Spinal cord injury: spinal precautions, log rolling, autonomic dysreflexia, bladder and bowel
- Safe practice
After a spinal cord injury the nurse keeps the spine aligned, turns the patient in one piece, prevents pressure injuries and knows autonomic dysreflexia.
What it is
A spinal cord injury cuts the messages between the brain and the body below the injury: movement, feeling, bladder, bowel, blood pressure and, in neck injuries, breathing. On the ward the patient is usually past the first critical days (the ICU phase has its own page). Nursing then has two goals. First, protect the spine until the team says it is stable: alignment, log rolling and the ordered collar or brace. Second, prevent the secondary problems that cause most harm and death, especially in the first year: pressure injuries, urinary infections, blood clots, chest infections, pain and depression. Patients with injuries high in the spine can develop autonomic dysreflexia, a sudden dangerous rise in blood pressure set off by something below the injury, most often a full bladder.
What it requires
- Neck injuries can weaken or paralyse the breathing muscles; chest-level injuries can cause swings in blood pressure, sweating and temperature control problems.
- Dysreflexia can be set off by anything irritating below the injury, even if the patient cannot feel it: a full bladder or blocked catheter, constipation, skin sores, pain, tight clothing.
- Signs of dysreflexia: high blood pressure, slow, fast or irregular pulse, pounding headache, flushing, goose bumps or sweating above the injury, skin colour changes, blurred vision, nasal congestion.
- If the cause cannot be found or the blood pressure stays high, it is an emergency.
How it is applied (and why)
- Confirm the spinal orders (stability, collar or brace, bed position) before moving the patient: wrong movement can damage the cord further.
- Turn by log roll with a trained team, keeping head, trunk and legs in line: it prevents twisting of the spine.
- Check breathing, cough strength and saturation, especially in neck injuries: breathing muscles may weaken.
- Reposition on schedule and check the skin daily, especially over bones: the patient may not feel pressure.
- Keep the bladder from getting too full (catheter care or intermittent catheterisation as ordered) and the catheter free of kinks.
- Set a daily bowel routine at the same time each day: constipation and impaction are common triggers of dysreflexia.
- Apply clot-prevention measures as ordered and look for calf swelling: immobility raises the risk of thrombosis.
- If dysreflexia appears: sit up if the spine allows, loosen clothing, check bladder, catheter, bowel and skin, check BP and call.
- Ask about pain and mood and involve rehabilitation and the family: depression and chronic pain are common.
In nursing practice
- Call at once: signs of dysreflexia, new weakness or loss of feeling, trouble breathing or a weak cough, a drop in blood pressure or a slow pulse.
- Report: signs of a urinary infection (fever, burning, frequent urination), a new skin sore, a swollen calf, constipation beyond the usual pattern.
- Teach the patient and family the triggers and the first steps; carrying a card that explains dysreflexia helps other health workers.
- Rehabilitation includes daily bowel care, regular bladder emptying, skin care, assistive devices and home changes.
Common mistakes
- Turning the patient without enough trained people, or letting the head move separately from the trunk.
- Treating a pounding headache in a patient with a high spinal injury as an ordinary headache.
- Leaving the patient lying flat while searching for the cause of dysreflexia, when the spinal orders allow sitting up.
- Forgetting the bowel routine for days: constipation is a common, preventable trigger.
Test yourself
Think of the answer, then tap the question to see it.
What is log rolling and why is it used?
Turning the patient as one unit, with a trained team keeping head, trunk and legs in line. It avoids twisting the spine until it is stable.
What are the signs of autonomic dysreflexia?
High blood pressure, pounding headache, flushing and sweating above the injury, skin colour changes, a slow or irregular pulse, blurred vision or nasal congestion.
What is the most common cause of autonomic dysreflexia and what does the nurse check first?
The bladder: a full bladder or a kinked or blocked catheter. Then the bowel, skin and tight clothing.
Which secondary problems does nursing prevent after a spinal cord injury?
Pressure injuries, urinary tract infections, deep vein thrombosis, chest infections, chronic pain and depression.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Spinal cord injury (fact sheet) (World Health Organization (WHO), 2024); Spinal cord trauma (Medical Encyclopedia) (MedlinePlus, U.S. National Library of Medicine, 2024); Autonomic dysreflexia (Medical Encyclopedia) (MedlinePlus, U.S. National Library of Medicine, 2024); Autonomic dysreflexia (SCI factsheet) (Model Systems Knowledge Translation Center (MSKTC), funded by the U.S. National Institute on Disability, Independent Living, and Rehabilitation Research, 2022).
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Representative model, for educational purposes only.