Paraplegia is a serious neurological condition characterized by partial or complete paralysis of the lower extremities. As healthcare professionals, understanding the complexities of paraplegia and developing appropriate nursing diagnoses is crucial for optimal patient care. This comprehensive guide explores the essential nursing diagnoses, interventions, and care plans necessary for managing patients with paraplegia.
What is Paraplegia?
Paraplegia results from damage to the spinal cord, typically occurring at or below the thoracic level. The condition can be classified into:
- Complete Paraplegia: Total loss of sensory and motor function below the level of injury
- Incomplete Paraplegia: Partial preservation of sensory or motor function below the neurological level
Common Symptoms and Manifestations
Patients with paraplegia typically experience:
- Loss of voluntary movement in lower extremities
- Sensory deficits below the level of injury
- Bowel and bladder dysfunction
- Sexual dysfunction
- Autonomic dysreflexia
- Respiratory complications (depending on the level of injury)
- Psychological challenges, including depression and anxiety
Essential Nursing Care Plans for Paraplegia
1. Impaired Physical Mobility
Nursing Diagnosis Statement:
Impaired Physical Mobility related to neuromuscular impairment evidenced by inability to move lower extremities purposefully and decreased muscle strength.
Related Factors/Causes:
- Spinal cord injury
- Muscle weakness or paralysis
- Decreased muscle control
- Pain and discomfort
- Joint stiffness
Nursing Interventions and Rationales:
Implement a comprehensive range of motion exercise program
- Prevents contractures and maintains joint mobility
Position patient properly using appropriate devices
- Reduces risk of pressure injuries and promotes comfort
Assist with transfers using proper body mechanics
- Ensures safety and prevents complications
Teach proper use of assistive devices
- Promotes independence and safety
Collaborate with physical therapy for a rehabilitation program
- Maximizes potential for recovery and adaptation
Desired Outcomes:
- The patient will demonstrate proper use of assistive devices
- The patient will maintain an optimal range of motion
- The patient will participate actively in a rehabilitation program
2. Risk for Impaired Skin Integrity
Nursing Diagnosis Statement:
Risk for Impaired Skin Integrity related to immobility and decreased sensation below level of injury.
Related Factors/Causes:
- Prolonged immobility
- Decreased sensation
- Moisture
- Nutritional deficits
- Pressure points
Nursing Interventions and Rationales:
Perform regular skin assessments
- Early detection of potential skin breakdown
Implement a turning schedule every 2 hours
- Reduces pressure on vulnerable areas
Use pressure-relieving devices
- Distributes pressure evenly
Maintain proper nutrition and hydration
- Supports skin integrity
Educate patient and caregivers about skincare
- Promotes prevention of skin breakdown
Desired Outcomes:
- The patient will maintain intact skin integrity
- The patient will demonstrate knowledge of pressure injury prevention
- The patient will participate in a skin care regimen
3. Impaired Urinary Elimination
Nursing Diagnosis Statement:
Impaired Urinary Elimination related to neurogenic bladder evidenced by urinary retention or incontinence.
Related Factors/Causes:
- Neurogenic bladder
- Altered nerve transmission
- Decreased bladder sensation
- Urinary retention
- Frequent urinary tract infections
Nursing Interventions and Rationales:
Implement a bladder training program
- Establishes regular elimination pattern
Teach clean intermittent catheterization
- Prevents complications and promotes independence
Monitor intake and output
- Ensures adequate hydration and bladder emptying
Assess for signs of urinary tract infection
- Early detection and treatment of complications
Educate about proper hygiene
- Prevents infection and maintains skin integrity
Desired Outcomes:
- The patient will maintain adequate urinary elimination
- The patient will demonstrate proper catheterization technique
- The patient will remain free from urinary tract infections
4. Risk for Autonomic Dysreflexia
Nursing Diagnosis Statement:
Risk for Autonomic Dysreflexia related to spinal cord injury above T6 level.
Related Factors/Causes:
- Spinal cord injury above T6
- Bladder distention
- Bowel impaction
- Skin irritation
- Pain or discomfort
Nursing Interventions and Rationales:
Monitor vital signs regularly
- Early detection of autonomic dysreflexia
Assess for triggering factors
- Prevents episodes of autonomic dysreflexia
Maintain proper bladder and bowel elimination
- Reduces risk of triggering factors
Position patient properly
- Minimizes risk of pressure and discomfort
Educate patient and family about warning signs
- Promotes early recognition and intervention
Desired Outcomes:
- The patient will remain free from episodes of autonomic dysreflexia
- The patient will demonstrate knowledge of prevention strategies
- The patient will identify early warning signs
5. Ineffective Coping
Nursing Diagnosis Statement:
Ineffective Coping related to life-altering disability evidenced by expressed feelings of helplessness and anxiety.
Related Factors/Causes:
- Major life changes
- Loss of independence
- Altered body image
- Social isolation
- Financial concerns
Nursing Interventions and Rationales:
Provide emotional support and active listening
- Builds therapeutic relationships and trust
Refer to support groups and counseling
- Connects patient with others who share similar experiences
Teach stress management techniques
- Provides tools for coping with challenges
Involve family in care planning
- Strengthens support system
Set realistic goals with the patient
- Promotes a sense of achievement and progress
Desired Outcomes:
- The patient will demonstrate effective coping strategies.
- The patient will express feelings appropriately
- The patient will participate in support groups or counseling
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Consortium for Spinal Cord Medicine. Early acute management in adults with spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med. 2008;31(4):403-79. doi: 10.1043/1079-0268-31.4.408. PMID: 18959359; PMCID: PMC2582434.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
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- Wing PC. Early acute management in adults with spinal cord injury: a clinical practice guideline for health-care providers. Who should read it? J Spinal Cord Med. 2008;31(4):360. doi: 10.1080/10790268.2008.11760737. PMID: 18959352; PMCID: PMC2582432.
