Nursing problems 1, urinary disorders In the early stage of spinal cord injury due to the bladder can be completely lost innervation, causing urine retention, and in the late stage may be due to a large amount of residual urine, which produces more than the flow of urine, so generally in the two weeks after the injury to the patient should be left catheterization, to keep the catheter continuously open, so that the amount of urine does not accumulate in the bladder, which can prevent the bladder from over-distension. After 2-3 weeks, the continuous open drainage will be changed to regular open drainage. To promote bladder filling and emptying training. Strictly execute aseptic operation when catheterizing and change the catheter regularly. Clean the urethral opening twice a day to make it clean and free of secretion, and encourage the patient to drink more water to increase the volume of urination in order to flush the bladder. 2.Bowel dysfunction is a common complication after spinal cord injury, mainly manifested as stubborn constipation, fecal incontinence and abdominal distension. We first take dietary treatment, to time, quality, quantity more food containing more fiber, such as vegetables, fruits. Can promote intestinal peristalsis and fluid secretion, so that the intestinal contents increase, the formation of hard fecal matter to reduce the opportunity, and can be massaged along the direction of the colon, to promote intestinal peristalsis, to help defecation. Then there are enemas to promote gastrointestinal peristalsis and defecation. In the abdominal distension is serious and affect the breathing, can be used to exhaust the anal tube. 3, thermoregulatory disorders normal human body through metabolism, nerves and body fluids to complete thermoregulation. And through the spinal cord and brain thermoregulation center to coordinate control and maintenance. So that the body in the process of heat production and heat dissipation to maintain a balance. Cervical spinal cord injury paralyzed patients due to the loss of sympathetic innervation, sweat glands are also paralyzed, body temperature regulation ability is reduced, so the body temperature is abnormal, mostly manifested as persistent hyperthermia, this kind of casualty should be physical cooling, and supplement enough water, electrolytes, sugar and amino acids to supplement the consumption of hyperthermia. If necessary, medication should be used to lower the temperature. 4.Respiratory dysfunction after cervical spinal cord injury, located in the brainstem, medullary reticular structure of the respiratory center downward conduction bundle loss of function, respiratory autonomy rhythm and depth of breath due to the inability to control and respiratory disorders. In addition, the patient’s body position is not proper, and it is difficult to expel the mucus in the throat. It may be inhaled into the trachea and cause infection. Therefore, the main goal is to improve the patency of the respiratory tract, discharge secretions and prevent aspiration into the lungs. The patient should change position frequently, turn over diligently, encourage the patient to take deep breaths and cough up sputum, and buckle the chest and back every time he turns over, so as to facilitate the discharge of sputum. Eliminate excessive secretions from the respiratory tract and keep the respiratory tract clear. 5. Decubitus ulcer Decubitus ulcer is the most common complication of spinal cord injury patients. They can occur in any period of time. Because the paralyzed part of the feeling disappears, the lack of damage to the stimulus protective reaction. In addition to their own weight pressure, continuous extrusion of the skin, skin and subcutaneous tissue ischemia and necrosis can occur. And excretory impregnation and friction, such as feces, urine and sweat. Easy to make the skin erosion, broken. Therefore, we are required to keep the bedding dry and clean, flat and soft, no wrinkles, no crumbs. And turn over regularly, turn over every 2 hours. Keep the body dry and clean, often scrub, clean the skin with warm water every day, the skin is easy to sweat parts of the body powder can be used to rub, if bedsores occur, should be relieved of compression, wound cleaning, and with the different symptoms of the different phases of the appropriate treatment. 6.Pain Spinal cord injury, there are corresponding soft tissues in the injured segment with different degrees of damage, which can cause pain, usually taking pain medication, or acupuncture, moxibustion, etc., symptomatic treatment. Nursing measures: I. Prevention and care of lung infection 1. Help and encourage patients to cough up sputum: teach patients the correct and effective way of coughing. Regularly instruct patients to cough hard to promote lung expansion and sputum. Because of the pain have dared to cough, appropriate use of painkillers, chest injury can be used to fix the chest with both hands, intercostal muscle paralysis and coughing weakness, can be used to press the upper abdomen with both hands to assist breathing. Gently clapping on the back is also conducive to the discharge of secretions. The method of patting the back: bend the five fingers together, from the top to the bottom, from both sides to the center of the patient’s back. 2, position: long-term supine prone to secretion stagnation, is not conducive to drainage, should often change position. If one side of the lung is found to be infected or the lung expansion is full, the affected side should be placed on the top, in order to facilitate the expansion and drainage of the lung. 3, nebulized inhalation: can make the secretion dilution is conducive to discharge. The inhalation solution is saline with antibiotics, dexamethasone, chymotrypsin and other drugs as appropriate. Second, skin care, prevention of bedsores Spinal cord injury patients are prone to bedsores, related factors: 1, paralyzed parts of the inability to move 2, skin loss of sensation, there is no under the usual skin pressure after the stimulation of pain signals. 3, plant nerve dysfunction leads to local ischemia. The most common sites of decubitus ulcers are the sacrococcygeal area and the heel, followed by the ankle, the fibular head, the elbow and the posterior occipital area of those with high spinal cord injuries (those who have cranial traction) can also occur. The depth of tissue necrosis can be from the skin, subcutaneous tissue, muscle to bone. Decubitus ulcers are difficult to heal, and large, deep bedsores are often associated with malnutrition, high body temperature, decreased plasma proteins, toxicity, and malignant fluid. Decubitus ulcers can be the cause of death and should be prevented. Preventive measures: 1, turn over regularly and change the body position. Turn over once every 1-2 hours according to the patient’s condition. Precautions for turning over: (1) master the correct method of turning over: patients with cervical spine fracture should pay attention to the head, neck and shoulder in a straight line to prevent spinal distortion and aggravation of spinal cord injury: cranial traction should also pay attention to maintaining the effectiveness of traction to prevent the traction bow from falling off: chest and waist in a straight line; patients with lumbar spine should pay attention to the chest, waist and buttocks in a straight line. (2) turn over the patient will gently lift the mobile flip, prohibit drag the patient on the bed. 2. Keep the bed clean and dry. 3, guide the companion for the patient to eat a highly nutritious multi-vitamin diet, increase skin resistance. 4, and strict handover. Treatment of decubitus ulcers: The early signs of decubitus ulcers are dark red pressurized skin, reduced elasticity, followed by blisters, at this time to strengthen the care, so that the local pressure is no longer, the blisters will be pumped out, to keep the skin dry and gently massaged around the blisters, and hopefully recovered. If the skin and subcutaneous tissue necrosis, ulceration, should be changed, remove the necrotic tissue, local application of Oriental one (with the role of decay and muscle). After the wound is fresh, apply Beifu agent twice a day, and pay attention to increase systemic nutrition. Third, prevent urinary tract infection Urinary tract infection is very common in paraplegic patients, and its related factor is the long-term use of catheter, so in the nursing process, the aseptic operation should be strictly required to prevent aggravation of infection. Measures: 1, explain to the patient the harm of long-term indwelling urinary catheter, in order to obtain the cooperation of the patient in the implementation of nursing measures. 2.Assist the patient to drink 2500ml of water daily. 3.Perineal scrub for the patient daily. 4, properly fixed urinary catheter urine bag, the position is always below the level of the bladder, the patient changed to the lateral position, the urinary catheter should not be across the side of the body, but should be passed between the legs. 5.Urinary bags should be changed twice a week, and urinary catheters should be changed once every two weeks, with strict aseptic operation. Once infection occurs, when there is high fever and other clinical symptoms, the amount of water intake should be increased, the ureter should be held open and drained, and broad-spectrum antibiotics should be used to prevent retrograde infection from occurring in the renal pelvis pus. Fourth, high fever High spinal cord injury patients often appear high fever up to 40 degrees or more, but the clinical examination did not find pneumonia or urinary tract infection, this is due to the cervical cord injury, most of the sympathetic nerves lose their role, no sweating function below the plane of injury, so that thermoregulation ability is greatly reduced, and hyperthermia occurs. Therefore, the room temperature should be kept not too high, and ventilation and cooling measures should be taken in summer. Once the body temperature rises, physical cooling methods can be used, such as warm water bath, ice packs, fans and other cooling methods. Fifth, the care of bowel movement dysfunction is mainly manifested as a decrease in the number of times, constant days without defecation. Measures to deal with: 1, regulate diet. Eat more foods containing more fiber, such as green vegetables and fruits, stimulate intestinal peristalsis, promote defecation. 2, massage. Massage along the colon from right down to left down. 3.Use laxative and laxative medicines, such as laxative, fruit seeking, cecrops and so on. Requirements for patients with spinal cord injury, generally keep 2-3 days once can be, such as fecal incontinence, fecal soaking around the anus, easy to cause erosion, induced bedsores. At this time should be dealt with in a timely manner, with water to wash the perianal skin and apply oil, if necessary, with infrared lamps will be localized baked dry. Sixth, the prevention of waste syndrome 1, lung: the same measures to prevent lung infection. During the recovery period, if the patient’s condition permits, the patient can be assisted to take a semi-sitting position, and the patient will be instructed to do deep breathing exercises several times a day to exercise the lung function and increase the lung capacity. 2, the urinary system: patients without symptoms of urinary tract infection, the ureter should be changed to open regularly, so that the bladder has to expand and contract. This physiological stimulation helps to establish a reflexive bladder, but also to avoid the formation of a contractile bladder due to long-term non-expansion. Remove the urinary catheter after a few weeks and train urinary function. Urination can be assisted by gently pressing the lower abdomen with the palm of the hand. Through training, try to achieve the patient can urinate on their own when they are discharged from the hospital. 3, limb deformity: deformity most often occurs in the parts of the hip, knee, ankle and toes. Hip joints are prone to flexion, internal retraction and internal rotation deformities, which can be caused by the position and long-term inattention to passive activities of the hip joint in the early stage. Therefore, the hip joint should be moved to the greatest extent every day, and attention should be paid to full extension and abduction to prevent joint stiffness, and in the late stage of contracture paralysis, attention should be paid to keeping the hip joint straight and out of the booth and applying passive activities: the knee joint is prone to dorsiflexion deformity, and the knee joint should be straightened several times a day: the ankle joint and toes are prone to plantarflexion deformity, i.e., horseshoe foot and hammer toes, which will become a great obstacle to the ground activities after it. It becomes a great obstacle when they go down to the ground, and even needs surgery to correct. 4.Muscle atrophy: strengthen the functional exercise, including the activities of paralyzed and unparalyzed muscles and joints, with special emphasis on the active movement of unparalyzed parts, such as the use of dumbbells or pulling springs to exercise the muscles of the upper limbs and the chest and back, and be ready to go down to the ground for the support of the crutches: at the same time, they can be actively exercising the lumbar and back muscles in the supine position or the prone position. After the disease is stabilized, start to sit up and leave the bed as early as possible. With the help of the upper limbs and the driving of the upper body, with the help of auxiliary tools, such as double bar, support, four-legged crutches, etc., go down to the ground to practice standing and walking. Enhancing self-care ability through practice can make patients build up confidence. Pay attention to the patient’s psychological state and do a good job in psychological care.