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Spinal cord injury
pn141 test 3 book burke: pg 961
| Question | Answer |
|---|---|
| rehab begins when | at the date of admission |
| lifelong _________ | disability and problems |
| who get them most, male or femal | male |
| most common causes | mva, violence, falls, sports |
| is the divorce rate any different than normal stats | no it is normal, 50% |
| average stay in acute care | 15 days |
| average stay in rehab | 44 days |
| what is more common para or quad | para, slightly more common (only by 5%) |
| ages most common | 56% happen in ages 16-30 yo |
| what is a spinal cord injury (SCI) usually due to | trauma |
| what does the spinal cord do | it provides a two way path to conduct impulses between the brain and the body |
| how do nerves in teh spinal cord connect to the body | through nerve roots that exit the spinal column |
| the nerves in the spinal cord prived motor and sensory information to where | the entire body below the head |
| how is the spinal cord divided | into cervical, tharacic and lumbar regions |
| spinal cord: the cervical region carries sensations to where | head, neck, diaphragm, shoulders and arms |
| spinal cord: the thoracic region carries sensations to where | to the chest, nerves of the SNS |
| spinal cord: the lumbar region carries sensations to where | to legs, pelvis, B |
| where in the spinal cord are injuries targeted usually; why | in the cervica; and lumbar regions; b/c the vertebrae are not protected by other parts of the skeleton like the rib cage or pelvis |
| how are the SCI classified | according to the level of injury and the amount of damage |
| what is a complete SCI | in total loss of motor or sensory function below the level of injury, the cord is completely severed |
| what is an incomplete SCI | there are varying degrees of function below the level of injury; partial shredding or the cord |
| paraplegia: cause | damage at the thoracic level |
| paraplegia: what is it | paralysis of teh lower part of the body |
| tetraplegia: cause | high cervical injuries |
| tetraplegia: what is it | (aka quadriplegia) paralysis of the arms, trunk, legs, and pelvic organs |
| what happens as soon as there is bruising or compression of the spinal cord | bleeding into the gray matter occurs |
| what does the body's inflammatory response cause | edema, hypoxia and ischemia of the spinal cord |
| the body's inflammatory response does what to the injury | it expands the injury and may cause more damage than the original injury |
| what med is given if the cord has not suffered irreversable damage w/ the injury; w/in how many hours of the injury is the med given | corticosteriods; w/ in 4-6 hours |
| what does the corticosteroids do | stop teh inflamation |
| how long does it take for tissue to repair | 3-4 weeks |
| can the spinal cord regenerate | no |
| who is more prone to complications, tetraplegia pt or paraplegia | tetraplegia |
| complications: what are they to the integumentary system | decubitus ulcers |
| complications: what are they to the neurologic system | pain, hypotonia, autonomic dysreflexia |
| complications: what are they to the CV and PV system | spinal shock, orthostatic hypotension, bradycardia, DVT |
| complications: what are they to the respiratory system | limited chest expansion, PNA |
| complications: what are they to the GI system | stress ulcers, paralytic ileus, stool impactation, stool incontenence |
| complications: what are they to the GU system | urinary retension, incontinence, neurogenic bladder, UTIs, impotence, decreased vaginal lubrication |
| complications: what are they to the MS system | joint contractures, muscle spasms, muscle atrophy, pathologic Fx, hypercalcemia |
| functional ability by level of spinal cord injury- c1-c3- what can they do | no movement or sensation belowt he neck, vent dependent, need to use a sip and puff wheelchair |
| functional ability by level of spinal cord injury- c4- what can they do | movement and sensation of head and neck, some partial functions of the diaphram, they can operate awheelchair w/ their chin |
| functional ability by level of spinal cord injury- c5- what can they do | controls head, neck, and shoulders, can flex elbows, can use electric WC |
| functional ability by level of spinal cord injury- c6- what can they do | uses shoudlers and extends wrists, WC and self transfer |
| functional ability by level of spinal cord injury- c7-c8- what can they do | extends elbows, flexes wrists, some use of fingers, manual WC |
| functional ability by level of spinal cord injury- t1-t5- what can they do | has full hand and finger control, full use of thoracic muscles, manual wc |
| functional ability by level of spinal cord injury- r6-t10- what can they do | controls abdominal muscles, has good balance, manual wc |
| functional ability by level of spinal cord injury- t11-l5- what can they do | flexes and abducts the hips, flexes and extends knees, ambulates with leg braces or cane |
| functional ability by level of spinal cord injury- s1-s5- what can they do | full control of legs, progressive B&B, sexual function, ambulates w/ leg braces cane |
| Spinal Shock: def | temporary loss of relfex activity below the level of spinal cord injury |
| Spinal Shock: when does it occur | 30-60 minutes after a complete SCI |
| Spinal Shock: what are s/s | loss of motor function, sensations, spinal reflex, and autonomic functions, bradycardia, hypotension, loss of sweating and temp control, bowel and bladder dysfunction, flaccid paralysis, loss of abiltiy to perspire |
| Spinal Shock: how long does it last | days to weeks |
| Spinal Shock: what happens when it is over | reflex activity returns |
| Spinal Shock: what does pt need until it resolves | medical intervention and IV support |
| autonomic dysreflexia: what is it | an exaggerated sympathetic response in pt with SCIs at or above the T6 level |
| autonomic dysreflexia: why does it occur | b/c the impulses from the ANS are blocked by the SCI |
| autonomic dysreflexia: what can trigger a hypertensive crisis | noxious stimuli (full bladder of fecal impactation, ejaculation, renal stones, labor |
| autonomic dysreflexia: s/s | pounding HA, flushed, diaphoretic skin, pale cold and dry skin below issue, goosebumps, anxiety |
| autonomic dysreflexia: what can happen if untreated | it can cause seizures, CVAs, or death |
| autonomic dysreflexia: is this a medical emergency | yes |
| autonomic dysreflexia: what can SBP be | up into the 300 |
| autonomic dysreflexia: what to do to lower BP | elevate HOB 45 degrees, give antihypertensive emds, monitor BP q2-3 minutes, assesscause, |
| autonomic dysreflexia: what should you do if pt has foley | check for kinks or irrigate cath for patency, or if no cath insert a straight cath |
| autonomic dysreflexia: what to do for fecal impactation | insert nupercaine crean into the anus, wait 10 minutes and manually remove the impactation |
| immediate care: what could happen if pt is moved incorrectly right after SCI | can further damage the SC, peices from a fractured vertebrae could penetrate the cord and cause permanent damage |
| immediate care: when are clients moved | they are not moved unless their is a lige threatening danger |
| immediate care: how should all accident victems be managed | as if they have a SCI |
| immediate care: what is first assessed | ABCs |
| immediate care: what should you assess C/o from pt | neck pain or change in movement or sensations |
| immediate care: what should be done to the neck | immobilize |
| immediate care: what should always remain immobilized throughout assessment | the neck and head |
| immediate care: oxygen is given to whom | thoracic and cervical injuries |
| immediate care: why are IV fluids started | to prevent shock |
| immediate care: what med is given at high dose; why | methylpredisdone or corticosteroid; to prevent secondary spinal cord damage from edema and ischemia |
| diagnostic test: cervical spine Xray- why done | it shows Fx or displacement of the vertebrea |
| diagnostic test: CT or MRI- why done | shows damage to the vertebrae, spinal cord and tissue around thecord |
| meds: how long are corticosteroids given; why | 1-2 weeks; to decrease or control edema around the cord |
| meds: why is an antispasmotic given | to treat muscle spasms |
| meds: why are histamine h2-receptor antoagonsit (zantac) given | to prevent stress related gastric ulcers |
| meds: why are anticoagulants give n | to prevent thrombophlebitis |
| meds: why are stool softeners give n | as part of a bowel training program |
| immobilization: how are thoracic and lumbar injuries immobilized | with braces or body casts |
| immobilization: how are cervical injuries immobilized | with cervical tongs or a halo |
| cervical tongs: what are they | they are inserted into the skul and attached to weights to keep the spine in correct alignment |
| cervical tongs: what is the disadvantage | the pt is monitored closely bc the tongs could displace, not frequently used |
| halo vest: what is it used for | stable cervical or thoracic fx w/ out cord damage |
| halo vest: what does it allow for | greater mobility, self care, and participation in a rehab program. |
| halo vest: how does it work | it is secured through four pins inserted into the skull,two in the frontal bone and two in the occipital bone. the halo ring is then attached to a rigid plaster vest lined with sheepskin |
| halo vest: why should pins and be checked for tightness | b/c loose ones need to be tightened by MD, pt should not be able to move head or neck |
| halo vest: what should pin sights be assessed for | redness, edema, drainage |
| halo vest: why should skin under the vest be checked | for pressure areas |
| halo vest: when should the sheepskin be changed | as ordered, if it is soiled etc |
| what is the highest priority in nursing care | promoting respiratory funtion, and prevent complications of immobility (UIT, paralytic ileus, pressure ulcers) |
| nx Dx: impaired physical mobility: why are splints , trochantar rolls and high top tennis shoes used | to prevent wrist drop, footdrop, and eternal rotation of the hips |
| SCI: what is a closed one | trauma in which skin and meningeal covering are intact, no wound or obvious injury, twisting and pulling of the cord |
| SCI: what is a open one | damage to the protective coverings, obvious wound |
| SCI: what one is most common incomplete or complete | incomplete |
| imcomplete SCI: what cannot be predicted; why | the outcome; b/c there is cordal edeme |
| how long does it take for cordal edema to heal; this is the reason why ______ is unpredictable | a minimum of 6 months; the outcome |
| the higer the level of injury the _________ is it | worse it is |
| initial medical goals | save pt life, prevent frther injury to the cord, perserve as much function as possible |
| immediate management: guidlines for establishing an airway | never tilt neck back, do a modified jaw thrust, intibate |
| how long may pt be in traction | temporary and until surgery |
| halo vest: how ong does it stay on | 12 weeks |
| if the patient is a tetrapalegic, how should arims be positioned | up on pillows |
| halo: what to do if pins are loose and head moves | hold head, ask pt how long it has been moving, press call light and call for assistance, call doc to let them know cervical halo is loose, do not leave pt until someone takes over or the device is fixed by MD |
| halo: what can it do to skin | cause yeast infection and iritation |
| halo: bras for wm | they have special tube type onesto give supprot |
| halo: psych issues r/t it | depression, body image |
| halo: what assessment should be thorough | skin and check pressure poitns |
| halo: what to do when CPR is needed | 3 ppl are needed (one to hold head, one for compressions, one to bag), release straps on both sides of vest and break plastic shell at crease, order a new halo |
| halo: why is changing the sheepskin driven by MD order | b/c changing it can manipulate the appliance |
| halo: how is sheelpskin washed | in washing machine , airdry |
| halo: why are there a wrench and screwdriver | they come with the halo, always with the pateint, used to tighten bolts etch |
| halo: care for drill sites | acute care- saline drops and home care- soap and water |
| meds: methylprednisone - how long is pt infused with it | 23 hours |
| meds: methylprednisone - outcome with therapy | 20% complete injury regain, incmoplete up to 75% |
| surgery: what is done | lamectomy, removal of fx fractments, fusion |
| respiratory impairment: with what injury does it occur | C1-C4 |
| respiratory impairment: with out full lung expansion, what can happen | alveoliar can collapse |
| respiratory impairment: what happens with cough | it is weak, they do not have muscles or control to cough |
| spinal shock: is it temporary or permanent | temporary |
| autonomic dysreflexia: what happens when the arterioles constrict | svere HTn occurs , vagus nerves try to help so there is Bradycardia |
| sexual function: males report deficiency in what | erectile ability and ejaculatory function, decrease in libido |
| sexual function: females report deficiency in what | to achieve orgasm, or comfortable intercourse, decrease in libido |
| sexual function: tx for males | viagra, electrical stimulation, penile device, vaccume, intracavernous injections, penile implants |
| sexual function: tx for females | fertility, invitro, , lube |
| B7B: what is retraining program | pt on tolet same time each day, do digital stimulation, suposity, anama, increase fluids and fiber |
| meds: methylprednisone - USE | antiinflammatory, stabilizes lysosomal membrane and prevents the release of prteolytic enzymes during the inflammatory process |
Created by:
jmkettel
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