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LSC-Ch 45 Spinal Cor
Nursing
| Question | Answer |
|---|---|
| Factors Contributing to Low Back Pain | changes in support structures-spinal stenosis, osteoarthritis, change in vertebrall support & alignment-scoliosis, lordosis, Vascular changes, intervertebral disc generation |
| Prevetion of Low Back Pain & Injury | use proper body mechanics, get assistance, exercise, no high heals, good posture, avoid prolong sitting/standing, keep weight within 10% of ideal body weight, stop smoking |
| Diagnostics - Low Back Pain | CT w or w/o contrast, MRI, EMG & Nerve Conduction |
| Non Surgical Interventions Back Pain I | William's Position-semi-fowler's position pillow under knees to keep flexed, change positions frequently, dont just lie in bed-exercise Firm Mattress/Backboard under soft mattress |
| Non Surgical Interventions Back Pain II | Heat & Ice- Heat Promotes Circulation use for 20-30minutes, Deep Heat uS & Diathermy, Phenophoresis-topical lidocaine &/or hydrocortisone cream f/u with US 10min, Ice-reduces inflammation 10-15min |
| Extension Exercises | Stomach Lying Upper trunk Extension, Prone Pushups |
| Flexion Exercises | Pelvic Tilt, Semi Sit Ups, Knee to chest |
| Drug Therapy For Back Pain | NSAIDS Ibuprofen 800mg rx strength, Muscle relaxants Flexeril-sleepy, Chronic Pain-neurontin, Chronic Neuropathic pain-Oxcarbazepine (Trileptal) |
| Surgical Interventions For Back Pain | Diskectomy, Laminectomy, Spinal Fusion, Interbody cage fusion, Direct Current stimulation:implantable promote bone fusion |
| Surgical Procedure For Back Pain | MIS-home same day, Conventional Open Surgery-VS, Laminectomy checks, cervical movement, sensation in arms, all the functions in legs as well as feet, Voiding, CSF leak, Post Op Bleeding, Pain Control, Log ROll, TCDB, IS |
| Complications for Back | Most Common Complications: CSF Leak & urinary Retention-Men Stand |
| Care after Back Surgery | Firm Mattress, Bed Board, Lifting Restrictions 5# gradually increase, weight reduction, moist heat, Exercise PT-2WEEKS after surgery, conventional surg RTW: 4-6wks, MIS 3wks, proper body mechanics after surgery |
| Cervical Neck Pain | 5th&6th Vertebrae, Neck & Arm Pain, Herniation of nuceus pulposus resulting in spinal nerve root compression |
| Interventions for Cervical Neck Pain | Same as for lower back pain except exercises are related to shoulders/arms: shoulder shrugs, shoulder squeeze, rowing PRIORITY NURSING POST OP: Airway & Breathing |
| Spinal Cord Injury | Hyperflexion, Hyperextension, Axial loading, Vertical Extension, Excessive rotation, 2ndary Injuries: Ischemia, Neurogenic Shock, Hemorrhage, |
| Anterior Cord Syndrome | Loss of pain, tempsensation, motor function, still have touch, position & vibration sensation |
| Posterior Cord Syndrome | Retain Motor Function, Lose touch position, vibration |
| Brown Sequard | Penetrating injuries affecting half of the spinal cord; SAME SIDE: loss of motor function, proprioception & deep touch OPP SIDE: Loss of pain sensation, temp, & light touch |
| Central Cord Syndrome | central of spinal cord is affected, Loss of motor function of UE more than in LE |
| Dmage to Cauda Equina or Conus Medullaris (Horse's Tail) | Variable motor & sensory loss, injuries in this area have potential for recovery and regrowth, no nerve control to B&B |
| SBAR | Situation, Background Assessment Response |
| Physical Assessments for SCI | ABC's, Resp. Impairment-Cervical, note breathing pattern, look for other causes of resp distress, may need to be intubated or vent, SaO2 & PaO2, Abd-hemorrhage signs: low bp, tachycardia, weak pulse, U/O, Glascow Coma Scale: LOC |
| Level Of Injury | Cervical, High Thoracic: Quadriplegia/Tetraplegia, Quadriparesis. Lower Thoracic Lumbar: Paraplegia, Paraparesis |
| Assessment Sensation (SIC) | Light touch/Pin Prick Complete Loss, Hypoesthesia, Hyperesthesia, proprioception- move fingers/toes up or down |
| Assessment Motor Ability (SCI) | Flex, Extend, Joints shoulder to fingers, hips to toes |
| Assessment Cardiovascul (SCI) | above 6th Cervical: Disruption of sympathetic function, bradycardia, hypotension, hypothermia, cardiac dysrhythmias, Keep BP above 90mmHG to perfuse SC |
| GI/GU Assessment (SCI) | Decreased Peristalsis, Note abd distention: paralytic ileus, bleeding, monitor abd pain, firm, Nueruogenic bladder/urine retention, monitor UTI, Foley Cath - Cloudy Urine |
| Musculoskeletal Assessment (SCI) | Muscle wasting/flaccid paralysis, muscle spasticity/contractures, Monitor SKIN, Pressure reducing Mattress, Log roll every 2hrs |
| LABS and Dx Tests for SCI | Urine Analysis, ABG's (risk for pneumonia), Hgb, Hct, WBC, Platlets drop, CT and/or MRI, Leel of SC injury, presence of blood and bone in SC |
| Nursing Diagnosis SCI: Ineffective Tissue Perfusion | Reduce & Immobilize Fx Neuro checks, VS Pulse Oximetry Pain, Neurogenic Shock-life threatening, severe bradycardia & hypertension warm dry skin, POSITIONING: Prevent further cord injury, immobilize cervical spine, cervical tongs w/traction |
| Cervical Traction | Keeps vertebrae from compressing SC (reduce fx) Used until pt is stabilized for surgery, Vertebra stabilized w/surgery, Cervical & upper thoracic injuries-Halo fixator until bone regrows 6mo, pin care-betadine swab or ETOH, Skin Care, Lower Thoracic: TLSO |
| Drug Therapy for SCI | Methylprednisonlone (Solu-Medrol) reduces inflammation at SC Injury, Hope to regain 1-2levels of SC function, Monitor BG, signs of infection, stress ulcers. Dextran: Plasma expander, Atropine: Bradycardia, Dopamine: Hypertension |
| More Drugs for SCI | Muscle relaxants, Intrathecal Baclofen or Dantrium infusion pump: Decreases muscle spasticity w/o severe drowsiness, Celebryx-prevent bony overgrowth |
| Surgical Mgmt | Decompressive Laminectomy-allows cord expansion from edema, spinal usion, steel rods, needs halo/brace during recovery. Post Op Neuro Checks, VS |
| Ineffective Airway Clearance: Nursing Diagnosis SCI | Interventions: TCB, Cough Assist, IS, Level of injury determines if intubation or trach are necessary, risk: PE or Pneumonia |
| Impaired Physical Mobility: Nursing Diagnosis SCI | Intervenions: #1SKIN B/D! Positioning, Teach to reposition self(Lower level injuries), Pressure reducing devices for wc, monitor for hypotension w/position changes |
| Impaired Urinary Elimination &/OR Constipation Nursing Diagnosis SCI | Establish B&B program, Valsalva to empty bladder (Pressing down on bladder), Intermittent self cath (q3-4hrs), Risk: Long Term Kidney Stones, Unaware of infection, need to void, urgency |
| Interventions continued for Bowel Program SCI | Stool Softners, Increased Fluid Intake, Fiber in Diet, COnsistent time to eacuate, digital stim, ducolax suppository |
| Autonomic Dysreflexia | Uncontrolled Sympathetic stim from a noxious stimulus: Full Bladder, Shoes tied too tight, Constipation Neurological EMERGENCY Sudden hypertensive Crisis |
| Symptoms of Autonomic Dysreflexia | Sudden onset severe throbbing HA, Severy rapidly occuring Hypertension, Bradycardia, Flshing above level of lesion (face&chest) Pale extremities below lesion, Nasal Stuffiness, Sweating, Nausea, Blurred Vision, Piloerection, Apprehension |
| Autonomic Dysreflexia Interventions | Place in sitting position*, page/notify physician, loosen tight clothing, assess for & treat the cause, check catheter for kinks, check bladder distention, check for fecal impaction, check room temp, monitor bp q10-15min, give nitrates or hydralazine |
| Multiple Sclerosis MS | Chronic Autoimmune disease afecting mylelin sheath & conduction pathways of CNS, characterized by periods of remissions & exacerbations-most common, mild to mod disease, relapses occur for 1-2 weeks and remission over 4-8mos return to baseline. |
| Assessment of MS | Dx can be difficult due to mimicking of other diseases, thorough hx, vision changes, motor skills, sensations, often vague, aggravating factors: stress, overexertion, temp extremes, personality changes |
| Motor Assessment of MS | weakness clumsy, loss of balance, unsteady gait, poor coordination, fatigue, intenion tremors, flexor spasms at night, dyspagia |
| sensory Assessment of MS | Hypalgesia (decreased sensativity to pain), Paresthesia (pins&needles), Numbness, tingling, and burning, crawling sensations, facial pain, diplopia, blurring, decreased temp recognition, b&b incontinence, sex dysfunction |
| Cognitive & Psychosocial Assessment of MS | Mental status changes usually not seen til late in disease, Decreased Short term memory, Concentration and ability to perform calcuations, inattentiveness, impaired judgment, anxiety, fear apathy depression, lability |
| Nursing Dx for MS | Fatigue, Activity Intolerance, Disturbed Sensory Perception, Impaired Physical Mobility, Impaired Urinary Elimination, Chronic Pain |
| Drug therapy for MS | BRM's Interferon: Avonex IM Inj, Betaseron: SQ Inj, Copaxone SQ Inj, Monoclonal Antibody: Natalizumab (Tysabri) ANticholinergics: bladder dysfunction. MANY SE: Suicide, depression, thrombocytopenia, leukopenia |
| More Drug Therapy for MS | Steroids: Methylprednisolone (Solu-Medrol) IV corticosteroids, nursing considerations: Fluid & Electrolytes, blood glucose, K+, GI Bleeds, Ulcers, Personality changes, decreasing exposure to infectious diseases, steroid rages |
| More Drug Therapy FOR MS | Antispasmodics: Baclofen, Diazepam, or Dantrium for muscle spasms, Adjunctive Therapy meds to treat symptoms including bladder spasms, paresthesia, pain, uncontrolled fatigue (belladonna suppository to decrease bladder spasms |
| Health Teaching for MS | Exacerbations & Remissions, Avoid over exercise, extremes of temps, people w/URI's, PT, use of adaptive equipment, B/B mgmt, need for daily rest/avoid stress |
| Amyotrophic Lateral Sclerosis (ALS) | Progressive & degenerative disease of motor system, atrophy of hands, forearms & legs, results in paralysis & eventually death, no cause, cure, prevention, or standard of tx, no changes in mental status flacid quad, Dvlp Pneumonia, 2-5yrs to live |
| Clinical Manifestations of ALS | Fatigue, especially w/speech, tongue atrophy, dysphagia, muscle weakness & atrophy, nasal quality to voice, dysarthria (slurred speech), resp compromise |
| Drug Therapy for ALS | Riluzone (rilutek) is used to extend survival time. Liver toxic so enzymes must be monitored. Multiple other meds to treat pain, spasms, excessive secretions, and aid in sleep |
Created by:
ginabeana
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