| Question |
Answer |
| Complete injury |
spinal cord is severed or severely damaged, prevents all innervation below injury |
| Incomplete injury |
some function or movement below injury |
| Primary mechanisms of injury |
(1) hyperflexion, (2) hyperextension, (3) axial loading/vertical compression, (4) excessive rotation |
| Anterior cord syndrome (Cervical) |
loss of motor function, px and temp sensation; intact tough, position, vibration sensation |
| Posterior cord syndrome (Cervical) |
loss or vibration, crude tough, position sensations; intact motor function |
| Brown-Sequard syndrome (Cervical) |
ipsilateral loss of motor function, proprioreception, vibration, deep touch sensation; contralateral loss of px, temp, light touch sensation |
| Central cord syndrome (Cervical) |
loss of motor function pronounced in upper extremities; variable degrees/patterns |
| Conus medullaris syndrome |
T11 to L1; neurogenic bladder & bowel |
| Cauda equina syndrome |
L2 to S5; neurogenic bladder & bowel |
| Assess of C4 to C5 |
apply downward pressure while client shrugs shoulders |
| Assess of C5 to C6 |
apply resistance while client pulls up arms |
| Assess C7 |
apply resistance while client straightens arms |
| Assess C8 |
client able to grasp object & form fist |
| Assess L2 to L4 |
apply resistance while client lifts legs of bed |
| Assess L5 |
apply resistance to dorsiflexion |
| Assess S1 |
apply resistance to plantar flexion |
| C3 to C5 |
phrenic nerve |
| Tetraplegia |
paralysis of all 4 extremities |
| Quadraparesis |
weakness in all 4 extremities |
| Paraplegia |
paralysis of lower extremities |
| Paraparesis |
weakness in lower extremities |
| Spinal Shock (etiology) |
disrupted communication between upper and lower motor neurons |
| Spinal Shock (s/s) |
flaccid paralysis, loss of reflex activity below injury level, bradycardia, hypotension |
| Spinal Shock (indication of reversal) |
return of reflex activity |
| Autonomic dysreflexia (s/s) |
severe hypertension, bradycardia, headache (sudden onset, severe), stuffiness, flushing (above injury), pale (below injury) |
| Autonomic dysreflexia (etiology) |
noxious stimulus (i.e. bladder distention, constipation) |
| Autonomic dysreflexia (Meds) |
nitrates, hydralazine |
| Lower motor neuron injury |
flaccid paralysis |
| Upper motor neuron injury |
muscle spasticity |
| Heterotopic ossification |
bony overgrowth; AEB swelling, redness, warmth, decreased ROM |
| Neurogenic shock (s/s) |
hypotension, bradycardia |
| Halo fixator |
static traction; 4 pins in skull; halo attached to vest/cast when spine is stable |
| Dextran (plasma expander) |
improve capillary blood flow, prevent treat hypotension |
| Decompressive laminectomy |
removal of laminae to allow cord expansion from edema |
| Cough assist |
hands on lower rib cage below diaphragm, as client inhales push upward to expand lungs and cough |
| Assess vulnerability to skin breakdown |
press on reddened area, no blanching |
| DVT prevention |
combo LMWH & rotational bed, SCDs, PCBs |
| Stimulate voiding w/ spastic bladder |
stroke inner thigh, pull pubic/upper thigh hair, warm water over perineum, tap bladder area (stimulates detrusor muscle) |
| Bethanechol chloride (Urecholine) |
cholinergic used to stimulate voiding, given 1 hr before attempt to void |
| Voiding w/ spastic bladder |
Valsalva maneuver and tighten ABD muscles; assess for effectiveness by cath. for residual urine |
| Bowel retraining |
consistent time, high fluid & fiber, rectal stimulation (w/ or w/o suppositories) |
| Teaching for SCIs |
physical mobility & activity skills; ADL skills; bowel/bladder training; medications; sexuality education |
| Nsg. Intervention: Get flu shots, tetanus (q10y), and pneumonia vaccine |
Rationale: respiratory complication is most common cause of death after SCI |
| Nsg. Intervention: Annual PAP smear/mammogram |
Rationale: movement limitations make self exam difficult |
| Nsg. Intervention: Preventative measures for osteoporosis |
Rationale: women >50yrs loose bone density |
| Nsg. Intervention: Meticulous skin care |
Rationale: Aging decreases elasticity and increases dryness |
| Nsg. Intervention: Constipation prevention |
Rationale: most SCI pts have constipation, more likely in older people |
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