Spinal cord injury

Added: 2026-05-10

[00:00:00]Welcome to today's session. In today's surgery session, we are looking at spinal injury.

[00:00:07]So, we'll go straight to the question for spinal injury.

[00:00:12]So, the question reads, "Mr. Nyambe, a 25-year-old bricklayer, sustains a spinal cord injury after falling off the ladder during his construction work.

[00:00:23]He is admitted to your ward." Question A1, "Define spinal cord injury." So, we can define spinal cord injury as "This is the damage to any part of the spinal cord or nerve endings of the spinal canal characterized by stiff muscles, uh reduced sensation on touch, and also reduced uh physical mobility."

[00:00:53]So, when we talk about injury to the spinal cord, we are talking about injury to any portion of the spinal cord >> [snorts] >> from the branching uh from the branching of the cervical spinal region all the way to the thoracic region and this lumbar region. Any injury to this particular portion, then we're talking about this person to have suffered from spinal cord injury. And normally, when there's injury to the spinal region, you've seen uh stiff muscles because the nerves cannot uh uh transmit impulses correctly to the muscles to the neuromuscular junction muscles. Apart from that, you may see reduced sensation on touch. This person may have difficulties with physical mobility depending on the type of um uh nerves that have been injured during this particular uh accident. So, basically, that is what how we can define uh spinal cord injury.

[00:01:54]Question A2 says, "Explain five causes of predisposing factors to spinal cord injury."

[00:02:00]injury.

[00:02:02]The first one, like the scenario says, trauma itself. So, one of the commonest causes of uh of spinal cord injuries trauma, which can occur due to accident or violence.

[00:02:16]For example, where an individual is involved in a motor uh vehicle accident.

[00:02:22]Uh apart from that, falls like our scenario, an individual falls from high heights and ends up injuring themselves on the spinal region. Sometimes it could be sports injuries, where an individual sustains spinal cord injury during um uh sports or even uh acts of violence.

[00:02:43]These are physical traumas examples. So, acts of violence when an where an individual sustains maybe a stab or gunshot uh injury to the spinal region.

[00:02:56]All these can cause injury to the spinal cord. Apart from that, apart from these examples I've given in terms of uh the trauma, you can write any of them or all of them.

[00:03:08]Uh we also have degenerative conditions.

[00:03:12]Degenerative conditions uh can lead to spinal cord injury over time. For example, osteoarthritis, uh which can cause the vertebrae to compress on the on the spinal cord.

[00:03:25]Apart from that, degenerative disc diseases, uh which can cause herniation of the of the spinal disc, uh causing spinal cord injury. So, those two are examples of degenerative conditions. We also have infections uh that can damage the spinal cord.

[00:03:46]Uh for example, the patient may have spinal epidural abscess. Uh this infection can compress the spinal cord causing damage.

[00:03:56]Meningitis.

[00:03:57]And with meningitis, this causes inflammation of the protective membrane of the brain and the spinal cord.

[00:04:06]And this can cause injuries if not treated faster. Apart from that, we have tumors.

[00:04:15]With the tumors, we are talking of, for example, spinal cord tumors, whether benign or malignant. This can cause injury by compressing the spinal cord tissue. We have other disorders like vascular disorders, condition that affect blood flow to the spinal cord can cause injury where the spinal cord has spinal where the patient may be a spinal cord ischemia. Uh this can cause injury to the spinal cord itself. So, these are examples in terms of vascular disorders, tumors, infections, degenerative diseases, and trauma that can cause spinal cord injury.

[00:05:01]Question B is saying, "With the aid of a well-labeled diagram, explain the simple reflex action." So, when we talk about the simple reflex action, of course, you can utilize this particular diagram. On a stage one, there's always a stimulus, uh which can be heat or anything else.

[00:05:22]So, in this particular case, we are using an example of heat. So, this particular individual is exposed to heat. Immediately, the hand or any portion of the body is exposed to a stimulus like heat, the pain receptors on stage two will be stimulated. And these pain receptors basically will now send signals along the a neuron. And where are these signals going to? They are going to the brain. So, once the sensory neurons receive these particular signals, the signals will be passed on along a relay of neurons. And the message now is sent to the brain. So, these relay neurons take the information to the brain so that the brain interprets whatever this hand or portion of the body has been exposed to. So, once the brain has interpreted that particular information, the information comes back. This is, of course, our spinal cord. So, the information will be sent back back to the body or the portion of the body exposed to the stimulus by using the motor neurons. So, once the motor neurons receives this information, the information will be directly innervated on the effector muscle. And the effector muscles will then contract. Once the effector muscles contract, it will force the hand that was exposed to this heat to move away from this heat. So, you need to understand that this is what we call as a simple reflex action. And this simple reflex action occurs at a very faster pace, and the brain receives this information at a very faster pace as well. Such that you'll be able to move your hand away from any stimulus or stimuli within seconds before your you even experience that um uh that damage to the hand or any portion of the body. But, an individual who has a spinal cord injury, they may not be able to perform these simple reflex actions because the nerves are damaged, and the nerves cannot conduct information normally to to have this reflex action performed on any portion of the body. So, this is the simple reflex see action.

[00:07:52]Okay, the next question was saying identify five nursing problems that Mr. Nyambe may may have during hospitalization and using a nursing care plan, outline how you are going to manage them.

[00:08:07]So, I will for for those of you who may have challenges on filling up the nursing care plan, please be sure to look out for the nursing care plan and read it through on the YouTube channel because how you do finish up this problem I will mention is a similar. So, go through the nursing care plan that I've done on this channel and you'll be able to get the information correctly.

[00:08:33]But, amongst the problem in terms of the nursing diagnosis that we can see in this particular individual the first one is pain on the spinal region and pain on the spinal region is related to nerve injuries of the spinal cord evidenced by patient's verbalization of spinal pain.

[00:08:54]The other problem that we can see is impaired physical mobility. So, impaired physical mobility is related to loss of motor function evidenced by failure to move the affected limbs.

[00:09:07]The other point or problem that we can see in terms of the diagnosis is activity intolerance. So, activity intolerance is related to presence of spinal pain evidenced by patient's inability to perform activities of daily living. The other problem are risk problems of course, we can see risk for nutritional deficit less than the body requirement related to inability of the patient to to take enough foods or even to swallow.

[00:09:43]The other problem is risk for pressure sore formation related to impaired physical mobility. We can also see risk for fluid volume deficit related to patient's inability to take in enough fluids.

[00:09:59]Risk for ineffective breathing pattern related to damage of the spinal region causing paralysis to the respiratory muscles. Now, this is a risk because in this particular scenario, we don't know which portion of the spinal cord has been injured. Probably if it's the lumbar region, maybe the patient may not have the difficulties in breathing, hence it is a risk. But if the question maybe says the patient has sustained spinal cord injury to the C3 or cervical region or the thoracic region, then we can put this as an actual problem. So these are some of the nursing care plan problem that we can see in this particular condition.

[00:10:50]Then the last question is saying mention four complications that Mr. Nyambe may have and explain how you are going to manage each of them.

[00:10:59]So among us the problems that or complications that the patient may have is and the first one is pressure ulcers.

[00:11:08]So with pressure ulcers, the pressure ulcers are skin injury that are caused by prolonged pressure, especially in areas where there is bone prominence, like the sacrum, the hips, the heels, and they can range from mild redness to severe open sores. So how to manage this complication is that to prevent pressure sores, you need to regularly position the patient I mean, you need to regularly position or change the position of the patient.

[00:11:44]Apart from that, specialized mattresses and cushions can help distribute the pressure evenly. So, proper skin care, including keeping the skin clean and moisturized by doing pressure area care is very important as well as early detection and treatment of any signs of pressure sores can prevent severe complications.

[00:12:09]The other complication that we can see is urinary tract infections.

[00:12:14]Now, due to disrupted nerve signals, bladder control is often often compromised in spinal cord injuries. And this can lead to issues like urinary urine retention or incontinence. And this increases the risk of urinary tract infections. So, how can we prevent this?

[00:12:36]Normally, bladder management program is essential, often involving catheterization, where you have the indwelling catheters, bladder stimulation techniques, maintaining good hygiene, and drinking a lot of water or fluids can help reduce the risk of urinary tract infection. At the same time, we can give the patient antibiotics to prevent the infection.

[00:13:03]Apart from that, the other complication that can be seen in spinal cord injury is what is known as a spas- spas- spasticity.

[00:13:12]So, when we talk about spasticity, this is where there is involuntary tightening or stiffness of the muscles, which can affect mobility and comfort.

[00:13:24]So, how do we manage this? Normally, physical therapy and regular stretching exercises are key to managing spasticity.

[00:13:34]Medication like like botulinum toxin injection can be prescribed to reduce muscle tightness. Apart from that, in severe cases, surgical interventions like intrathecal baclofen pump can be considered and this can reduce muscle stiffness.

[00:13:59]The fourth one is autonomic dysreflexia.

[00:14:03]So, with autonomic dysreflexia as a complication, uh when we talk about autonomic dysreflexia, dysreflexia dysreflexia is uh this is where we're talking about a potential life-threatening condition in which an irritant below the level of the spinal cord injury triggers a dangerous spike in blood pressure.

[00:14:29]And common triggers include a full bladder, constipation, or pressure sores. These can cause or trigger a spike or an increase drastic in the blood pressure. And then the patient will be deemed as having an autonomic dysreflexia.

[00:14:46]Because the nerves have been automatically stimulated by another organ or an organ below the level of the injury of the spinal cord.

[00:14:57]So, how do we manage this?

[00:15:00]To manage this complication, we first identify and address the trigger. That is the first step. Apart from that, then quick action to lower the blood pressure is crucial, such as making the patient to sit upright and loosening the tight clothings. Medications like antihypertensives are necessary. And of course, other interventions may be used.

[00:15:26]Then the other complication is deep vein thrombosis or pulmonary embolism. Both can be seen in spinal cord injury.

[00:15:35]>> [snorts] >> So, with deep vein thrombosis, this can normally occur where there is reduced mobility, and this increases the risk of blood clots in the deep veins, which can potentially lead to pulmonary embolism if the clots travel to the lungs.

[00:15:54]Then [snorts] how do we manage this? To prevent deep vein thrombosis, we normally advise regular movements of the patient or exercises, compression stockings. Apart from that, we can use pneumatic compression devices. We can use anticoagulants like heparin or warfarin.

[00:16:14]Apart from that, of course, regular exercises, which can be minimal exercises, or you're doing passive exercises on the patient. All these can prevent deep vein thrombosis. Even low-dose aspirin can be used to prevent pulmonary embolism or deep vein thrombosis. So, that is how this question could be attempted. So, thank you so much for taking time to go through today's session. Till next time. Goodbye.