Nursing Care Plan for a Spinal Cord Injury

A spinal cord injury can be a very serious condition that requires around-the-clock care for the patient. As a nurse, it's your job not only to make sure the patient is receiving any treatments, medications, or tests the doctor orders; it's also your job to see that the patient is comfortable, that he is taken care of mentally and emotionally as well. The complexity of a spinal cord injury requires you to pay close attention to every detail the patient tells you about or that you observe, so that you can report any problems or complications to the doctor in charge.

If you work in the emergency department of the hospital, you will, at some point, have a patient come in with a spinal cord injury. In order for the patient's prognosis to be the best that it can be, you must work very closely with the doctors and other nurses to make sure that several things don't happen. For instance, the patient's head and neck need to be stabilized to ensure that he doesn't receive even more injury; it may be necessary for you to place the patient into traction. He may need help breathing also, depending on the severity of his injury. Keep him as still as possible, administering sedatives, if ordered, to allow for less movement or irritation during tests and treatments; you must also monitor his oxygen intake as well. Other things the doctor may order are the placement of a catheter, so as to allow the patient to be rid of wastes and not have it sitting in his bladder. Vital signs will also need to be monitored very closely, as the patient could develop cardiovascular signs of distress or blood clots. The doctor may order a medication called Medrol to be given to the patient, and this needs to be done right away to possibly minimize damage done to the spinal cord. Of course, keeping the charts carefully updated is always a must, as this keeps the doctors and other nurses who come in at different shifts updated and aware of any history or potential complications.
The patient will most likely be admitted to the hospital to stay for several days or even weeks. If he is not able to move below a certain point, he may be at risk for certain complications. You will need to keep monitoring his cardiovascular and respiratory health, especially watching for blood clots, as immobilization drastically increases the risk for these. He may need exercises called range-of-motion exercises to keep his arms and legs from losing the muscle and to keep them from becoming flaccid and cramped. Make sure the patient is turned or moved to a different position every two hours so that the risk for pressure ulcers can be minimized; examine his skin every eight hours. The patient's input and output need to be charted; that way if signs of retention show up, something can be done to help the patient. You must give all medications that are ordered and chart that they were given. Again, charting is crucial at this point to show the patient's progress and history.
As the patient improves, he may be transferred to a rehabilitation facility to recover and learn how to live with his injury. As a nurse in the rehab center, you may have several jobs. Most rehab involves therapists and physical therapists, but you will be monitoring the patient's health overall, and you may assist with certain things. You will help the patient in his recovery process by encouraging him to go to every session with the physical therapist, as this will speed his recovery. While there, he will be working not only with movement and strength training, but he will be learning how to live with his injury, such as using a wheelchair. He'll be relearning even the simplest tasks because he will have to do them in a different way now. You will also need to teach the patient about certain physical aspects of his injury and things that he might expect when he gets home. He may need to be taught how to use a catheter; he may need teaching on UTI's and taking care of his skin, as well as making sure his home is ready for him when he gets there.

Through all of the added stress that a spinal cord injury produces, your patient will need you sometimes to just be there as his nurse. He will need encouragement and all the help you can muster from the beginning. He's going to probably go through a grieving process, as he feels he's lost a part of his life that he might never regain. He may have problems coping. As his nurse, you need to make sure that you communicate effectively with him; study and research his injury, so that you fully understand what is going on with him physically. This will allow for much better communication with the patient. Be honest and upfront with him; don't sugarcoat any detail because this could lead to distrust later on. Most importantly, listen to the patient. He just needs a listening ear at this point. As he improves and starts gaining ability to do certain things on his own, encourage him and praise him, as this will improve his emotional well-being overall and could spur him to keep going and not to give up. Get to know your patient and what he likes or dislikes. If you are going to administer a treatment, tell the patient what you are doing in full detail, so that he understands what to expect. If the patient gets bored, which is very possible with immobilization, find interesting things for him to do, based on what you've learned about him, by getting to know him. Lastly, watch for and report any signs of psychological distress in the patient, so that if the need arises, he can be seen by a social worker or therapist.