📄 NCLEX Daily Training— Spinal Cord Injury 🧠🦴

Braulio Bolano Trujillo

9d (edited) • 📘 My Weekly Focus

🎥 Videos recommended:

🧠 Spinal Cord Injury

🔗 https://youtu.be/lkOTDW1KZ0A?si=L0P21faYykJjGClH

🦴 Peripheral Nerve and Spinal Cord Disorders Questions

🔗 https://youtu.be/74kX1ue1mUs?si=POMpbK0oimL8YD7W

Today’s topic is spinal cord injury 🧠🦴. The big idea is simple: when the spinal cord is damaged, messages between the brain and body are blocked. The higher the injury, the more dangerous it is because more body functions can be affected.

Cervical injuries are the highest priority because they can affect breathing 🫁. Remember: C3, C4, and C5 keep the diaphragm alive. If the injury is high in the neck, the patient may need ventilator support and can have quadriplegia, also called tetraplegia. Thoracic and lumbar injuries usually affect the lower body and can cause paraplegia, bowel and bladder problems 🚽, skin breakdown risk 🩹, and mobility issues.

A complete spinal cord injury means there is no movement or sensation below the level of injury ❌. An incomplete injury means some signals still get through, so the patient may have patchy sensation or some movement below the injury ✅.

One of the biggest NCLEX traps is knowing the difference between spinal shock and neurogenic shock ⚡🩸. Spinal shock is a reflex problem. The patient temporarily loses reflexes, muscle tone, sensation, and movement below the injury. The sign that spinal shock is improving is the return of reflexes.

Neurogenic shock is a circulation problem 🩸. The blood vessels dilate, blood pools in the body, blood pressure drops, and the heart rate slows down. Think: low and slow ⬇️🐢 — low blood pressure and slow heart rate. The skin may be warm, dry, and flushed, which is different from many other types of shock. Nursing care focuses on spinal immobilization, airway and breathing support 🫁, IV fluids as ordered, vasopressors if needed, and atropine for severe bradycardia if ordered.

Autonomic dysreflexia is another major NCLEX emergency 🚨. It usually happens in patients with spinal cord injuries at T6 or higher. The key sign is sudden, dangerous hypertension. Something irritating happens below the injury, but the brain cannot control the response correctly, so the body overreacts and the blood pressure shoots up.

The most common trigger is the bladder 🚽. Think: full bladder, kinked Foley catheter, blocked catheter, or UTI. If it is not the bladder, think bowel problems 💩 like constipation or fecal impaction. Skin irritation can also trigger it, like tight clothes, wrinkled sheets, pressure ulcers, tight shoes, or an ingrown toenail 🩹.

The classic picture of autonomic dysreflexia is a patient with a T6 or higher spinal cord injury who suddenly has a pounding headache and very high blood pressure 🚨. Above the injury, they may have sweating, flushing, nasal congestion, headache, and bradycardia. Below the injury, they may have pale, cool skin and goosebumps.

For autonomic dysreflexia, the first nursing action is to sit the patient up in High Fowler’s ⬆️. Do not lay them flat. Then check the blood pressure, loosen tight clothing, and look for the trigger. Start with the bladder first 🚽. Check the Foley, look for kinks, check if the bladder is full, and catheterize if needed. If the blood pressure stays high, antihypertensive medication may be given as ordered 💊. Do not choose “notify the provider” first if there is an immediate nursing action you can do.

Halo traction is also important ⚙️. A halo vest keeps the cervical spine still after a neck injury. The biggest NCLEX point is that the emergency wrench must stay taped to the vest 🛠️. If the patient goes into cardiac arrest, the front of the vest may need to be removed for CPR. Never pull on the halo rods, never use the frame to move the patient, log-roll the patient, keep the vest dry, check the skin, and monitor pin sites for infection. Signs of pin site infection include redness, swelling, drainage, and increased pain 🚨. Do not tighten loose pins yourself; notify the provider.

The main nursing priorities for spinal cord injury are breathing 🫁, preventing more spinal cord damage 🦴, and watching for complications 🚨. Cervical injuries are airway and breathing priority. Keep the spine aligned, use the cervical collar, log-roll, and avoid twisting. Watch for spinal shock, neurogenic shock, autonomic dysreflexia, skin breakdown, bowel and bladder problems, and DVT from immobility.

Simple board logic 🔥:

⚡ Spinal shock = reflexes are gone.

🩸 Neurogenic shock = low BP, slow HR, warm skin.

🚨 Autonomic dysreflexia = high BP, pounding headache, T6 or higher injury.

⬆️ First action for autonomic dysreflexia = sit the patient up.

🚽 Most common trigger = bladder.

🛠️ Halo safety = wrench on vest, no pulling rods.

🫁 Cervical injury priority = breathing.

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📄 NCLEX Daily Training— Spinal Cord Injury 🧠🦴