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NPTE: SCI

Review of Spinal cord Injuries & Treatment

QuestionAnswer
Lumbar Level of Most Common SCI L1-L2
Define Spinal Shock Temporary phenomenon that occurs after trauma to SC in which cord ceases to function below lesion; usually resolves within 24 hrs of injury
Designation of spinal level Defined as the most caudal level of SC that exhibits intact sensory & motor function; muscles must have grade 3+/5 strength
Define Complete Lesion Total & permanent functional disruption of SC more than 3 segments below level of lesion
Define Incomplete Lesion SC is not totally disrupted at level of injury; preservation of some function more than 3 levels below lesion
Describe presentation of Brown-Sequard Lesion Hemisection of cord; IPSI motor weakness/paralysis, loss of proprioception, two-point touch and CONTRA loss of pain & temperature
Describe presentation of Anterior Cord Lesion Results from ant trauma to SC or ant spinal artery; loss of motor function & pain & temperature below level of lesion
Describe presentation of Central Cord Lesion Most common cause hyperext injuries; effects UE sensation & motor function with normal LE function
Describe presentation of Posterior Cord Lesion Very rare; deficits of stereognosis, proprioception, 2-point discrimination; Ataxic gait with wide BOS
Describe presentation of Cauda Equina Lesion Injury below L1 segments: Sensory loss, paralysis, loss of B/B function; bc damage to peripheral nerve roots regeneration possible
The Diaphragm is innervated by which nerve & it's cord segments. Phrenic Nerve; C3-C5
General effects on Respiratory System following SCI Decreased Tidal Volume & Vital Capacity; accessory muscles of inhalation may be used more
General effects on Cardiac System following SCI When symp input lost, parasym input remains causing bradycardia, peripheral vasodilation, & hypotension
Pressure relief guidelines to prevent pressure sores Should take place 3-4xs/hr OR every 15-20 minutes regardless of material under pt
The most common cause of death following SCI is due to... Respiratory dysfunction
Techniques to prevent DVTs in SCI population A regular turning program, PROM exercise, elastic stockings & proper positioning of LEs
Define Autonomic Dysreflexia A medical emergency characterized by increase in BP, bradycardia, pounding HA, profuse sweating, and anxiety
What is the most common cause of Autonomic Dysreflexia? Bladder Distention
Immediate things to do if pt is experiencing Autonomic Dysreflexia Check bladder drainage system & open up if necessary. If lying flat, pt should be brought to sitting position to lower BP.
Treatment for Postural/Orthostatic Hypotension Slow progression to vertical while monitoring vitals, use of compression stockings & abdominal binder to minimize effects of hypotension
Key muscles in C1-C3 injury Face & Neck muscles
Clinical picture of pt with C1-C3 injury Capable of talking, mastication, sipping, blowing; Protable ventilator or phrenic stimulator, power "tilt-in-space" WC with mouth control & seatbelt for trunk control
Key muscles in C4 injury Diaphragm & Trapezius
Clinical picture of pt with C4 injury Capable of respiration & shoulder elevation; Chin control WC, adaptive eating equipment, head and mouth stick etc, limited feeding & ADLs, uses glossopharyngeal breath to cough
Key muscles in C5 injury Biceps, Brachialis, Brachioradialis, Deltoids, Infraspinatus, Rhomboids, & Supinator
Clinical picture of pt with C5 injury Power chair with hand controls for community, manual WC with rim projections 200-300 ft indoors, mobile arm supports to assist UEs, needs assistance for manual cough
Key muscles in C6 injury Extensor carpi radialis, Infraspinatus, Lats, Pec Major, Serratus Ant, Teres Minor
Clinical picture of pt with C6 injury Manual WC with projections or friction hand rims, May require power WC for community, can drive auto with hand controls, Tenodesis grip, uses manual cough ind
Key muscles in C7 injury Extensor pollicus longus & brevis, Extrinsic finger extensors, Flexor carpi radialis, Triceps
Clinical picture of pt with C7 injury Capable of elbow ext, wrist flex, finger ext; Manual WC for community with some difficulty on rough terrain, able to get WC in/out car, button hook may be necessary for dressing
Key muscles in C8 injury Extrinsic finger flexors, flexor carpi ulnaris, flexor pollicus longus & brevis
Clinical picture of pt with C8 injury Capable of full use UEs except intrinsic mm of hand; Ind at home except with heavy work, May need tub seat, grab bars etc for full ind at home, Manual WC, Able to work in building free of barriers
Key muscles in T1-T5 injury Top half of intercostals, long back extensors, intrinsic finger flexors
Clinical picture of pt with T1-T5 injury Capable of full use UEs, improved trunk control & resp reserve, Standing table for physiological standing, Manual WC, able to wheelie & participate in WC sports
Key muscles in T6-T8 injury Long muscles of back including sacrospinalis and semispinalis
Clinical picture of pt with T6-T8 injury Capable of improved trunk control, increased respiratory reserve; Ind in swing-to gait parallel bars with Bilat KAFOs & walker/crutches; WC for community amb
Key muscles in T9-T12 injury Lower abdominals & all intercostals
Clinical picture of pt with T9-T12 Capable of incr endurance & improved trunk control; Ind floor-WC transfers, swing-to/thru gait with bilat KAFOs & forearm crutches level surfaces, may be ind home amb, may use WC for community & energy conserv
Key muscles in T12-L3 injury Gracilis, Iliopsoas, QL, Rectus femoris, & Sartorius
Clinical picture of pt with T12-L3 injury Capable of hip flex, ADD, & knee ext; Ind home ambulator, Ind swing-to/thru or 4point with bilat KAFOs & forearm crutches level surfaces, WC for energy conserv, may be ind n community
Key muscles in L4-L5 injury Lowback mms, Medial hamstring(weak), Post Tib, Quadriceps, Tib Ant
Clinical picture of pt with L4-L5 injury Capable of strong hip flex, knee ext, weak knee flex, improved trunk control; Ind home ambulators, can be community ambulators, may use WC for convenience or energy conserv
Cord segments of Abdominal Innervation T5-T12
Cord Segments of Intercostal Innervation T1-T12
Created by: zimrizzle on 2010-09-14



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