Chapter 40: Concepts of Care for Patients With Problems of the Central Nervous System: The Spinal Cord

Multiple sclerosis represents a chronic autoimmune condition characterized by demyelination of nerve fibers, resulting in progressive neurological dysfunction marked by episodes of extreme fatigue, muscular spasticity, intention tremors, and visual disturbances including diplopia. Clinical management of multiple sclerosis requires sustained immunomodulatory therapy paired with targeted symptom management, while nursing vigilance must account for potentially severe medication-related complications such as progressive multifocal leukoencephalopathy, which demands ongoing assessment of cognitive function and neurological status. Spinal cord injury, frequently resulting from traumatic mechanisms like axial loading forces, produces variable degrees of neurological impairment ranging from paraplegia to tetraplegia depending on the level and completeness of injury. Acute phase nursing priorities center on rapid airway management, spinal immobilization techniques including hard cervical collar application and log rolling maneuvers, and prevention of secondary injury through careful patient handling. A particularly critical nursing concern involves recognition and immediate intervention for autonomic dysreflexia, a life-threatening emergency presenting with sudden severe hypertension and severe headache in patients with high-level injuries, requiring rapid positioning changes and identification of noxious stimuli such as catheter kinks or fecal impaction. Neurogenic shock, characterized by loss of vascular tone requiring aggressive fluid resuscitation and vasopressor support, represents another acute cardiovascular complication demanding close hemodynamic monitoring. Chronic spinal cord injury management emphasizes prevention of secondary complications including pressure ulcers, venous thromboembolism, and heterotopic ossification through systematic preventive strategies. The chapter additionally addresses low back pain syndromes commonly caused by muscular strain or herniated intervertebral discs, emphasizing ergonomic education and conservative positioning strategies such as the Williams position. Postoperative nursing care following spinal surgical procedures, including anterior cervical discectomy and fusion, requires meticulous monitoring for cerebrospinal fluid leakage identified by characteristic halo signs and continuous neurological reassessment to ensure adequate spinal cord perfusion.