Care of patients with paraplegia
Definition
A condition in which both the lower limbs are paralyzed due to an injury or a disease of the spinal cord
Care at the site of Accident
Immobilize patient on a spinal board
Head and neck in a neutral position to prevent further damage
One person holds the head near the ears to prevent movements; keep alignment while the spinal board is placed under with
At least four people to help.
Prevent any twisting movement
Care During Treatment
In the emergency and x-ray departments, the patient is kept on the transfer board.
Always maintain an extended position.
No part of the body should be twisted or turned, no sitting up.
Rotating bed or a firm mattress with a bedboard under it and a cervical collar
(Acute Phase)
Observe for symptoms of progressive neurologic deficits.
Oxygenation and cardiovascular stability are maintained.
High-dose corticosteroids
Transplanting fetal tissue into the injured spinal cord being experimented to regenerate damaged tissue
PHARMACOLOGIC THERAPY
High-dose corticosteroids, (methylprednisolone) within 8 hours of injury
RESPIRATORY THERAPY
Promote breathing and airway clearance - monitor SpO2, arterial blood gas, clear bronchial and pharyngeal secretions
Chest physiotherapy or assisted coughing
Breathing exercises
Prevent or treat respiratory infections
Smoking stopped
Oxygen is administered to maintain a high arterial PO2
If endotracheal intubation is necessary, avoid flexing or extending the neck.
IMPROVING MOBILITY
Proper body alignment is maintained
Splints to prevent foot drop - removed and reapplied every 2 hours
Trochanter rolls to prevent external rotation of the hip joints
Passive range of exercises to prevent contractures
Toes, metatarsals, ankles, knees, and hips put through a full range of motion at least four, and ideally five, times daily.
PERCEPTUAL ALTERATIONS
Managed by Prism mirrors to see the whole body while supine.
MAINTAINING SKIN INTEGRITY
Pressure ulcers develp within 6 hours.
Position changed at least every 2 hours.
Wrinkle free bed spread
Skin inspected for redness or breaks;
Perineal care
Catheter is observed for adequate drainage.
Skin kept clean by washing with a mildsoap, rinsed well, and blotted dry.
Pressure-sensitive areas kept well lubricated and soft with bland cream or lotion.
Patient informed about the danger of pressure ulcers
wheelchairs, custom made cushions used - abrasions and trauma avoided
Wetness aoided
Should inspect skin if neede using mirrors
Obesitiy avoided
MAINTAINING URINARY ELIMINATION
Intermittent catheterization / an indwelling catheter
Family taught intermittent catheterization
Patient taught to record fluid intake, voiding pattern, amounts of residual urine after catheterization, characteristics of urine, and any unusual sensations that may occur.
The nurse emphasizes the importance of maintaining an adequate flow of urine
Encourage a fluid intake of about 2.5 L daily.
Empty the bladder frequently
Personal hygiene maintained especially of the perineum
Underwear should be cotton (more absorbent) and changed at least once a day.
If an external catheter (condom catheter) is used, the sheath is removed nightly; the penis is cleansed to remove urine and is dried carefully
Female patient who cannot achieve reflex bladder control or self-catheterization may need to wear pads or waterproof undergarments. Urinary diversion may be needed
IMPROVING BOWEL FUNCTION
Neurogenic paralysis of the bowel: nasogastric tube to relieve distention and prevent aspiration.
When bowel sounds return: a high-calorie, high-protein, high-fiber diet
Use stool softeners
Establish bowel evacuation through reflex conditioning.
The anal sphincter may be massaged to stimulate defecation.
A diet with sufficient fluids and fiber
MONITORING AND MANAGING POTENTIAL COMPLICATIONS
Look for thrombophlebitis and Pulmonary Embolism:
The circumferences of the thighs and calves are measured and recorded.
Anticoagulation is initiated: LMWH
Range-of-motion exercises, thighhigh elastic compression stockings, and adequate hydration
Pneumatic compression devices may be used
Avoid external pressure on the lower extremities.
Orthostatic Hypotension should be avoided during attempts at mobilizing the patient
Closely monitor vital signs before and during position changes
Vasopressor medication can be used
Thigh-high elastic compression stockings
Tilt tables are helpful for a gradual return to upright position
Autonomic Dysreflexia
May cause hypertension.
The following measures are carried out:
•Assume sitting position to lower blood pressure.
• The bladder is emptied immediately.
• The rectum is examined for a fecal mass. If one is present, a topical anesthetic is inserted 10 to 15 minutes before the mass is removed, because visceral distention or contractioncan cause autonomic dysreflexia.
• If these measures do not relieve the hypertension and excruciating headache, a ganglionic blocking agent (hydralazine hydrochloride [Apresoline]) is prescribed and given slowly intravenously.
• The medical record or chart should be labeled with a clearly visible note about the risk for autonomic dysreflexia.
PROMOTING HOME AND COMMUNITY-BASED CARE
Teach Patients Self-Care
Patient needs long-term rehabilitation.
Begin during hospitalization as acute symptoms begin to subside
Teach strategies necessary to cope with the alterations that injury imposes on activities of daily living.
Family given dedicated nursing support until they become confident.
Continuing Care
Aim at independence of the patient.
Arrange for nursing, medicine, rehabilitation, respiratory therapy, physical and occupational therapy, social services, and so forth. Coordinate the management
Arrange for mental health care professional if needed.
Exercise Programs
The strength of normal parts developed to bear full weight & ambulate.
The triceps and the latissimus dorsi important for crutch walking.
The muscles of the abdomen and the back strenthened to maintain the upright position.
Gait training and ambulation activities.
Range-of-motion exercises to prevent disuse syndrome
Mobilization
Braces and crutches enable patients to ambulate.
Motorized wheelchairs provide greater independence and mobility
Encourage the patient to be as mobile and active as possible.
COUNSELING ON SEXUAL EXPRESSION
For men with erectile failure, penile prostheses; Sildenafil (Viagra) may be tried
Sexual education and counseling services
Small-group meetings produce effective attitudes and adjustments
ENHANCING COPING MECHANISMS
Grief reactions and depression to be treated
Family therapy is helpful to help work through issues as they arise.
Adjustment to the disability leads to the development of realistic
