Providing prism glasses to enable the patient to see from the supine position
Encouraging use of hearing aids, if indicated, to enable the patient to hear
conversations and environmental sounds
Providing emotional support to the patient
Teaching the patient strategies to compensate for or cope with these deficitsMaintaining Skin Integrity
Because patients with SCI are immobilized and have loss of sensation below the level
of the lesion, they have the highest prevalence of pressure ulcers in the United States
(Phillips, 2003). Pressure ulcers have developed within 6 hours in areas of local tissue
ischemia, where there is continuous pressure and where the peripheral circulation is
inadequate as a result of spinal shock and a recumbent position. Prolonged
immobilization of the patient on a transfer board also increases the risk for pressure
ulcers. The most common sites are over the ischial tuberosity, the greater trochanter,
the sacrum, and the occiput (back of head). Patients who wear cervical collars for
prolonged periods may develop breakdown from the pressure of the collar under the
chin, on the shoulders, and at the occiput.
The patient's position is changed at least every 2 hours. Turning not only assists in the
prevention of pressure ulcers but also prevents pooling of blood and edema in the
dependent areas.
Careful inspection of the skin is made each time the patient is turned. The skin over the
pressure points is assessed for redness or breaks; the perineum is checked for soilage,
and the catheter is observed for adequate drainage. The patient's general body
alignment and comfort are assessed. Special attention should be given to pressure areas
in contact with the transfer board.
The patient's skin should be kept clean by washing with a mild soap, rinsing well, and
blotting dry. Pressure-sensitive areas should be kept well lubricated and soft with hand
cream or lotion. To increase understanding of the reasons for preventive measures, the
patient is educated about the danger of pressure ulcers and is encouraged to take control
and make decisions about appropriate skin care (Kinder, 2005). See Chapter 11 for
other aspects of the prevention of pressure ulcers.
Maintaining Urinary Elimination
Immediately after SCI, the urinary bladder becomes atonic and cannot contract by
reflex activity. Urinary retention is the immediate result. Because the patient has no
sensation of bladder distention, overstretching of the bladder and detrusor muscle may
occur, delaying the return of bladder function.
Intermittent catheterization is carried out to avoid overdistention of the bladder and
UTI. If this is not feasible, an indwelling catheter is inserted temporarily. At an early
stage, family members are shown how to carry out intermittent catheterization and are
encouraged to participate in this facet of care, because they will be involved in long-
term follow-up and must be able to recognize complications so that treatment can be
instituted.
The patient is taught to record fluid intake, voiding pattern, amounts of residual urine
after catheterization, characteristics of urine, and any unusual sensations that may
occur. The management of a neurogenic bladder (bladder dysfunction that results from
a disorder or dysfunction of the nervous system) is discussed in detail in Chapter 11.
Improving Bowel Function
Immediately after SCI, a paralytic ileus usually develops due to neurogenic paralysis of
the bowel; therefore, a nasogastric tube is often required to relieve distention and to
prevent vomiting and aspiration.