
Evidenced By
Desired Outcomes
Risk for Constipation Assessment
Risk for Constipation Nursing Interventions
Rationale: Assists with bowel evacuation when the patient can't perform voluntarily.
Rationale: Improves the consistency of the stool and movement through the bowel.
Rationale: Help to move stool through the bowel.
Rationale: Reduces bowel distension and prevents nausea and vomiting.
Rationale: Reduces bowel distension.
Rationale: Alleviates symptoms of constipation and promotes defecation.
Impaired Urinary Elimination Care PlanIt's common for patients with spinal cord injury to experience impaired urinary elimination related to impaired nerve innervation. Common signs include urinary retention, incontinence, and urinary tract infections. It is crucial to assess the patient's bladder and kidney functions, monitor changes in urine output, and encourage preventive and management strategies to reduce the likelihood of infections and other complications.
Nursing Diagnosis: Impaired Urinary Elimination
Potentially Related to
Evidenced By
Desired Outcomes
Impaired Urinary Elimination Assessment
Impaired Urinary Elimination Nursing Interventions
Rationale: Improves urinary control.
Rationale: Promotes urine production and reduces the risk of a urinary tract infection.
Rationale: Reduces the risk of urinary tract infection.
Rationale: Promotes self-care and decreases the risk of urinary tract infection.
Rationale: Reduces urine retention and improves bladder muscle strength.
Anticipatory Grieving Care PlanPatients with spinal cord injuries may experience grief related to the significant changes in their life before and after the injury. Grief is a natural yet normal response to loss, and anticipatory grief is the process of mourning the losses associated with impending death or other sudden tragic life changes.
These patients may experience extreme loss of function, changes in their professional and social life, and alterations in their relationships, just to name of few of the many possible changes. These changes can lead to feelings of loss, sadness, and grief.
Nursing Diagnosis: Anticipatory Grieving
Potentially Related to
Evidenced By
Desired Outcomes
Anticipatory Grieving Assessment
Anticipatory Grieving Interventions
Rationale: Promotes self-expression of feelings.
Rationale: Increases knowledge that this is considered normal and provides help.
Rationale: Provides specialized mental health and grief counseling care.
Rationale: Treats anxiety and depression.
Situational Low Self-Esteem Care PlanLow self-esteem can be a common side effect of spinal cord injury related to the injury's substantial impact on their emotional, physical, and overall well-being. For example, they may face challenges like feeling reliant on others, struggling with the changes to their body and its ability to function independently, or how they perceive themselves as a person, in their relationships, and as a worker.
Nurses are often the closest healthcare professionals to the patient because they spend much time with the patient providing care. This closeness you'll experience with the patient can provide cues as to their feelings about their situation and if their self-esteem is low. Therefore, it's crucial to be observant and to allow the patient to talk freely about their feelings.
Nursing Diagnosis: Situational Low Self-Esteem
Potentially Related to
Evidenced By
Desired Outcomes
Situational Low Self-Esteem Assessment
Situational Low Self-Esteem Nursing Interventions
Rationale: Promotes self-care and knowledge of the condition.
Rationale: Establishes community support.
Rationale: Promotes self-care and realistic coping strategies.
Rationale: Provides education and allows them to set realistic goals for the future.
Rationale: Allows for an open, honest conversation with support.
Rationale: Provides hope and gives them a role model for the future.
Disturbed Sensory Perception Care PlanWhen the spinal cord injury is damaged, it disrupts the normal functioning of the nerves and sensory pathways. This damage may cause altered sensations like tingling and numbness. These alterations to their sensory function can make it challenging for patients to perceive changes to their body movement and positioning.
Patients may fear falling out of bed or not realize when their arms or legs are in an unnatural position. This new sensory deficit status can take time to get accustomed to for many patients. Nurses can help by educating patients and providing extra support during routine care activities.
Nursing Diagnosis: Disturbed Sensory Perception
Potentially Related to
Evidenced By
Desired Outcomes
Disturbed Sensory Perception Assessment
Disturbed Sensory Perception Nursing Interventions
Rationale: Promotes self-care and provides support.
Rationale: Provides normal activities and reality orientation.
Rationale: Promotes relaxation and reduces sensory overload.
Rationale: Provides safety measures the patient may be unable to provide themselves.
Deficient Knowledge Care PlanPatients with a new spinal cord injury will likely not fully understand the condition, treatment, and prognosis. The complexity of a spinal cord injury can be challenging to grasp just following the initial trauma, as there may still be many unknowns. As the patient's condition stabilizes, they'll have to learn many new self-care treatments and require lots of education to perform their care independently.
Nurses play a primary role in patient education. They will teach about the injury, prescribed treatments, and any new self-care activities the patient must perform. Nurses also play an essential role in teaching family members and other caregivers how to appropriately provide care for the patient when they return home.
Nursing Diagnosis: Deficient Knowledge
Potentially Related to
Evidenced By
Desired Outcomes
Deficient Knowledge Assessment
Deficient Knowledge Nursing Interventions
Rationale: Provides knowledge for self-care.
Rationale: Empowers the patient to be an active participant in their care.
Rationale: Provides knowledge for self-care and tests retention and understanding.
Rationale: Provides knowledge for self-care.
Rationale: Provides knowledge for self-care.
Rationale: Provides knowledge for self-care.
Rationale: Promotes safety and provides access to emergency assistance when needed.
Rationale: Promotes self-care and acclimation back into the community.
Rationale: Provides access to emergency assistance.
Self-Care Deficit Care PlanSelf-care deficit happens when the patient cannot engage in activities of daily living, including bathing, grooming, dressing, and eating. This nursing problem occurs because of the impaired muscles and nerves from the spinal cord injury. Coping with a self-care deficit can be overwhelming and frustrating for the patient, especially if they were once independent, because now they may need to rely on others for a significant amount of care.
While the self-care deficit is related to the physical nature of the injury, it's crucial to understand that there is a psychological component to this nursing diagnosis for the patient. Nurses, nursing aides, and therapists will provide hands-on care for patients with spinal cord injuries, but it's critical not to treat the patient as though they are a child. Patients should be given as much freedom to choose how and when care is provided so they continue to feel in control.
Nursing Diagnosis: Self-Care Deficit
Potentially Related to
Evidenced By
Desired Outcomes
Self-Care Deficit Assessment
Self-Care Deficit Nursing Interventions
Rationale: Teaches new ways of tackling care activities that promote self-care and independence.
Rationale: Promotes independence.
Rationale: Promotes independence and provides time so they don't get frustrated or feel rushed.
Rationale: Promotes independence and a strong sense of self.
Rationale: Promotes self-care and independence.
Rationale: Provides assistance and promotes safety.
Rationale: Promotes self-care and promotes self-esteem.
More Spinal Cord Injury DiagnosesThe care plan for spinal cord injury can vary depending on the resulting damage and individual patient needs. Other nursing diagnoses to consider may include the following:
Spinal Cord Injury NCLEX Test QuestionsIf you're a student, it's never too early to practice taking NCLEX questions. The care of patients after spinal cord injury will likely be on your test, so practice with the below questions so you can be prepared for the big day!
Q1: What is the most common cause of spinal cord injury?
A1: The most common cause of spinal cord injuries is motor vehicle accidents. Other causes include falls, violence, and sports-related injuries.
Q2: What are the signs and symptoms of spinal cord injury?
A2: Signs and symptoms of spinal cord injuries may include loss of sensation or movement in affected areas, changes in skin color, pain or tingling sensations in hands and feet, difficulty breathing, weakness or lack of coordination, dizziness, and blurred vision.
Q3: How is a spinal cord injury diagnosed?
A3: Spinal cord injuries are typically diagnosed with imaging tests such as MRI, CT scan, and X-rays. Other diagnostic tests may include physical examinations, neurological tests, and laboratory tests.
Q4: What is the treatment for spinal cord injury?
A4: Treatment for spinal cord injuries depends on many factors, such as the location and severity of the injury, and may include surgery, medication, physical therapy, occupational therapy, and lifestyle modifications.
Q5: What is the prognosis for someone with a spinal cord injury?
A5: The prognosis for someone with a spinal cord injury depends on the location and severity of the injury. In some cases, some level of recovery is possible. However, in other cases, the damage may be permanent.
Additional Readings and ResourcesWant more information about caring for patients with spinal cord injuries? Check out these posts on AllNurses:
Wrapping Up Spinal Cord Injury Care PlansSpinal cord injuries require an extreme amount of physical and psychological care. The nurse may be busy performing high-acuity hands-on care during the acute phase. As the patient stabilizes, they'll need holistic psychological and social support. These spinal cord injury nursing diagnoses can help you create comprehensive care plans for your patients.
References
About Melissa Mills, BSN
Melissa is a nurse with over two decades of experience in leadership and workforce development. She loves to help other healthcare professionals advance their careers.
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