Paraplegia is caused by direct manipulation (e.g. firearms, knife stab wounds, etc.) and indirect manipulation (vertebral fractures, subluxations, etc.) of the spinal cord. Spinal operations can affect progressive muscle atrophy, loss of relevant sensation and perception, impaired function of certain organs (e.g. loss of bladder control, etc.) or loss of certain mobility, etc., which can be life-threatening in severe cases. Therefore, traumatic paraplegics should be actively rescued and reasonably treated at an early stage, combined with the rehabilitation guidance of health care managers and enhanced nursing care, in order to achieve reset of vertebral fractures and dislocations and maximum recovery of spinal cord function at an early stage.
Rehabilitation care mainly focuses on the following aspects.
(1) Skin care.
①Check daily for the prevalence of pressure sores (decubitus ulcers) and keep the skin dry and clean;
(2) Axial turning of bedridden patients at 2-hour intervals.
(2) Urinary system care.
①Keep the urinary catheter unobstructed when the catheter is left in place, and pay attention to clamping and opening the catheter regularly;
(2) Drink 2000-2500 ml of water daily and control urine volume at 1000-1500 ml in 24 hours; urine volume can be increased during critical resuscitation. Start intermittent clean catheterization as early as possible under the guidance of doctors and nurses.
(3) Defecation care.
①Usually keep defecation once a day or two and develop the habit of regular defecation;
②If there is fecal incontinence, feces soaking around the anus can easily cause erosion and induce pressure sores, so the perianal skin should be washed with water and protective oil should be applied in time.
(4) Hyperthermia care.
For elevated body temperature due to thermoregulatory disorders, physical cooling methods can be used to reduce coverings, warm water baths (rubbing the extremities, armpits, groin), ice packs (forehead, both sides of the neck), fans and other cooling methods, and antipyretics should be used if the hyperthermia does not subside. In case of infectious hyperthermia, an adequate amount of sensitive antimicrobial agents should be used.
(5) Autonomic dysfunction care.
① Patients with tetraplegia due to cervical medullary injury may suddenly develop headache, profuse sweating, breath-holding, skin flushing, tachycardia or bradycardia, increased blood pressure and other manifestations called autonomic hyperreflexia, which can be caused by adverse stimuli (such as bladder filling, pressure sores, muscle spasm, constipation) below the injury site;
②When the above symptoms appear, immediately take the head high position and remove the causative factors as soon as possible;
(3) Check whether the bladder is full, and check whether the urinary catheter is unobstructed in patients with indwelling urinary catheters; (4) If the patient cannot pass stool because of constipation, assist in defecation immediately.
(6) Management of postural hypotension.
① Early carry out head elevation training, the angle from small gradually increase to 90 °, sitting 90 ° can persist for 1 hour, you can take a wheelchair;
②Wear a waist brace and elastic stockings before getting out of bed;
③When the patient is in a wheelchair, if hypotensive symptoms appear, immediately raise the front wheel of the wheelchair so that the patient is in an approximate semi-recumbent or flat position. After the patient’s symptoms are relieved, flatten the wheelchair. If the patient cannot be relieved, immediately place the patient flat on the bed.