ACUTE PHASE NURSING: RESPIRATORY AND CARDIOVASCULAR PROBLEMS

RESPIRATORY SYSTEM

  1. Problems include respiratory arrest and insufficiency, atelectasis, bronchial obstruction, and pneumonia, the major contributors to mortality and morbidity after SCI, especially during the first year (Lucke, 1998)

  2. Causes include extended immobilization and bed rest, paralysis of some or all of the respiratory musculature, ineffective cough, possible surgical interventions, pre-existing pulmonary disease, concurrent chest trauma, anemia, gastric distention, paralytic ileus, and especially, ascending edema

  3. Nursing Diagnoses include possible ineffective airway clearance and breathing pattern; high risk for aspiration, infection, and/or altered respiratory function; impaired gas exchange; inability to sustain spontaneous ventilation; and problems such as hypoxemia, atelectasis, pneumonia, pneumothorax, and respiratory arrest

  4. Assessments include determining baseline respiratory status (assess patient's ability to cough and deep breathe effectively, auscultate the chest, and note the breathing pattern); monitor chest x-rays, blood gas levels, CBC, sputum cultures, and pulmonary function tests

  5. Nursing Interventions include intubation and ventilator support, as well as supplementary oxygen and consultation with pulmonologist, if necessary, and the respiratory regimen of chest percussion, respiratory toilet, suctioning, and deep breathing if on a ventilator; assist with cough as needed; provide tracheostomy care every 4 hours, chest physical therapy and deep breathing exercises every 2 - 4 hours, IPPB every 4 hours, and use of incentive spirometer every 4 hours

CARDIOVASCULAR SYSTEM

  1. Problems include cardiac arrest and arrhythmias, thrombophlebitis, deep venous thrombosis, pulmonary embolus, and orthostatic hypotension

  2. Causes include bradycardia and lowered blood pressure due to vasomotor paralysis, vasodilation, decreased blood return, blood pooling, and increased risk of vascular stasis

  3. Nursing Diagnoses include impaired gas exchange, decreased cardiac output, altered tissue perfusion, risk for peripheral neurovascular dysfunction, dysrhythmias, DVT, and hypovolemia

  4. Assessments include monitoring vital signs, cardiac monitoring for arrhythmias, monitoring response to head elevation, observation for signs of thrombophlebitis, DVT, and PE, and EKG, electrolyte and coagulation tests

  5. Nursing Interventions include treating life-threatening arrhythmias, heparin to prevent DVT, use of sequential compression boots, vasopressors and consultation with a cardiologist as needed

The PoinTIS Spinal Cord Nursing site of the SCI Manual for Providers is based on information in Hickey JV. The Clinical Practice of Neurological and Neurosurgical Nursing, 4th ed., Philadelphia: Lippincott, 1997; Chin PA, et al. Rehabilitation Nursing Practice, N.Y.: McGraw-Hill, 1998; and Wirtz KM, Managing chronic spinal cord injury: issues in critical care, Critical Care Nurse 1996 16(4):24-35 Aug., except for information where other papers are cited.