Page 311 - Critical Care Nursing Demystified

296 CRITICAL CARE NURSING DeMYSTIFIED

prevent a complete neurologic deficit or paralysis. Spinal surgery involves
laminectomy, spinal fusion, or rods inserted into the spinal column.
Laminectomy – The spinal cord is decompressed by removing bony frag-
ments or herniated disk material from the spinal canal.
Spinal fusion – Two to six vertebral disks are fused together to provide stabil-
ity and to prevent motion. The fusion is achieved by using bone parts or bone
chips taken from the iliac crest, or by using wire to achieve fusion, or by
using acrylic glue.
Rods – Larger areas of the spinal column are stabilized and realigned by using
rods attached to the posterior aspects of the spinal column by means of
screws and glue. Rod procedures are most often done to stabilize the thora-
columbar area.

Nursing Diagnosis for SCI Expected Outcomes
Ineffective breathing pat- The patient will have normal rate, rhythm, and
tern related to transection depth of respirations
of the spinal cord or edema The patient will have baseline SaO , ABGs
above the level of C4 2
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Nursing Interventions
Maintain head and neck alignment until spinal x-rays are completed and rule
out a spinal injury or the spine is stabilized using an external fixation device
like cervical traction or tongs.
Assess the patient’s neurologic status including Glasgow Coma Scale, deep
tendon reflexes, and spinal cord assessment levels to determine if status is sta-
bilizing and edema is subsiding.
Monitor the patient for respiratory status with vital signs, SaO , ABGs, and
2
respiratory mechanics to check for early signs of respiratory depression.
Observe for changes in cardiac status including BP and hemodynamic status
to identify neurogenic shock, which can be caused by hypotension.
Prepare for administration of IVF if hypotension occurs.
Prepare to administer vasopressors if IVF does not improve the patient’s BP.
Administer corticosteroids like methylprednisolone immediately and for the
first 24 hours post SCI to decrease inflammation and resultant edema.
Assist with the application and care of cervical traction to keep the alignment
of the spine and to decrease muscle spasms.