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spinalcordinjury
| Question | Answer |
|---|---|
| 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 |
| Degenerative Disorders of the Spine are | Degenerative disk disease (DDD) Spondylolysis Spondylolisthesis Spinal stenosis Low back pain Herniated intervertebral disk |
| 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 |
| 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 |
| 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 |
| Stiff neck Radiating shoulder pain down arm into hand Paresthesias and sensory disturbances in hand Are all S&S of..... | CERVICAL |
| 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 |
| Progressive weakness of lower extremities Loss of sphincter control, anal numbness Urinary retention Notify MD; may require emergency decompression | CAUDA EQUINA SYNDROME |
| NURSING DIAGNOSES FOR DISC DISEASE | Acute and chronic pain Deficit knowledge Risk for perioperative positioning injury Disturbed sensory perception |
| NIC LABELS FOR INTERVERTEBRAL DISC DISEASE | Pain management, analgesic administration Teaching disease process Positioning, intraoperative Health education |
| MECHANISMS OF INJURY | Hyperflexion Hyperextension Vertical compression or axial loading Excessive rotation |
| IMMEDIATE CARE & ASSESSMENT | Respiratory pattern & airway (use jaw thrust) Determine circumstances of injury Correct immobilization & transport |
| DEGREE OF INJURY Complete | permanent loss of motor & sensory function below level of injury |
| DEGREE OF INJURY Incomplete | some nerve fibers preserved distal to point of injury |
| 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 |
| occurs immediately after injury | Spinal shock also can lead to Neurogenic shock too |
| occurs after spinal shock resolves in injuries above T-6 | Autonomic dysreflexia |
| 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 |
| Loss of ability to shiver and retain heat or perspire to release heat Body temperature varies with the environment Monitor for temperature extremes | POIKILOTHERMIA |
| Flaccid paralysis Bradycardia Hypotension Occasional paralytic ileus Priapism | SCI above T6 SIGNS & SYMPTOMS |
| 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 |
| 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 |
| S/S OF DYSREFLEXIA | Hypertension Bradycardia Flushing & diaphoresis above SCI level Severe headache Nasal stuffiness Blurred vision |
| 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 |
| 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!! |
| 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 |
| PULMONARY COMPLICATIONS C4 and higher affects | all muscles controlling breathing |
| PULMONARY COMPLICATIONS C4 – T6 | diaphragm function preserved; different degrees of accessory muscle function |
| PULMONARY COMPLICATIONS T6 – T12 | ability to cough impaired |
| 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 |
| Intermittent catheterization Force fluids to 2500 mL/ day Fluids to acidify urine Limit milk, dairy products, carbonated beverages | BLADDER RETRAINING INTERVENTIONS |
| 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 |
| Key is prevention Weight shift every 15 min 2 hour turning schedule Back tilt position 60 - 65 degrees | DECUBITUS ULCERS |
| 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 |
| 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 |
| 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 |
| MEDICAL PROBLEMS Heterotrophic ossification | HO calcification around a joint, most often hip. 20% TBI or SCI exhibit within 12 weeks after injury |
| _______ cord syndrome is manifested by motor and sensory loss greater in the upper extremities than the lower extremities. | Central |
| _________ cord syndrome results in motor and sensory loss but not reflexes. | Anterior |
| _________ syndrome is characterized by ipsilateral loss of motor function and contralateral loss of sensory function. | Brown-Séquard |
| _________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) |
| ________is the most important goal for a patient with a high cervical fracture. | Maintaining a patent airway |
| the most common cause of autonomic dysreflexia is | bladder irritation/constipation |
| __________ is a common problem accompanying spinal cord injury during the first 3 months | Deep vein thrombosis |
| 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. |
| 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 |
| Look under the Slide tab for autonomic dysreflexia and spinal cord pic | slide tab |
| C5 spinal cord injury highest priority? | airway |
| 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. |
| 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. |
| A positive Brudzinski’s sign is seen in | meningitis |
Created by:
troop27
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