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