spinalcordinjury
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| Most common locations of spinal cord injuries | cervical (1, 2, 4-7), and T1–L2 lumbar vertebrae
Locations reflect most mobile portions of vertebral column and the locations where the spinal cord occupies most of the vertebral canal
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| Degenerative Disorders of the Spine are | Degenerative disk disease (DDD)
Spondylolysis
Spondylolisthesis
Spinal stenosis
Low back pain
Herniated intervertebral disk
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| S&S of injury at the level of L 4 – 5 | pain in hip, groin, post-lateral thigh, dorsal surface of foot
Difficulty walking on heels
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| S&S of injury at the level L 5 – S 1 | pain mid gluteal, post thigh, calf down to heel, outer surface of foot
Difficulty walking on toes
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| Sensory deficits in affected areas Diminished or lost reflexes Back movement restricted Spastic paravertebral muscles Difficulty, pain with straight leg raise Aggravated by cough, sneeze or strain Are all S&S of..... | LUMBAR AREA
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| Stiff neck Radiating shoulder pain down arm into hand Paresthesias and sensory disturbances in hand Are all S&S of..... | CERVICAL
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| POST OPERATIVE ASSESSMENT | CSF leakage
Acute urinary retention & paralytic ileus
Arachnoiditis, diskitis
Larngeal and tracheal edema with anterior cervical laminectomy
Donor site for autologous graft for spinal fusion
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| Progressive weakness of lower extremities Loss of sphincter control, anal numbness Urinary retention Notify MD; may require emergency decompression | CAUDA EQUINA SYNDROME
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| NURSING DIAGNOSES FOR DISC DISEASE | Acute and chronic pain
Deficit knowledge
Risk for perioperative
positioning injury
Disturbed sensory perception
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| NIC LABELS FOR INTERVERTEBRAL DISC DISEASE | Pain management, analgesic administration
Teaching disease process
Positioning, intraoperative
Health education
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| MECHANISMS OF INJURY | Hyperflexion
Hyperextension
Vertical compression or axial loading
Excessive rotation
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| IMMEDIATE CARE & ASSESSMENT | Respiratory pattern & airway (use jaw thrust)
Determine circumstances of injury
Correct immobilization & transport
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| DEGREE OF INJURY Complete | permanent loss of motor & sensory function below level of injury
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| DEGREE OF INJURY Incomplete | some nerve fibers preserved distal to point of injury
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| Ischemia and edema Within 1 hour calcium flood accompanies dying cells Free radicals scavenge oxygen from healthy cells In 6 to 12 hours secondary wave of immune cells clear injured cells & also destroy live nerve | SECONDARY INJURY CASCADE
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| occurs immediately after injury | Spinal shock
also can lead to Neurogenic shock too
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| occurs after spinal shock resolves in injuries above T-6 | Autonomic dysreflexia
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| SPINAL SHOCK Below level of injury: | Loss of sensation to
Pain, touch, temperature & pressure
Absence of all voluntary activity (flaccid paralysis) and reflex neurologic activity
Bowel and bladder dysfunction
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| Loss of ability to shiver and retain heat or perspire to release heat Body temperature varies with the environment Monitor for temperature extremes | POIKILOTHERMIA
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| Flaccid paralysis Bradycardia Hypotension Occasional paralytic ileus Priapism | SCI above T6 SIGNS & SYMPTOMS
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| Loss of vasomotor tone (hypotension) Generalized vasodilation in PVS Interruption of sympathetic NS Decreased cardiac output Rx with sympathomimetic drugs phenylephrine, dopamine atropine for bradycardia | Neurogenic Shock
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| Medical emergency – severe hypertension up to 240-300 mm Hg Occurs with SCI above T-6 Exaggerated sympathetic response to noxious stimulus (usually full bladder) Complimentary parasympathetic system unable to balance below level of injury | AUTONOMIC DYSREFLEXIA
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| S/S OF DYSREFLEXIA | Hypertension
Bradycardia
Flushing & diaphoresis above SCI level
Severe headache
Nasal stuffiness
Blurred vision
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| DYSREFLEXIA MANAGEMENT | Sit upright to produce orthostatic hypotentsion (First action)
Monitor BP every 5 minutes
Check Foley Catheter for patency or bladder for distension (Empty bladder)
Assess for fecal impaction using local anesthetic
Notify MD
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| MEDICAL TREATMENT | Order to irrigate catheter, use only 30 mL
Obtain order for anesthetic gel (Lidocaine or Nupercaine)
Medications if needed: nitropaste, nifedipine (Procardia), hydralazine (Apresoline)
Key treatment – Prevention!!
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| Nursing Diagnoses in Subacute Phase | Risk for ineffective breathing pattern
R/T Neuromuscular impairment
Ineffective tissue perfusion: peripheral R/T interruption of venous flow
DVT occurs in 80% SCI patients
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| PULMONARY COMPLICATIONS C4 and higher affects | all muscles controlling breathing
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| PULMONARY COMPLICATIONS C4 – T6 | diaphragm function preserved; different degrees of accessory muscle function
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| PULMONARY COMPLICATIONS T6 – T12 | ability to cough impaired
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| NURSING MANAGEMENT IN SUBACUTE PHASE | Risk for impaired skin integrity R/T decreased sensation, immobility & vasodilation
Altered urinary elimination and constipation R/T neurogenic bowel and bladder
Risk for nutritional deficit R/T hypermetabolism & high caloric needs
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| Intermittent catheterization Force fluids to 2500 mL/ day Fluids to acidify urine Limit milk, dairy products, carbonated beverages | BLADDER RETRAINING INTERVENTIONS
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| Constipation can trigger dysreflexia Establish consistent time for elimination 30 min to 1 hour after eating High fluid intake & high fiber diet Rectal stimulation with or without suppositories Stool softeners | BOWEL RETRAINING INTERVENTIONS
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| Key is prevention Weight shift every 15 min 2 hour turning schedule Back tilt position 60 - 65 degrees | DECUBITUS ULCERS
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| MALE SEXUALITY & SCI | Sexual function controlled S 2 – 4
Men with UMN: 70% with complete injury & 80% with incomplete able to have intercourse
Reflex erection
Loss of psychogenic or fantasy responses
Psychogenic erection present 19% incomplete UMN
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| MALE SEXUALITY Three performance factors | Erection
Function of parasympathetic NS
Requires intact sacral reflexes
Ejaculation
Function of sympathetic NS
Fertility
Decreased sperm quality and motility
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| FEMALE SEXUALITY & SCI | Lack sensation during intercourse,Childbearing age–can become,pregnant,Hormonal BCP’s increase,Vaginal delivery possible,Risk of autonomic dysreflexia in labor,Pregnancy
Complicated by loss of sensation,increases in BP,& possible precipitation of AD
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| MEDICAL PROBLEMS Heterotrophic ossification | HO calcification around a joint, most often hip. 20% TBI or SCI exhibit within 12 weeks after injury
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| _______ cord syndrome is manifested by motor and sensory loss greater in the upper extremities than the lower extremities. | Central
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| _________ cord syndrome results in motor and sensory loss but not reflexes. | Anterior
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| _________ syndrome is characterized by ipsilateral loss of motor function and contralateral loss of sensory function. | Brown-Séquard
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| _________is related to reflex stimulation of the sympathetic nervous system reflected by hypertension, bradycardia, throbbing headache, and diaphoresis. | Autonomic dysreflexia (Autonomic reflexia is a massive, uncompensated cardiovascular reaction mediated by the sympathetic nervous system)
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| ________is the most important goal for a patient with a high cervical fracture. | Maintaining a patent airway
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| the most common cause of autonomic dysreflexia is | bladder irritation/constipation
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| __________ is a common problem accompanying spinal cord injury during the first 3 months | Deep vein thrombosis
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| What is most important action for a patient who has a suspected cervical spinal injury? | A patient with a suspected cervical spine injury should be immobilized with a hard collar and placed on a firm surface.
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| About 50% of people with acute spinal cord injury experience a temporary loss of reflexes, sensation, and motor activity that is known as... | spinal shock
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| Look under the Slide tab for autonomic dysreflexia and spinal cord pic | slide tab
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| C5 spinal cord injury highest priority? | airway
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| Rehabilitation goals for a patient with a spinal cord injury at the C6 level include ability to assist with: | transfer and perform some self-care; feed self with hand devices; push wheelchair on smooth, flat surface; drive adapted van from wheelchair; independent computer use with adaptive equipment; and needing attendant care only for 6 hours per day.
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| A patient with a C7 spinal cord injury undergoing rehabilitation tells you he must have the flu because he has a bad headache and nausea. What is your initial action? | It is important to measure blood pressure when a patient with a spinal cord injury complains of a headache. You must monitor blood pressure frequently during the episode. An α-adrenergic blocker or an arteriolar vasodilator may be administered.
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| A positive Brudzinski’s sign is seen in | meningitis
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