Inpatient medical/surgical and subacute/rehabilitation units.
- Disc surgery
- Pneumonia: microbial
- Psychosocial aspects of care
- Thrombophlebitis: deep vein thrombosis
- Total nutritional support: parenteral/enteral feeding
- Upper gastrointestinal/esophageal bleeding
- Ventilatory assistance (mechanical)
- Patient Assessment Database
Paralysis of muscles (flaccid during spinal shock) at/below level of lesion
Muscle/generalized weakness (cord contusion and compression)
- Dizziness with position changes
- Low BP, postural BP changes, bradycardia
- Cool, pale extremities
- Absence of perspiration in affected area
- Incontinence of bladder and bowel
- Urinary retention
- Abdominal distension; loss of bowel sounds
- Melena, coffee-ground emesis/hematemesis
Denial, disbelief, sadness, anger
Fear, anxiety, irritability, withdrawal
Abdominal distension; loss of bowel sounds (paralytic ileus)
Variable level of dependence in ADLs
- Absence of sensation below area of injury, or opposite side sensation
- Numbness, tingling, burning, twitching of arms/legs
- May exhibit: Flaccid paralysis (spasticity may develop as spinal shock resolves, depending on area of cord involvement)
- Loss of sensation (varying degrees may return after spinal shock resolves)
- Loss of muscle/vasomotor tone
- Loss of/asymmetrical reflexes, including deep tendon reflexes
- Changes in pupil reaction, ptosis of upper eyelid
- Loss of sweating in affected area
Pain/tenderness in muscles
Hyperesthesia immediately above level of injury
Vertebral tenderness, deformity
Shortness of breath, “air hunger,” inability to breathe
- Shallow/labored respirations; periods of apnea
- Diminished breath sounds, rhonchi
- Pallor, cyanosis
Temperature fluctuations (taking on temperature of environment)
Expressions of concern about return to normal functioning
Uncontrolled erection (priapism)
- Discharge plan
- DRG projected mean length of inpatient stay: 17.1–90 days (inclusive of inpatient rehabilitation)
- Will require varying degrees of assistance with transportation, shopping, food preparation, self-care, finances, medications/treatment, and homemaker/maintenance tasks
- May require changes in physical layout of home and/or placement in a rehabilitative center
- Refer to section at end of plan for postdischarge considerations.
- Spinal x-rays: Locates level and type of bony injury (fracture, dislocation); determines alignment and reduction after traction or surgery.
- CT scan: Locates injury, evaluates structural alterations. Useful for rapid screening and providing additional information if x-rays questionable for fracture/cord status.
- MRI: Identifies spinal cord lesions, edema, and compression.
- Myelogram: May be done to visualize spinal column if pathology is unclear or if occlusion of spinal subarachnoid space is suspected (not usually done after penetrating injuries).
- Somatosensory evoked potentials (SEP): Elicited by presenting a peripheral stimulus and measuring degree of latency in cortical response to evaluate spinal cord functioning/potential for recovery.
- Chest x-ray: Demonstrates pulmonary status (e.g., changes in level of diaphragm, atelectasis).
- Pulmonary function studies (vital capacity, tidal volume): Measures maximum volume of inspiration and expiration; especially important in patients with low cervical lesions or thoracic lesions with possible phrenic nerve and intercostal muscle involvement.
- ABGs: Indicates effectiveness of gas exchange and ventilatory effort.
- Maximize respiratory function.
- Prevent further injury to spinal cord.
- Promote mobility/independence.
- Prevent or minimize complications.
- Support psychological adjustment of patient/SO.
- Provide information about injury, prognosis and expectations, treatment needs, possible and preventable complications.
- Ventilatory effort adequate for individual needs.
- Spinal injury stabilized.
- Complications prevented/controlled.
- Self-care needs met by self/with assistance, depending on specific situation.
- Beginning to cope with current situation and planning for future.
- Condition/prognosis, therapeutic regimen, and possible complications understood.
- Plan in place to meet needs after discharge.