Spinal patients are also predisposed to urinary tract infections due to factors including urinary incontinence leading to skin moisture, prolonged recumbency and reduced immune function following spinal cord injury [ 11 ]. Nursing observations should therefore include assessment of the colour and odour of the urine, with routine urinalysis, including bacterial culture and sensitivity testing, performed as indicated. Appropriate antimicrobial therapy should subsequently be initiated under the direction of the VS, based on the test results [ 11 ].
Some patients may also present with faecal incontinence, which can occur not only with more severe spinal cord compression but also with certain neurolocalisations and diagnoses, such as chronic T3 – L3 disorders, for example, subarachnoid diverticulum, or acute L4 – S3 intervertebral disc disease [ 12 ]. Other patients may simply have reduced awareness of passing faeces. In all cases, prompt attention to cleanliness is essential to prevent faecal scalding and to maintain overall patient hygiene. Regularly monitoring the vital signs of these patients, including their respiratory rate, respiratory effort and body temperature, is essential for identifying any deterioration in neurological status.
Myelomalacia, a progressive and frequently fatal degeneration of the spinal cord [ 13 ], is the most serious complication in patients that have lost deep pain perception. Clinical indicators may include increased respiratory rate or effort as a result of respiratory muscle involvement, along with progressive loss of tone or flaccidity in the abdominal wall, hindlimbs and anus, corresponding to the involvement of LMN grey matter in the caudal spinal cord.
Patients may also become spontaneously hyperthermic due to haemorrhage caudal to the initial lesion, and behavioural changes such as marked dullness or a‘ flat’ demeanour may be observed, as well as pain. Horner ' s syndrome may also develop, with clinical signs including a constricted pupil, a drooping eyelid and an elevated third eyelid [ 14 ]. Any of these changes should be treated as an emergency and reported to the VS immediately.
Conclusions
Spinal emergencies require careful, consistent nursing support from the point of admission through to recovery or referral. Diagnosis and treatment decisions may depend on imaging, neurolocalisation, and whether the condition is managed conservatively or surgically. Although the underlying conditions and treatment pathways may differ, the fundamental nursing priorities are the same, with close monitoring, nutrition and hydration support being key. Bladder and bowel management and monitoring are essential, as well as prompt recognition of any deterioration. VNs therefore play a vital role in improving patient comfort, preventing complications and supporting the best possible outcomes for these vulnerable patients.
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