Paraplegia Nursing Care Plans Diagnosis and Interventions
Paraplegia NCLEX Review and Nursing Care Plans
Paraplegia is described as the inability of a person to voluntarily move the lower part of the body. It happens when an injury or chronic illness affects the nervous system which is responsible for controlling the lower half of a person’s body.
A person with paraplegia might experience trouble moving his or her legs, feet, and stomach muscles.
A person with paraplegia experiences mobility problems that will require the use of mobility devices. Long-term treatment may be an option to help a person with paraplegia reduce possible symptoms and complications. If a person experiences paralysis of only one leg it is called incomplete paraplegia.
Paraplegia can lead to a decline in a person’s function and independence as the symptoms become worse. The medical team is needed to help the patient reduce possible complications, if complications develop additional medication and treatments are needed.
Partial or complete loss of movement because of paralysis may happen in one or more parts of the body. Paralysis has different forms depending on the underlying cause and severity. Types of paralysis include:
Signs and Symptoms of Paraplegia
A person with paraplegia may show the following symptoms which will change over time. Symptoms of paraplegia depend on the person’s bodily response and depend on the severity of paraplegia.
The symptoms of paraplegia might include:
- loss of sensation of the person’s lower body
- impaired mobility
- weight gain
- phantom bouts of pain or sensation in the person’s lower body
- chronic pain
- sexual dysfunction
- changes and difficulty with bladder and bowel function
- secondary infections including bedsores and skin problems
- autonomic dysreflexia
- high blood pressure
Causes of Paraplegia
Paraplegia is usually caused by an injury to the person’s spinal cord and brain that stops signals from reaching the lower body resulting in paralysis. Accidents that cause injuries that may lead to paraplegia include:
- car and motorcycle accidents
- sports accidents
- being a victim of a crime
Sometimes paraplegia may happen because of a condition that damages the person’s spinal cord and brain. These can include:
- Spinal cord injury. An injury that involves the thoracic spinal nerves in the upper back that causes paralysis in the legs and the lower part of the abdomen.
- Cerebral palsy. Cerebral palsy is a disorder that affects the capacity of a person to move and maintain balance and posture. Cerebral palsy affects the outer layer of the person’s brain called the cerebral cortex, which is responsible for controlling muscle movement.
- Cancer. Cancer is a disease that happens when abnormal cells divide rapidly in a person’s body and spread to other tissues and organs.
- Nerve conditions. Nerve conditions may cause paralysis, weakness of the muscles, poor coordination, loss of sensation, seizures, pain, and an altered level of consciousness.
- Multiple sclerosis. Multiple sclerosis is a condition that involves the person’s central nervous system that causes inflammation and lesions which will make it hard for the brain to send signals to the person’s body. Severe multiple sclerosis can cause partial or complete paralysis in the patient.
- Stroke. A stroke happens when a blood vessel in the person’s brain ruptures and bleeds which will cause difficulty for the blood and oxygen to reach the brain tissues due to blockage. A stroke is a life-threatening condition that requires emergency and urgent treatment.
- Spinal tumors. A spinal tumor is the abnormal mass of tissue that surrounds the person’s spinal cord and the spinal column.
- Brain tumors. A brain tumor is the abnormal growth of cells in a person’s body. Brain tumors affect the function of the person’s nervous system.
- Hereditary spastic paraplegia. Hereditary spastic paraplegia is a group of rare inherited disorders that causes weakness and stiffness of the person’s leg muscles and the symptoms gradually worsen over time.
Risk Factors to Paraplegia
Paraplegia is usually caused by a disease or accidental injury which means it can happen to anyone, there are risk factors that may increase the chance of having paraplegia. The nurse should note that the risk factor is not the cause of paraplegia.
The following are the common risk factors of having paraplegia:
- plays high-impact sports such as football and wrestling
- actively participates in sports like gymnastics, diving, and surfing
- with a history of cancer
- with a family history of a condition that affects the person’s nervous system
Complications of Paraplegia
Medical complications may happen to patients with paraplegia because the patient may not be able to walk, stand up, and move. This situation may cause a variety of additional conditions that can range from being mildly inconvenient and painful for a person that may also be life-threatening.
The following are some common medical complications that can happen to patients with paraplegia:
- Pressure sores. The patient’s inability to move may cause pressure sores which are commonly developed on the patient’s legs and buttocks. The nurse should do paraplegia exercises and adjust the position of the patient regularly if possible to avoid pressure sores.
- Urinary tract infections. A patient with paraplegia often experiences urinary retention because the link between the brain and the nerves that control the bowels and bladder are damaged. Urinary retention can lead to urinary tract infection because of the bacteria in the urinary tract that infects the bladder.
- Chronic depression. The patient may experience depression because of the extreme difficulty of the condition. A patient with chronic depression will show a lack of interest in life and may feel hopeless because of the condition. A patient experiencing chronic depression may need support from his or her loved ones and other support groups.
- Circulatory disorders. Circulatory disorders may happen because the patient cannot move freely. Referring the patient to an occupational therapist can help.
Diagnosis of Paraplegia
To correctly diagnose paraplegia, the physician will typically perform an in-depth examination. This examination is needed to identify the best paraplegia therapy and exercise that the patient might need to increase his or her life expectancy and promote wellness. A medical provider may also ask the patient about the recent accidents and illnesses that the patient has experienced.
To diagnose paraplegia, the following may be done:
- X-Rays. X-rays are a form of electromagnetic radiation that uses electromagnetic waves to create pictures inside the body which includes internal tissues, bones, and organs.
- Magnetic Resonance Imaging (MRI). MRI is used to create detailed images of the person’s organs and tissues in the body which uses a magnetic field and computer-generated radio waves. Magnetic Resonance Imaging(MRI) is frequently used to diagnose problems in the brain and the spinal cord.
- Computed Tomography Scan(CT-Scan). A CT Scan uses a computer and X-Ray machine to create cross-sectional images of the person’s body. CT scan provides detailed information on the soft tissues, blood vessels, and bones in various parts of the person’s body.
- Neurologic examinations. The neurologic examination helps in evaluating the person’s nervous system using lights and reflex hammers. This examination includes an assessment of the motor and sensory skills, balance and coordination, mental status, reflexes, and functioning of the nerves.
- Electromyography. Electromyography helps in measuring muscle response or the electrical activity in response to a nerve’s stimulation of a person’s muscles. Electromyography helps to detect neuromuscular abnormalities. During this test one or small needles also called electrodes are inserted through the patient’s skin into the muscles to reveal the dysfunction of the nerve to muscle signal transmission.
- Family history. Family history taking is done to detect hereditary factors that contribute to paraplegia. Family history is a record of the diseases and health conditions of a person and the biological family members.
Treatment for Paraplegia
A person with paraplegia may regain partial or complete control over the affected area even if paralysis is not curable. A range of treatments and management such as rehabilitation, coping and support can help for the patient’s fast recovery.
Treatments for paraplegia may include a combination of the following:
- Physical therapy. Physical therapy is a type of therapy that helps in reducing pain, strengthens muscles, and helps in preventing muscle deterioration. Physical therapy is usually done by a physical therapist to evaluate the condition of the patient and to develop a plan of care that would help the patient to move and live better.
- Occupational therapy. Occupational therapy helps the patient with paraplegia to adapt to the activities required in daily life. Occupational therapy helps in treating physical, mental, developmental, and emotional problems that affect the patient’s ability to do day-to-day tasks.
- Mobility devices. Mobility devices that include wheelchairs and power scooters are needed to help patients with paraplegia improve and maintain mobility. Mobility devices provide benefits to users because mobility devices may increase independence, reduce pain, and may increase confidence and self-esteem
- Medications. Medications such as muscle relaxants and pain relievers will help to reduce pain and blood thinners to decrease the risk of blood clots.
- Surgery. Surgical procedures may help in treating symptoms, and mobility, and improve patients’ health. Doctors may do emergency surgical procedures to treat the primary cause of central nervous system damage, including blocked arteries, swelling around the brain and spinal cord, fractured vertebrae, and tumors on the spinal cord.
Nursing Diagnosis for Paraplegia
Nursing Care Plan for Paraplegia 1
Nursing Diagnosis: Impaired Physical Mobility related to neuromuscular impairment secondary to paraplegia as evidenced by the inability to purposefully move and muscle atrophy.
- The patient will be able to maintain his or her position of function as evidenced absence of contractures and foot drops.
- The Patient will be able to increase his or her strength of the unaffected body parts.
- The patient will be able to demonstrate techniques and behaviors that will enable the resumption of the patient’s activity.
|Nursing Interventions for Paraplegia||Rationale|
|1. Check the patient’s motor function by asking the patient to do certain actions such as shrug shoulders, spread fingers, squeeze, and release the nurse’s hands.||This will help the nurse evaluate the patient’s motor–sensory status from a specific level of injury which will also help the nurse to formulate proper intervention.|
|2. Teach and assist the patient to perform full ROM exercises on all extremities and joints, using slow, and smooth movements.||Range of motion (ROM) helps the patient enhance circulation, and restores muscle tone. Range of motion exercises helps in preventing disuse contractures and muscle atrophy.|
|3. Place the patient’s arms at a 90-degree angle at regular intervals.||This will prevent foot drop and external rotation of the patient’s hips.|
|4. Elevate the patient’s extremities at intervals when the patient is in the chair or raise the foot of the bed when needed in the individual’s situation.||When pooling of blood and venous stasis in the lower abdomen and lower extremities happens this will increase the risk of hypotension and thrombus formation.|
|5. Provide uninterrupted rest periods and encourage patient involvement within individual tolerance and ability.||Uninterrupted rest periods will help prevent fatigue and allow an opportunity for maximal efforts and participation of the patient.|
|6. Monitor the patient’s blood pressure before and after activity during the acute phase or until the patient is stable and changes the position slowly.||The patient may experience orthostatic hypotension as a result of venous pooling due to loss of vascular time. Elevation of the patient’s head can aggravate hypotension and may cause syncope.|
Nursing Care Plan for Paraplegia 2
Risk for Autonomic Dysreflexia
Nursing Diagnosis: Risk for Autonomic Dysreflexia related to altered nerve function secondary to paraplegia.
- The patient will be able to identify signs and symptoms of the syndrome.
- The patient will be able to identify preventions for the condition.
- The patient will express no episodes of dysreflexia.
|Nursing Interventions for Paraplegia||Rationale|
|1. Assess and monitor the precipitating risk factors such as bowel and bladder distention or manipulation, bladder spasms, stones, infection, skin pressure areas, prolonged sitting position, and temperature extreme or drafts.||Patients with autonomic dysreflexia commonly experience visceral distention which is considered an emergency. Acute periods of autonomic dysreflexia must be carried out immediately and intervention must be geared towards prevention.|
|2. Monitor for any changes in the patient’s vital signs and presence of paroxysmal hypertension, tachycardia or bradycardia, sweating, flushing above the level of lesion, pallor below the injury, chills, nasal stuffiness, and a severe pounding headache.||The nurse should monitor the patient regularly for early detection and immediate intervention are important to prevent complications and serious consequences. Placing the patient in a sitting position automatically lowers the patient’s blood pressure.|
|3. Elevate the patient’s head to a 45-degree angle or place the patient in a sitting position.||Placing the patient in this position will lower the patient’s blood pressure which will prevent intracranial hemorrhage, seizures, or death.|
|4. Teach the patient and his or her significant others about the warning signs and the ways to avoid the onset of the syndrome. Advise the patient’s significant others to stay with the patient during the episodes.||The patient may avoid the lifelong problem by avoiding pressure and over-distension of the patient’s visceral organs or pressure on the patient’s skin.|
|5. Obtain and check urinary culture as indicated.||The nurse may detect the presence of infection through urine culture. Autonomic dysreflexia may be triggered by the presence of infection.|
Nursing Care Plan for Paraplegia 3
Risk for Impaired Skin Integrity
Nursing Diagnosis: Risk for Impaired Skin Integrity related to the altered peripheral circulation, presence of edema, and immobility secondary to paraplegia.
- The patient will identify individual risk factors and will verbalize understanding of treatment needs.
- The patient will participate with his or her level of ability to prevent skin breakdown.
|Nursing Interventions for Paraplegia||Rationale|
|1. Check the patient’s skin areas and note capillary blanching, refill, redness, and swelling. Check the patient’s back of the head, skin under the halo frame, and the folds where the skin continuously touches.||The nurse should inspect the patient’s skin integrity because the patient’s skin is prone to breakdown due to the changes in the peripheral circulation, inability to sense pressure, immobility, and altered temperature regulation.|
|2. Instruct and encourage the patient to continue a regular exercise program.||Regular exercise will help in the stimulation of circulation, enhancing cellular nutrition and oxygenation to improve the patient’s tissue health.|
|3. Place the patient’s lower extremities elevated periodically as tolerated.||Elevating the patient’s extremities will enhance venous return and reduces edema formation.|
|4. Protect the patient’s pressure points by massaging and putting lubricants on the patient’s skin with bland lotion or oil.||To protect the patient’s skin, the nurse may also use heel or elbow pads, lamb’s wool, foam padding, and an egg crate mattress. Protecting the patient’s skin will enhance circulation and protect skin surfaces to reduce the risk of ulceration and infection.|
|5. Change the patient’s position or turn the patient frequently when the patient is in bed or a sitting position.||Changing the position of the patient frequently will improve skin circulation and will reduce pressure time on the bony prominence part of the patient’s body.|
|6. Ensure that the high moisture areas of the skin are washed and dried such as the perineum.||To avoid excoriation and breakdown of the patient’s skin it is important to keep the skin dry and clean.|
Nursing Care Plan for Paraplegia 4
Nursing Diagnosis: Impaired Urinary Elimination related to disruption in bladder innervation and bladder atony secondary to paraplegia as evidenced by bladder distention, urinary tract infection, and renal dysfunction.
- The patient will express understanding about the condition and will be able to maintain balanced input and output with clear and odor-free urine.
- The patient will demonstrate and show behaviors and techniques that will help in preventing retention and urinary infection.
|Nursing Interventions for Paraplegia||Rationale|
|1. Ask the patient about his or her voiding pattern including the urine frequency and amount. Compare the patient’s urine output with the patient’s fluid intake and note the urine-specific gravity.||This will identify the characteristic of the patient’s bladder function and fluid balance. The nurse should check and note for urinary complications that may cause death.|
|2. Assess the patient’s bladder by palpating the bladder distension and observing for bladder overflow.||It is important to check and note bladder distension because this may precipitate autonomic dysreflexia. If the patient’s bladder is distended this may indicate an infection in the bladder, urinary tract, and the tissues surrounding it.|
|3. Advise the patient to take 2 to 4 liters of fluid per day including ash juices such as cranberry.||Increasing fluid intake will help in maintaining renal function and will prevent infection and the formation of urinary stones.|
|4. Check the patient’s urine color, and odor and observe for cloudy and bloody urine.||Changes in the urine color may indicate urinary tract and kidney infection that may lead to sepsis. The nurse may also do dipstick urine as indicated to provide a quick determination of the urine pH, nitrite, and leukocytes esterase that may indicate infection.|
|5. Keep the patient’s perineal area clean and dry at all times.||This will reduce the risk of skin irritation or skin breakdown.|
Nursing Care Plan for Paraplegia 5
Nursing Diagnosis: Risk for Injury related to temporary weakness and instability of the spinal column secondary to paraplegia.
- The patient will be able to maintain proper alignment of the spine without further spinal cord damage.
- The patient will be able to be free from injury and will be able to use immobilization devices as needed.
|Nursing Interventions for Paraplegia||Rationale|
|1. Advise the patient to maintain bed rest and use immobilization devices such as sandbags, traction, halo, hard or soft cervical collars, and brace.||Advising the patient to rest and use immobilization devices is important to prevent vertebral column instability and will help in healing. Bed rest will reduce the body’s metabolic demand which will help the patient’s fast recovery.|
|2. Maintain the traction frame or bed elevated and check if the traction frames are secured, pulleys are aligned, and weights are hanging free.||Checking the traction frames and keeping the bed elevated creates a safe, effective counterbalance to maintain the patient’s position and traction pull.|
|3. Change the position of the patient with intervals using adjuncts for turning and using support such as turn sheets, foam wedges, blanket rolls, and pillows. Ask for help from other staff members when turning the patient and follow special instructions for traction equipment, kinetic bed, and frames when the halo is in place.||Proper positioning and turning of the patient will maintain spinal column alignment and will decrease the risk of further trauma.|
|4. Instruct the patient on the use of medical alarm systems if needed and put the patient in a room near the nurse’s station.||A medical alarm system is important to alert the healthcare providers if the patient is experiencing an emergency that requires immediate treatment.|
|5. Advise the family and the significant others to be with the patient to prevent the incidence of accidental falls.||It is important to advise the family and significant others to be with the patient because that patient may not be able to move on their own. The patient’s family and significant others play an important part in ensuring the patient’s safety.|
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Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
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