NLE Neurosensory Nursing — Spinal Cord and Peripheral Nerve DisordersConcept Map

Concept

Spinal Cord Injury (SCI)

Sub Concepts

• Types of Injury: Complete vs Incomplete
• Levels of Injury: Cervical, Thoracic, Lumbar, Sacral
• Mechanisms: Compression, Contusion, Laceration, Transection
• Incomplete Syndromes: Central Cord, Anterior Cord, Brown-Séquard
• Secondary Injury: Edema, Hemorrhage, Ischemia
• Emergency Management: Immobilization, Log-Rolling, Airway Protection

Relationship To Central

Most critical acute condition requiring immediate immobilization and prevention of secondary injury

Concept

Spinal Shock

Sub Concepts

• Definition: Loss of all reflex activity below injury level
• Manifestations: Flaccid paralysis, absent reflexes, loss of sensation, autonomic dysfunction
• Duration: Days to weeks; resolves as reflexes return
• Nursing Priority: Prevent complications of immobility during shock phase

Relationship To Central

Temporary neurologic phenomenon following acute SCI; distinct from neurogenic shock

Concept

Neurogenic Shock

Sub Concepts

• Level: Occurs with injury at or above T6
• Classic Triad: Hypotension, Bradycardia, Warm dry skin
• Mechanism: Loss of sympathetic vasoconstrictor tone
• Distinguishing Feature: Warm, dry skin (vs hypovolemic shock)
• Management: IV fluids, Vasopressors, Atropine for bradycardia

Relationship To Central

Life-threatening hemodynamic emergency in cervical/high thoracic injuries; requires vasopressor support

Concept

Autonomic Dysreflexia (Hyperreflexia)

Sub Concepts

• Timing: Occurs after acute phase when reflexes return (weeks to months post-injury)
• Classic Presentation: Severe pounding headache, dangerous hypertension (often >200 mmHg systolic)
• Accompanying Signs: Bradycardia, profuse sweating above injury, pallor and coolness below injury
• Most Common Triggers: Distended bladder (blocked catheter), fecal impaction, pressure injuries
• Emergency Interventions: Raise head of bed FIRST, loosen restrictive clothing, find/remove trigger, check bladder then bowel, give antihypertensive if needed

Relationship To Central

Medical emergency in SCI at/above T6; uncontrolled sympathetic response to noxious stimulus below injury

Concept

Herniated Intervertebral Disc

Sub Concepts

• Location: Most common L4-L5, L5-S1 (lumbar); also cervical
• Pathophysiology: Nucleus pulposus protrudes through annulus fibrosus
• Lumbar Presentation: Low back pain, sciatica, numbness, positive straight-leg-raise test
• Cervical Presentation: Neck and arm pain, weakness, radiculopathy
• Diagnosis: MRI
• Conservative Management: Rest, physical therapy, heat/cold, NSAIDs, muscle relaxants, proper body mechanics
• Surgical Intervention: Discectomy, laminectomy, spinal fusion for persistent deficits
• Cauda Equina Syndrome: Bowel/bladder dysfunction, saddle anesthesia, bilateral leg weakness—SURGICAL EMERGENCY

Relationship To Central

Nerve root compression requiring conservative management or surgical intervention; cauda equina is surgical emergency

Concept

Peripheral Neuropathy

Sub Concepts

• Common Causes: Diabetes mellitus (leading cause), alcohol use, B12 deficiency, chemotherapy
• Distribution: Stocking-glove pattern (distal to proximal)
• Manifestations: Numbness, tingling, burning pain, weakness, diminished reflexes
• Central Danger: Loss of protective sensation leads to unnoticed wounds, ulcers, amputation
• Diagnosis: Clinical assessment, monofilament testing, vibration and reflex testing, nerve conduction studies/EMG
• Pharmacologic Management: Gabapentin/Pregabalin, Tricyclic antidepressants (Amitriptyline), Duloxetine
• Patient Education: Daily foot inspection, protective footwear, temperature testing, foot hygiene, glucose control

Relationship To Central

Chronic progressive nerve damage causing sensory loss and protective sensation deficit; major amputation risk in diabetes

Concept

Incomplete Cord Syndromes

Sub Concepts

• Central Cord Syndrome: Greater upper extremity weakness than lower; common in hyperextension injuries in older adults
• Anterior Cord Syndrome: Motor loss and pain/temperature loss below injury; preserved position and vibration sense
• Brown-Séquard Syndrome: Hemisection—ipsilateral motor and position loss with contralateral pain/temperature loss

Relationship To Central

Specific patterns of neurologic deficit determined by location and extent of damage; affect prognosis and rehabilitation

Concept

Classification by Level of Injury

Sub Concepts

• Cervical (C1-C8): Tetraplegia (quadriplegia)—all four limbs affected
• C3-C5 Landmark: Phrenic nerve origin; C3,4,5 keep the diaphragm alive—injuries above C4 require ventilatory support
• Thoracic (T1-T12): Paraplegia—lower extremities and trunk affected
• Lumbar (L1-L5): Paraplegia with varying lower extremity and bowel/bladder involvement
• Sacral (S1-S5): Minimal to variable dysfunction depending on completeness

Relationship To Central

Level determines functional capacity, need for ventilatory support, and rehabilitation potential

Concept

Neurogenic Bladder and Bowel

Sub Concepts

• Neurogenic Bladder: Spastic (reflex) or Flaccid types
• Preferred Management: Intermittent catheterization on schedule to prevent overdistension
• Complications Prevented: Infection, reflux, autonomic dysreflexia
• Bowel Program: Scheduled evacuation, adequate fiber and fluids, stool softeners
• Bowel Impaction: Major dysreflexia trigger; manual disimpaction requires anesthetic lubricant

Relationship To Central

Expected complication of SCI; long-term management essential to prevent dysreflexia and infection

Concept

Acute SCI Management Priorities

Sub Concepts

• Scene and Transport: Log-roll with spine in neutral alignment; maintain immobilization with collar and backboard
• Airway and Breathing: Assess ventilation; jaw-thrust without hyperextension if intubation needed
• Hemodynamic Stability: Maintain adequate mean arterial pressure for spinal cord perfusion
• Stabilization: Immobilization to prevent extending injury
• Corticosteroids: Historically used; now controversial and not routinely recommended
• Surgical Decompression: May be indicated depending on injury type and neurologic status

Relationship To Central

Time-critical interventions in first hours determine secondary injury prevention and long-term outcomes

Concept

Nursing Care and Complication Prevention

Sub Concepts

• Skin Care and Pressure Injury Prevention: Regular repositioning, turning schedule, skin assessment
• DVT Prophylaxis: Sequential compression devices, anticoagulation as ordered, leg exercises
• Respiratory Care: Incentive spirometry, assisted coughing for high injuries, airway clearance
• Range of Motion: Active and passive exercises to prevent contractures
• Orthostatic Hypotension Management: Gradual mobilization, compression stockings, adequate hydration
• Psychosocial Support: Counseling, adjustment to life-changing injury, family education, rehabilitation program participation

Relationship To Central

Comprehensive ongoing care addresses immobility complications and supports rehabilitation and adaptation

Concept

Patient Teaching for Spinal Cord Injury

Sub Concepts

• Spine Precautions: Proper body mechanics, log-rolling technique, avoiding twisting
• Autonomic Dysreflexia Recognition: Early signs, immediate response protocol, when to seek emergency care
• Bowel and Bladder Programs: Schedule adherence, catheterization technique, signs of infection
• Skin and Foot Care: Daily inspection, pressure relief, protective footwear, recognizing breakdown early
• Rehabilitation and Follow-Up: Adaptive equipment use, physical and occupational therapy adherence, community resources

Relationship To Central

Education essential for long-term management, independence, and prevention of life-threatening complications

Concept

Patient Teaching for Peripheral Neuropathy

Sub Concepts

• Daily Foot Inspection: Visual examination of all foot surfaces, between toes, under nails
• Protective Footwear: Well-fitting shoes, never barefoot, moisture-wicking socks, regular replacement
• Temperature Safety: Test water with thermometer or elbow, avoid hot water bottles, protect from cold
• Foot Hygiene and Nail Care: Daily washing, gentle drying, professional nail care, avoid self-treatment
• Glucose Control: Tight glycemic management is essential to slow neuropathy progression
• Wound Reporting: Prompt reporting of any redness, ulcer, blister, or wound to healthcare provider

Relationship To Central

Prevention-focused education targeting protection of insensate feet and early identification of complications

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Spinal Shock

From

Spinal Cord Injury

Strength

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Relationship

SCI triggers spinal shock as a secondary response; spinal shock is a defining complication of acute SCI

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Neurogenic Shock

From

Spinal Cord Injury

Strength

strong

Relationship

High cervical/thoracic SCI (at/above T6) causes neurogenic shock due to loss of sympathetic tone

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Autonomic Dysreflexia

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Spinal Cord Injury

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Relationship

Only occurs in SCI patients at/above T6 after acute phase when reflexes return; represents major long-term complication

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Neurogenic Shock

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Spinal Shock

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Relationship

Both occur simultaneously in high SCI but are distinct phenomena: spinal shock is neurologic, neurogenic shock is hemodynamic

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Vasopressor Management

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Neurogenic Shock

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Relationship

Primary treatment for neurogenic shock is fluid resuscitation followed by vasopressors to restore vascular tone

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Neurogenic Bladder and Bowel

From

Spinal Cord Injury

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Relationship

Expected complication of SCI; bladder/bowel dysfunction is major trigger for autonomic dysreflexia

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Neurogenic Bladder

From

Autonomic Dysreflexia

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Relationship

Distended bladder/blocked catheter is the most common trigger of autonomic dysreflexia; first priority is to check bladder

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Neurogenic Bowel

From

Autonomic Dysreflexia

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Relationship

Fecal impaction is second most common trigger of autonomic dysreflexia; manual disimpaction can paradoxically worsen response

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Herniated Intervertebral Disc

From

Spinal Cord Injury

Strength

moderate

Relationship

Both conditions cause nerve compression and neurologic deficits; both may involve similar spinal levels (lumbar, cervical)

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Cauda Equina Syndrome

From

Herniated Disc

Strength

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Relationship

Severe disc herniation can cause cauda equina syndrome which is a surgical emergency with specific symptom triad

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Diabetes Mellitus

From

Peripheral Neuropathy

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Relationship

Diabetes is the leading cause of peripheral neuropathy in developed countries; tight glycemic control slows progression

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Loss of Protective Sensation

From

Peripheral Neuropathy

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Neuropathy causes sensory loss that removes protective sensation, leading to unnoticed injuries and ulcer development

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Foot Ulcers and Amputation

From

Peripheral Neuropathy

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Primary complication of peripheral neuropathy; prevention through daily inspection and protective footwear is critical

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Classification by Level

From

Spinal Cord Injury

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Level of injury determines functional capacity, ventilatory needs, and risk of specific complications like neurogenic shock

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Diaphragm Involvement

From

Cervical SCI Above C4

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Relationship

Phrenic nerve (C3-C5 origin) is compromised in injuries above C4, requiring mechanical ventilation

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Neurogenic Shock Risk

From

SCI at or above T6

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Relationship

Loss of sympathetic vasoconstrictor tone causes hemodynamic instability in high thoracic and cervical injuries

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Prognosis

From

Incomplete Cord Syndromes

Strength

moderate

Relationship

Specific syndrome patterns help predict functional recovery and rehabilitation potential

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Log-rolling Technique

From

Emergency SCI Management

Strength

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Relationship

Log-rolling is fundamental technique to maintain spine alignment and prevent secondary injury extension

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Autonomic Dysreflexia Prevention

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Pressure Injury Prevention

Strength

moderate

Relationship

Skin breakdown can trigger dysreflexia; regular turning and skin care prevent both complications

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Autonomic Dysreflexia Prevention

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Bowel and Bladder Programs

Strength

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Relationship

Scheduled emptying prevents distension, the primary dysreflexia trigger; essential long-term management

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Long-term SCI Outcomes

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Patient Education

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Relationship

Education about dysreflexia recognition, bowel/bladder programs, and skin care determines prevention of complications

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Gabapentin or Pregabalin

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Neuropathic Pain Management

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Relationship

These are first-line pharmacologic agents for neuropathic pain in peripheral neuropathy

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Autonomic Dysreflexia Management

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Antihypertensive Agents

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Relationship

Rapid-acting antihypertensives (nifedipine, nitrates) used only after trigger removal if BP remains dangerously elevated

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Interdisciplinary Team

From

Spinal Cord Injury Rehabilitation

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Long-term outcomes depend on coordinated care by physical therapy, occupational therapy, nursing, psychology, and medicine