Deficits expected from a C7 spine injury depend on the severity of the injury, which is determined by whether a patient may or may not have lost motor or sensation below the level of injury. Spinal cord injuries can either be incomplete or complete. A complete spinal injury means that the spinal cord is severed all the way through, and hence the communication from the brain to the lower levels of the body is affected (Hachem et al., 2017). The C7 cervical nerve innervates the triceps, muscles of wrist flexion, and finger extension. Hence, with an injury at C7, patients can still move their shoulder elbow, wrist, and hand movement. Most patients with C7 spinal cord injury lose their sensation and motor in their trunk and lower limbs (Hachem et al., 2017). The patients will have paraplegia and be unable to move their lower limbs. Also, patients may lose bowel and bladder control (Dallred, 2017). This is because patients are not able to control their muscles and reflexes. Patients with incomplete spinal injury at C7 may report pain and muscle spasms below the level of injury.
Immobility is associated with a series of complications affecting several systems in the body. One of the complications of mobility is pressure ulcers on the areas that withstand body weight. To prevent pressure ulcers, nurses can ensure the patient has clean skin hygiene free of pressure and friction (de Brito et al., 2018). Besides, nurses can turn the patient every two hours to avoid continued pressure on specific parts of the body. Nurses can also recommend pressure-relieving mattresses for patients and provide adequate nutrition for patients. Immobility also causes complications in the gastrointestinal system. These complications include constipation and fecal impactions (de Brito et al., 2018). To prevent these complications, nurses should ensure adequate fluid intake for patients, provide high fiber diets, and administer stool softeners and laxatives.
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Prolonged immobility predisposes to deep venous thrombosis due to slow venous return to the heart. To prevent DVT, nurses can provide compression stockings, lower limb exercises, and administration of heparin (de Brito et al., 2018). The urinary system is also affected by immobility causing, urinary tract infections from instrumentation, renal calculi, and urinary stasis. To prevent complications in the urinary tract, nurses should ensure adequate fluid intake, prompt voiding, and intermittent catheterization. The musculoskeletal system is adversely affected by immobility. The resulting complications include osteoporosis, joint stiffness, joint pain, reduced ranges of motion, and muscle atrophy (Nas et al., 2015). For prevention, nurses can offer range of motion exercises, early weight-bearing, and bed mobility training.
Immobile patients are predisposed to pneumonia majorly because of respiratory secretions. Most immobile patients have thick respiratory secretions that pool within the respiratory system (Dallred, 2017). Another major problem is that these patients may not have a cough reflex that is good enough to mobilize and expectorate these secretions. The secretions then provide a nidus for the development of bacteria, which eventually lead to pneumonia. Also, most patients who are immobile lie in the supine position. This position affects the production of an effective cough reflex, leading to high chances of aspiration, which can cause aspiration pneumonia (de Brito et al., 2015). To prevent pneumonia, nurses can encourage the patient to do deep breathing exercises, cough, use an incentive spirometer, and do respiratory exercises (Hachem et al., 2017). Also, nurses can help in doing postural drainage and percussion to prevent the collection of secretions.
A bladder retraining program requires a patient that is mentally prepared and emotionally able to take part in the training. Besides, the patient should be able to take an active role in the program. Another requirement for the program is understanding the cause of the incontinence, symptoms presented, awareness of the need to void, and any methods used to aid voiding (Dallred, 2017). Another requirement is the record of the number of times of voiding in a day. Once the voiding pattern is established, a 2-hour schedule for toileting is then planned (Dallred, 2017). This schedule involves the patient taking about 2-3l of water before 6 pm, toileting before bed, and keeping a record of the training (Dallred, 2017). Another element a training program is the eradication of medication that worsens incontinence and teaching of maneuvers to help in voiding. An encouraging trainer that applauds a patient’s success and encourages progress.
Patients with spinal cord injuries, especially those with permanent neurologic deficit, deal with grief and loss. They often undergo drastic changes in lifestyle, leading to despair, apathy, and even depression (Wu et al., 2018). Nurses often spend time with the patients, and therefore they ought to implement interventions to help these patients deal with grief. Some of the interventions include active listening, being supportive, and assisting patients in focusing on any positive aspects of the treatment process (Dallred, 2017). Also, nurses can encourage visits to patients and offer other diversions. These interventions help the individual cope better with the loss experienced.
References
Dallred, S.D.H.S. C. (2017). Medical-Surgical Nursing: Concepts & Practice. [Bookshelf Ambassadored]. Retrieved from https://ambassadored.vitalsource.com/#/books/9780323243780/
de Brito, C. M. M., Battistella, L. R., & Guarita, M. L. C. (2018). Challenges and Complications of Immobility. In Topics in Cognitive Rehabilitation in the TBI Post-Hospital Phase (pp. 25-33). Springer, Cham.
Hachem, L. D., Ahuja, C. S., & Fehlings, M. G. (2017). Assessment and management of acute spinal cord injury: From point of injury to rehabilitation. The journal of spinal cord medicine , 40 (6), 665-675.
Nas, K., Yazmalar, L., Şah, V., Aydın, A., & Öneş, K. (2015). Rehabilitation of spinal cord injuries. World journal of orthopedics , 6 (1), 8–16. https://doi.org/10.5312/wjo.v6.i1.8
Wu, X., Li, Z., Cao, J., Jiao, J., Wang, Y., Liu, G., ... & Liu, Y. (2018). The association between major complications of immobility during hospitalization and quality of life among bedridden patients: A 3 month prospective multi-center study. PloS one , 13 (10), e0205729.
