Spinal Cord Injury | Nursing Diagnosis, Care Plans, & More

This article examines the different types of spinal cord injury nursing diagnoses and related care plans to support post-injury recovery.

Updated:   Published

This article was reviewed and fact-checked by our Editorial Team.
Spinal Cord Injury | Nursing Diagnosis, Care Plans, & More

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 Injury

The 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. 

  • Cervical injuries: Cervical spinal cord injuries are the most severe type of spinal cord injury because they affect a more extensive body area. This type of injury may result in paralysis of all four limbs, quadriplegia, or tetraplegia.
  • Thoracic injuries: Thoracic spinal cord injuries can cause partial paralysis in the legs and arms. They may result in paraplegia or paralysis of the lower body below the injury site.
  • Lumbar injuries: Lumbar spinal cord injuries may result in effects similar to thoracic spinal cord injuries, depending on where the injury occurred.
  • Lumbosacral injuries: Lumbosacral spinal cord injuries may result in incomplete or complete paralysis of the upper and lower extremities.

Complete vs. Incomplete

The main differences between a complete and incomplete injury are seen in the type of remaining function the patient experiences. 

  • Complete injuries result in total paralysis below the injured spinal cord on both sides of the body.
  • Incomplete injuries result in function remaining on one or both sides of the body because the body and brain can still communicate along intact pathways. 

Causes of Spinal Cord Injury

Spinal cord injuries are usually the result of traumatic events. However, they may be related to long-term conditions too. Common causes include:

  • Car accidents 
  • Falls
  • Sports injuries
  • Acts of violence
  • Non-traumatic incidents or conditions

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. 

Assessment 

The 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.

  • Magnetic resonance imaging, or MRI, creates 3D pictures of the body, including organs, tissues, bones, and nerves. It is a valuable tool for uncovering brain or spine trauma from an accident, observing herniated discs between vertebrae parts, and vascular issues such as bleeding and inflammation that can compress the spinal cord area.
  • Computerized tomography (CT) scans are invaluable in diagnosing various medical conditions, providing clinicians with clear two-dimensional images of bones, organs, and tissues. 
  • X-rays provide comprehensive views of body parts, such as joints and organs. Within minutes, an X-ray can detect misalignments or fractures in the spine.

At-Risk Populations

Multiple populations have an increased risk of sustaining a spinal cord injury. Risk factors include the following:

  • Motor vehicle accidents account for almost half of all spinal cord injuries, the vast majority from car accidents. People who drive often or engage in reckless behaviors while driving are at an increased risk of spinal injury.
  • Falls account for about one-quarter of spinal cord injuries, and the risk increases with age. Individuals over 65 with chronic diseases that cause mobility limitations are at risk for a spinal cord injury due to falls. 
  • Violence or assaults account for about 15 percent of spinal cord injuries. Anyone engaging in potentially risky behaviors is at risk of sustaining a spinal cord injury.
  • Athletes are likely to suffer from an incomplete traumatic spinal cord injury. Those that play contact sports, such as football and rugby, are especially at risk. 

Complications

Since 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:

  • Respiratory problems: If the spine gets damaged in the thoracic or cervical region, it can interfere with one's breathing ability and lead to complications such as pneumonia and atelectasis.
  • Urinary tract infections: With a spinal cord injury, the bladder may lose its ability to empty completely, leading to urinary tract infections. The patient may also experience bladder spams that can be uncomfortable and cause incontinence. 
  • Muscle and joint pain: The muscles may weaken, leading to reduced muscle tone, contractures, and joint and muscle pain. While the patient may not fully feel their extremities, they may still feel sensations, pain, and discomfort. 
  • Autonomic dysreflexia occurs when the nervous system overreacts to specific triggers, increasing blood pressure, lowering pulse, and causing flushing and headaches. Stimulation as simple as a full bladder, constipation, a sunburn, or an ingrown toenail can be enough to trigger this response.
  • Pressure sores: Patients with an absent or limited ability to change position may develop pressure sores due to the lack of sensation and decreased mobility. If not properly cared for, pressure sores can lead to mild or severe infections. 
  • Sexual dysfunction: Patients may experience erectile dysfunction or difficulty in achieving orgasm. This complication can be challenging for the patient to deal with psychologically.
  • Increased risk of heart problems: Heart problems can onset other issues like an increased risk of stroke or heart attack due to decreased physical activity.
  • Inability to control blood pressure: Patients experience fluctuations in blood pressure, experiencing both hypotension and hypertension, leading to potential health risks.

Treatments

Many 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:

  • Surgery: If the injury is severe, surgery may be necessary to stabilize and reduce spinal deformity.
  • Physical therapy: Physical therapists will work with individuals who have sustained a spinal cord injury to help them regain strength, balance, and coordination. Long-term physical therapy can help reduce pain and minimize the risk of contractures through splinting and other devices.
  • Occupational therapy: Occupational therapists teach patients new ways of performing activities of daily living, such as dressing, bathing, and cooking.
  • Medications: Medications may help manage pain, spasticity, and other complications of spinal cord injury.
  • Assistive devices: Assistive devices can help with mobility and daily activities. Such devices may include wheelchairs, walkers, or scooters.

Nurse's Role Caring for a Patient With Spinal Cord Injury

A 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 Injury

A 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 Plan 

An 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

  • Partial or complete loss of intercostal muscle function
  • Impairment of nerve innervation to the diaphragm (lesions at or above C-5)
  • Gastric distension
  • Reflexive abdominal spasms

Evidenced By

  • Bradypnea
  • Dyspnea
  • Nasal flaring
  • Accessory muscle use
  • Orthopnea
  • Shortness of breath
  • The abnormal or dysfunctional rhythm of breathing

Desired Outcomes

  • The patient will report more comfort in breathing.
  • The patient demonstrates an adequate oxygen saturation level.
  • The patient maintains a breathing pattern within normal limits,  characterized by normal rate, depth, and rhythm.

Risk for Ineffective Breathing Assessment

  1. Assess the patient's respiratory rate periodically.
  2. Auscultate lung sounds in all fields frequently.
  3. Monitor the patient's breathing pattern for apnea, ataxic, or Cheyne-Stokes respiration abnormalities.
  4. Assess for an effective cough to move secretions.
  5. Monitor for cyanosis or dusky skin tones. 
  6. Observe for abdominal distension or muscle spasms.
  7. Monitor pulse oximetry and serial ABGs.

Risk for Ineffective Breathing Nursing Interventions

  1. Encourage the patient to breathe slowly and deeply when experiencing dyspnea.
    Rationale: Helps to open the airways and reduce shortness of breath.
  2. Provide oxygen therapy as prescribed.
    Rationale: Helps to improve oxygen saturation levels.
  3. Educate on breathing exercises, such as pursed lip breathing, diaphragmatic breathing, and abdominal breathing, as indicated. 
    Rationale: Slows the breathing down, eases effort, and increases oxygenation.
  4. Refer to respiratory and physical therapy as needed.
    Rationale: Specialized therapists can educate on exercises to strengthen muscles and the effort needed to mobilize secretions.
  5. Assist with positioning techniques that are comfortable for the patient and promote relaxation.
    Rationale: Allows for optimal air entry and expansion of all lung fields.
  6. Encourage the patient to cough and perform the "quad cough" as needed.
    Rationale: Mobilizes secretions so they can be suctioned.
  7. Suction as needed. 
    Rationale: Removes secretions and improves oxygenation.

Risk for Autonomic Dysreflexia Care Plan 

Autonomic 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

  • Distention of the bladder
  • Urinary tract infection
  • Pressure sores
  • Fecal impaction
  • Bladder spasms
  • Constipation
  • Digital stimulation
  • Hemorrhoids
  • Tight or lumpy clothing
  • Ingrown toenails

Evidenced By

  • High blood pressure
  • Bradycardia
  • Redness or flushing above the level of the injury
  • Pale skin below the level of the injury
  • Headache
  • Nasal Congestion
  • Nausea
  • Vomiting
  • Blurred vision
  • Feelings of anxiety or impending doom

Desired Outcomes

  • The patient reports no symptoms of autonomic dysreflexia.
  • The patient will understand the triggers of autonomic dysreflexia.
  • The patient will verbalize three preventative measures to prevent autonomic dysreflexia.
  • The patient will verbalize three corrective measures.

Risk for Autonomic Dysreflexia Assessment 

  1. Assess for the presence of triggers of autonomic dysreflexia.
  2. Monitor for signs of autonomic dysreflexia, such as high blood pressure, rapid heart rate, redness of the face and neck, flushing, enlarged pupils, headache, or nasal congestion.
  3. Obtain blood pressure every 3-5 mins during an episode. 
  4. Obtain a urine culture if a UTI is suspected.

Risk for Autonomic Dysreflexia Nursing Interventions 

  1. Provide education about the condition and triggers of autonomic dysreflexia.
    Rationale: Promotes self-care and prevention.
  2. Administer medications as indicated for high blood pressure, bradycardia, and other conditions.
    Rationale: Treats condition and minimizes complications
  3. Eliminate any known stimulus.
    Rationale: Helps to stop the episode.
  4. Stay with the patient during the episode.
    Rationale: Reduces complications, allows quick treatment, and helps calm the patient.
  5. Place the patient in a sitting position or raise the head of the bed as tolerated.
    Rationale: Reduces blood pressure and prevents seizures, stroke, and intracranial hemorrhage.

Risk for Impaired Skin Integrity Care Plan 

The 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

  • Paralysis
  • Immobility
  • Pressure on the skin
  • Edema
  • Poor circulation
  • Altered metabolic state

Evidenced By

  • Pressure sore or ulcers
  • Redness of the skin
  • Pain or discomfort
  • Warmth
  • Color changes to the skin

Desired Outcomes

  • The patient will verbalize the risk factors of pressure ulcers.
  • The patient will verbalize strategies to prevent pressure ulcers. 
  • The patient will understand the importance of proper skincare and how to prevent further damage.

Risk for Impaired Skin Integrity Assessment

  1. Assess skin integrity of paralyzed areas regularly, noting redness, warmth, swelling, and discoloration.
  2. Monitor areas at risk of developing pressure ulcers more frequently, including the back of the head, skin folds, and bony prominences.

Risk for Impaired Skin Integrity Interventions 

  1. Provide education about proper skin care and prevention of pressure ulcers.
    Rationale: Promotes self-care and prevention.
  2. Turn the patient at least every two hours. 
    Rationale: Reduces pressure and promotes circulation to affected areas.
  3. Use positioning devices, such as pillows or foam wedges, as indicated. 
    Rationale: Relieves the pressure on bony regions and minimizes skin breakdown.
  4. Assist the patient in keeping the skin clean, dry, and moisturized.
     Rationale: Promotes skin health and reduces the risk of breakdown. 
  5. Assess the skin routinely for signs of infection, redness, open areas, and warmth.
    Rationale: Provides an opportunity to address any skin issues quickly. 
  6. Educate the patient on the importance of proper nutrition and hydration.
    Rationale: Keeps the skin hydrated and healthy, reducing the breakdown risk. 
  7. Use specialized mattresses as indicated.
    Rationale: Reduces pressure points and minimizes the risk of skin breakdown. 

Impaired Physical Mobility Care Plan

Physical 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

  • Impaired neuromuscular function
  • Immobilization from splinting, traction, or recent surgery

Evidenced By

  • Unable to move 
  • Paralysis
  • Decreased range of motion
  • Contractures
  • Atrophy of muscles

Desired Outcomes

  • The patient will maintain proper body alignment, evidenced by an absence of foot-drop or contractures.
  • The patient will maintain strength within normal limits in all non-involved body parts or extremities.
  • The patient will achieve an increased level of independence.

Impaired Physical Mobility Assessment 

  1. Assess the patient's motor function for appropriateness related to the level of injury. 
  2. Assess the patient's skin integrity daily. 
  3. Observe the patient's range of motion and ability to complete daily tasks independently.
  4. Assess for signs of pulmonary emboli, such as dyspnea or cyanosis. 
  5. Assess for signs of peripheral blood clots, such as redness or warmth in the lower extremities. 

Impaired Physical Mobility Nursing Interventions

  1. Encourage patients to be as active and involved in their care as possible.
    Rationale: Promotes independence and positive mental health.
  2. Encourage the use of adaptive equipment as needed.
    Rationale: Promotes independence. 
  3. Initiate referrals for physical and occupational therapy if needed.
    Rationale: Utilizes specialized therapists to promote physical movement and independence. 
  4. Provide a method for the patient to signal when they need help.
    Rationale: Promotes independence while reducing fears about being unable to move or care for oneself alone. 
  5. Assist with ROM and physical therapy exercises as needed. 
    Rationale: Enhances circulation and prevents contractures and muscle atrophy.
  6. Apply splints and other positioning devices as indicated. 
    Rationale: Maintains proper joint alignment and reduces the risk of contractures. 
  7. Reposition the patient often. 
    Rationale: Reduces the risk of pressure ulcers. 
  8. Encourage respiratory health, such as deep breathing, suctioning, and coughing. 
    Rationale: Reduces the risk of respiratory infection caused by immobility. 
  9. Apply sequential compression devices or compression stockings as needed. 
    Rationale: Reduces the risk of blood clots by improving leg vasomotor tone. 

Acute Pain Care Plan

Acute 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

  • Trauma or physical injury

Evidenced By

  • Self-reporting of pain 
  • Increased heart rate and blood pressure
  • Increased sensitivity to stimulation above the injury
  • Reports of burning pain below the level of injury
  • Muscle tension
  • Muscle spasms
  • Phantom pain
  • Headaches

Desired Outcomes

  • The patient will report a decrease in pain intensity.
  • The patient will demonstrate the ability to self-manage pain adequately.
  • The patient will demonstrate relaxation and other non-drug strategies to manage pain. 
  • The patient will participate in activities of daily living with minimal pain interference.

Acute Pain Assessment 

  1. Assess the patient's level of pain using a 0-10 scale frequently.
  2. Observe the patient's behavior for signs of pain, such as increased muscle spasms, restlessness, irritability, or change in vital signs.
  3. Evaluate the patient's response to analgesics and non-pharmacologic pain relief strategies.
  4. Assess the patient's ability to function in activities of daily living.

Acute Pain Nursing Interventions

  1. Encourage the patient to rest as needed.
    Rationale: Getting rest can help reduce the intensity of pain.
  2. Provide pain relief medications as needed.
    Rationale: Reduces pain levels. 
  3. Provide education about proper body mechanics, splinting, and positioning to relieve pressure on affected areas.
    Rationale: Reduces pressure and maintains proper body alignment, thereby reducing 
    pain. 
  4. Implement non-pharmacological strategies, such as massage and warm/cold compresses.
    Rationale: Reduces pain levels without the use of medications.
  5. Educate the patient on relaxation techniques, such as meditation and deep breathing. 
    Rationale: Promotes pain relief without the use of medications.

Risk for Constipation Care Plan

Constipation 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

  • Immobility and decreased physical activity
  • Lack of nerve innervation to the bowel and rectum
  • Perceived impairment
  • Poor diets, such as inadequate fluid or fiber intake

Evidenced By

  • Fewer bowel movements than usual
  • Difficulty in passing stool
  • Abdominal cramps
  • Nausea and vomiting
  • Anorexia
  • Inability to expel stool voluntarily
  • Ileus

Desired Outcomes

  • The patient will have sufficient elimination without difficulty.
  • The patient will participate in a bowel program. 
  • The patient will demonstrate proper bowel care techniques.
  • The patient will report decreased pain and discomfort related to constipation.

Risk for Constipation Assessment

  1. Assess for pain related to constipation.
  2. Record the frequency, amount, and consistency of bowel movements.
  3.  Observe the patient's behavior and response to constipation.
  4. Assess for medications that may contribute to constipation.
  5. Auscultate the location and characteristics of bowel sounds.
  6. Assess for abdominal distension, especially in the presence of decreased or absent bowel sounds.
  7. Assess for nausea and vomiting.
  8. Assess for blood in vomit, gastric secretions, and stool.
  9. Monitor for the signs of impaction, such as the absence of stools for several days, semiliquid stools, abdominal distension, restlessness, or reports of abdominal pressure or pain.

Risk for Constipation Nursing Interventions 

  1. Create and administer a daily bowel program that may include stool softeners, prune juice, digital stimulation, or suppositories. 
    Rationale: Assists with bowel evacuation when the patient can't perform voluntarily.
  2. Educate the patient on a high-fiber diet and increased fluid intake. 
    Rationale: Improves the consistency of the stool and movement through the bowel. 
  3. Encourage the patient to change positions as tolerated, including sitting up in a chair and increasing activity.
    Rationale: Help to move stool through the bowel. 
  4. Insert an NG tube and attach it to suction, as necessary.
    Rationale: Reduces bowel distension and prevents nausea and vomiting.
  5. Insert a rectal tube as needed. 
    Rationale: Reduces bowel distension. 
  6. Administer medications, such as laxatives, stool softeners, and antacids, if indicated. 
    Rationale: Alleviates symptoms of constipation and promotes defecation. 

Impaired Urinary Elimination Care Plan 

It'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

  • Bladder atony
  • Disruption in nerve innervation to the bladder

Evidenced By

  • Bladder distension
  • Incontinence or overflow
  • Urinary retention
  • Bladder or kidney stones
  • Renal dysfunction
  • Urinary tract infections

Desired Outcomes

  • The patient will participate in a daily bladder program. 
  • The patient will verbalize/demonstrate how to prevent urinary retention. 
  • The patient will verbalize/demonstrate how to prevent urinary tract infections.

Impaired Urinary Elimination Assessment 

  1. Assess for bladder distention. 
  2. Observe for bladder overflow.
  3. Observe the signs of urinary tract infection, such as bloody or cloudy urine, foul odor, or sediment in the urine. 
  4. Check the urine for the presence of bacteria.
  5. Assess the patient's urinary patterns, such as frequency and amount.
  6. Monitor urinary tract health laboratory values, such as BUN and creatinine.
  7. Assess residual urine amounts via postvoid ultrasound or catheterization.

Impaired Urinary Elimination Nursing Interventions

  1. Implement bladder retraining techniques, such as fluid management, timed voiding, and bladder stretching exercises. 
    Rationale:  Improves urinary control. 
  2. Encourage the patient to drink between 2 and 4 liters of fluid daily, if not contraindicated.
    Rationale: Promotes urine production and reduces the risk of a urinary tract infection.
  3. Provide urinary catheter care per protocols.
    Rationale: Reduces the risk of urinary tract infection. 
  4. Teach the patient or family members how to perform intermittent catheterization as needed. 
    Rationale: Promotes self-care and decreases the risk of urinary tract infection. 
  5. Educate on the importance of increased mobility.
    Rationale: Reduces urine retention and improves bladder muscle strength.

Anticipatory Grieving Care Plan

Patients 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

  • Loss of physical abilities
  • Unfamiliar environment
  • Fear of the unknown
  • Forced changes in lifestyle due to spinal cord injury
  • Impact on relationships

Evidenced By

  • Sadness
  • Feelings of hopelessness
  • Withdrawal from activities and social contacts
  • Increased anxiety or fear
  • Depression
  • Anger
  • Bereavement
  • Changes in sleep patterns

Desired Outcomes

  • The patient will verbalize an understanding of anticipatory grief.
  • The patient will demonstrate effective coping strategies to manage grief reactions.
  • The patient will be able to express feelings openly.

Anticipatory Grieving Assessment 

  1. Assess the patient's knowledge and understanding of their spinal cord injury.
  2. Observe signs or symptoms of anticipatory grief, such as depression, anxiety, and sadness.
  3. Assess for signs of grieving (shock, denial, anger, depression)

Anticipatory Grieving Interventions 

  1. Provide a safe space for the patient to talk about their feelings. 
    Rationale: Promotes self-expression of feelings.
  2. Educate the patient and family regarding anticipatory grief and the available resources to help cope.
    Rationale: Increases knowledge that this is considered normal and provides help.
  3. Refer the patient to a psychologist, psychiatrist, or other mental health professional, if needed. 
    Rationale: Provides specialized mental health and grief counseling care.
  4. Administer anti-anxiety and antidepressants as prescribed. 
    Rationale: Treats anxiety and depression.

Situational Low Self-Esteem Care Plan

Low 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

  • Loss of physical abilities
  • Changes in appearance and physical function
  • Needing help to perform activities of daily living
  • Impact on relationships

Evidenced By

  • Reduced or negative self-talk
  • Anxiety
  • Lack of motivation
  • Lack of resilience
  • Focusing on their past abilities
  • Feelings of hopelessness or helplessness
  • Withdrawing from social interactions
  • Verbalization of confusion about the purpose of their life

Desired Outcomes

  • The patient will verbalize an improved sense of self-worth.
  • The patient will demonstrate positive and realistic thoughts about themselves.
  • The patient will engage in activities that are meaningful and enjoyable.
  • The patient will actively participate in therapy and other activities to boost self-esteem and morale.

Situational Low Self-Esteem Assessment 

  1. Assess the patient's knowledge and understanding of their spinal cord injury.
  2. Observe for any signs of low self-esteem, such as reduced or negative self-talk, lack of motivation, or avoidance of activities.
  3. Assess the patient's emotional state, including signs of anxiety or depression.
  4. Review any prior medical history, such as psychiatric diagnoses, previous mental health treatments, and use of medications for mental health.
  5. Actively listen to the patient's statements about their situation and feelings. 
  6. Assess how the patient interacts with their family and close friends. 
  7. Observe for inappropriate sexual comments or behaviors. 

Situational Low Self-Esteem Nursing Interventions

  1. Provide patient and family with education regarding low self-esteem and the available resources to help cope.
    Rationale: Promotes self-care and knowledge of the condition. 
  2. Refer the patient and family to counseling or support groups as needed.
    Rationale: Establishes community support.
  3. Educate the patient and family on healthy expression and understanding.
    Rationale: Promotes self-care and realistic coping strategies.
  4. Provide accurate information about their prognosis, treatment, and chronicity of the condition. 
    Rationale: Provides education and allows them to set realistic goals for the future. 
  5. Talk with the patient about the changes in their relationships and roles. 
    Rationale: Allows for an open, honest conversation with support. 
  6. Find another person with a spinal cord injury willing to speak to the patient about coping with the changes. 
    Rationale: Provides hope and gives them a role model for the future. 

Disturbed Sensory Perception Care Plan

When 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

  • Changes to sensory reception secondary to the spinal cord injury

Evidenced By

  • Changes in proprioception
  • Changes to sensory acuity
  • Uncoordinated motor movements

Desired Outcomes

  • The patient will demonstrate improved sensory perception.
  • The patient will communicate an understanding of their environment, situation, and feelings of security.
  • The patient will verbalize strategies to compensate for their sensory changes.

Disturbed Sensory Perception Assessment 

  1. Assess the patient's sensory function by asking when they feel touch, hot/cold, or pinprick sensations. 
  2. Assess the patient's knowledge and understanding of their spinal cord injury.
  3. Observe for any signs or symptoms of disturbed sensory perception, such as confusion and disorientation.
  4. Assess the patient's current emotional state, including signs of anxiety or depression.
  5. Review any medical history, such as psychiatric diagnoses, previous mental health treatments, environment, and stimulation level.
  6. Ask the patient if they are experiencing any difficulties with sensory perception.

Disturbed Sensory Perception Nursing Interventions 

  1. Provide patient and family with education regarding disturbed sensory perception and the available resources to help cope.
    Rationale: Promotes self-care and provides support. 
  2. Encourage the patient to engage in meaningful and enjoyable activities.
    Rationale: Provides normal activities and reality orientation.
  3. Incorporate relaxation techniques, such as deep breathing and meditation, into the care plan.
    Rationale: Promotes relaxation and reduces sensory overload. 
  4. Protect from falls, burns, and improper positioning of extremities. 
    Rationale: Provides safety measures the patient may be unable to provide themselves.

Deficient Knowledge Care Plan 

Patients 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

  • Lack of access to information
  • Cognitive deficits related to the injury
  • New information
  • Misinterpretation of information

Evidenced By

  • Expressing uncertainty or misconceptions
  • Inability to answer questions related to injury/treatment
  • Questions or requests for information
  • Inappropriate behaviors, such as agitation or apathy

Desired Outcomes

  • The patient will demonstrate an understanding of information related to the injury and treatments.
  • The patient will express increased comfort in discussing the injury/treatment.
  • The patient will apply strategies to manage changes caused by the injury.

Deficient Knowledge Assessment

  1. Assess the patient's understanding of their injury/treatment.
  2. Identify any gaps in knowledge or confusion the patient may have regarding the injury/treatment.
  3. Assess the patient's understanding of the mental and physical changes caused by the injury.

Deficient Knowledge Nursing Interventions 

  1. Educate the patient and family about the injury, treatment, and self-care needs.
    Rationale: Provides knowledge for self-care.
  2. Engage in self-directed and designed learning.
    Rationale: Empowers the patient to be an active participant in their care. 
  3. Teach the patient self-care activities and use the teach-back method for activities such as positioning, splint application, or catheterization. 
    Rationale: Provides knowledge for self-care and tests retention and understanding. 
  4. Educate the patient on the importance of participating in daily exercises or therapies, such as physical therapy or occupational therapy.
    Rationale: Provides knowledge for self-care. 
  5. Educate on the use, dose, and side effects of all medications. 
    Rationale: Provides knowledge for self-care. 
  6. Instruct on proper skin care routines, such as skin assessment, keeping skin clean and dry, and using specialized skin devices such as foam or silicone gel. 
    Rationale: Provides knowledge for self-care. 
  7. Provide a call system and other emergency assistance or e    equipment as needed. 
    Rationale: Promotes safety and provides access to emergency assistance when needed. 
  8. Coordinate care with community-based providers and programs as needed. 
    Rationale: Promotes self-care and acclimation back into the community.
  9. Educate the patient on the need to notify their electric company and other utilities if being without power causes significant health problems, as seen with ventilator support.
    Rationale: Provides access to emergency assistance.  

Self-Care Deficit Care Plan 

Self-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

  • Physical limitations; immobility
  • Paralysis
  • Weakness of muscles
  • Impaired or absent nerve transmission

Evidenced By

  • Inability to perform activities of daily living
  • Verbal and nonverbal expressions of frustration or fatigue
  • Physical limitations that interfere with self-care

Desired Outcomes

  •  The patient will demonstrate how to safely perform self-care activities with or without using adaptive equipment.
  • The patient will actively participate in determining what activities they need help with and what they can perform independently.
  • The patient will verbalize all steps they must take to perform a self-care task safely and independently. 

Self-Care Deficit Assessment 

  1. Assess the patient's current abilities to perform self-care activities.
  2. Identify any physical or cognitive limitations that may interfere with self-care.
  3. Assess the patient's current support system and their willingness and ability to help with personal care needs.

Self-Care Deficit Nursing Interventions 

  1. Educate the patient on strategies they can use to be as independent as possible during care activities. 
    Rationale: Teaches new ways of tackling care activities that promote self-care and independence. 
  2. Encourage the patient to perform self-care activities when possible. 
    Rationale: Promotes independence. 
  3. Give the patient as much time as needed to perform care themselves.
    Rationale: Promotes independence and provides time so they don't get frustrated or feel rushed. 
  4. Encourage the patient to make decisions about their care. 
    Rationale: Promotes independence and a strong sense of self. 
  5. Ask for a referral to occupational therapy for a home assessment to make suggestions on modifications that can be made to allow the patient to remain independent in their care. 
    Rationale: Promotes self-care and independence. 
  6. Request a referral to home care services for personal care assistance.
    Rationale: Provides assistance and promotes safety. 
  7. Encourage the patient and their family to understand their needs for independence and dependence.
    Rationale: Promotes self-care and promotes self-esteem. 

More Spinal Cord Injury Diagnoses

The 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:

  • Risk for Trauma
  • Risk for infection related to compromised skin
  • Grieving
  • Constipation
  • Risk for disuse syndrome
  • Lack of caregiver knowledge

Spinal Cord Injury NCLEX Test Questions

If 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 Resources

Want more information about caring for patients with spinal cord injuries? Check out these posts on AllNurses:

Wrapping Up Spinal Cord Injury Care Plans

Spinal 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

  1. Spinal Cord Injury Facts and Figures at a Glance
  2. Classifications In Brief: American Spinal Injury Association (ASIA) Impairment Scale
  3. Cervical Injury
  4. Neurological and Functional Recovery After Thoracic Spinal Cord Injury
  5. Lumbar Spine Injuries in Sports: Review of the Literature and Current Treatment Recommendations
  6. Lumbosacral Spine Acute Bony Injuries
  7. Spinal Cord Injuries
  8. MRI Scans
  9. Computed Tomography (CT)
  10. Spinal Cord Injury
  11. Autonomic dysreflexia
  12. Cheyne Stokes Respirations
  13. Autonomic dysreflexia
  14. IASP Terminology
  15. Spinal Shock (Nursing) 
  16. Spinal cord Injury
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Melissa Mills

About Melissa Mills, BSN

Workforce Development Columnist

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.

126 Articles   373 Posts

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Specializes in Home Health, PDN, LTC, subacute.

Thank you.  This is very comprehensive.  When I take my client, who has C-4 quadriplegia to the hospital, not everyone understands autonomic dysreflexia and how dangerous it can be.  

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