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Spinal Quiz

Chpter 61. Med Surg

QuestionAnswer
Top 4 causes of Spinal Injuries and percent? MVA: 42%. Falls: 27%. Violence 15%. Sports 7%.
Premature death of Spinal injury is due to? Respiratory Function
Who are at greatest risk for Spinal injury? Men between ages 16-30. The average is 19 year old males
Paralysis? loss or impairment of voluntary movement in a body part caused by injury
Tetraplegia/quadriplegia? paralysis of all four extremities
Paraplegia? usually in the legs results if thoracic or lumbar cord is damaged.
Spinal Shock? temporary neurological syndrome that can last days or months. Only 50% of people with SCI experience it.
S/S of Spinal Shock?(3) Decrease reflexes, loss of sensation, flaccid paralysis
Neurogenic Shock? loss of vasomotor tone(circulation of blood) caused by injury
Vasomotor? relating to the nerves and muscles that cause blood vessels to constrict or dilate.
S/S of Neurogenic Shock?(5) decrease B.P, decrease HR, decrease cardiac output, venous pooling, loss of Sympathetic Nervous System.
Complete Cord Involvement? total loss of sensory and motor function below level of lesion/injury
Incomplete(Partial) Cord Involvement? mixed loss of voluntary motor activity and sensation and leaves some motor and sensory tracts intact.
Central Cord Syndrome? partial cord involvement, caused by damage to the central spinal cord(C1-C7). common in older adults.
S/S of Central Cord Syndrome?(2) motor weakness and sensory loss in both upper and lower extremities. effects upper more than lower.
Anterior Cord Syndrome? partial cord involvement, caused by damage to anterior spinal artery resulting in compromised blood flow to the anterior spinal cord.
S/S of Anterior Cord Syndrome?(2) loss of pain and temperature sensation. The touch, position vibration and motion remain intact.
Common type of Anterior Cord Syndrome injury? Flexion Injury, for example whiplash
Brown-Sequard Syndrome? damage to 1/2 of spinal cord by penetrating injury.
S/S of Brown-Sequard Syndrome?(3) loss of motor function, position and vibration sense that occurs on the same side as the lesion.
Posterior Cord Syndrome? compression or damage to the posterior spinal artery. its a very rare condition
S/S of Posterior Cord Syndrome?(1) loss of proprioception. Pain, temperature and motor function below lesion are intact.
Common type of Posterior Cord Syndrome injury? damage to dorsal columns
Conus Medullaris Syndrome? damage to low portion of spinal cord
Cauda Equina Syndrome? damage to lumbar and sacral nerve roots.
S/S of Conus Medullaris Syndrome and Cauda Equina Syndrome?(3) Flaccid Paralysis to lower limbs, bowel and bladder.
Flaccid Paralysis? weakening or loss of muscle tone
What are the three immediate goals to maintain after an SCI? 1.Airway. 2.Ventilation. 3.Circulating Blood Volume
What Drug Therapy for SCI should be used immediately? Methylprednisolone, used as treatment to stop swelling that can make an injury worse. Only beneficial if admin is early and in large doses, no benefit after 8hrs post injury.
What Drug Therapy for SCI should be used during acute phase? Vasopressor Agents, is used to maintain mean arterial pressure
Poikilothermism? means the patient is unable to regulate body heat, could be a dysfunction to the Hypothalamus.
Expected findings with Neurogenic Shock? warm dry skin below level of injury
Respiratory concerns above the C4?(6) apnea,inability to cough, labored breathing, endotracheal and tracheostomy. Mechanical Ventilation is REQUIRED!
Respiratory concerns below the C4?(5) Hypoventilation, no cough, atelectasis, pneumonia, neurogenic pulmonary edema.
Injury below C4 why Hypoventilation? because of respiratory insufficiency
Injury below C4 why no cough? due to paralysis to abdominal muscles
Injury below C4 why Atelectasis or pneumonia? unable to remove secretions because no cough which leads to Neurogenic Pulmonary Edema(fluid overload in the lungs)
Cardiovascular concerns with lesions above T5?(3) Bradycardia, Hypotension and hypovolemia. Cardiac monitoring, vasopressor and IV fluids are necessary to support B.P
Injury above T5 why Hypotension? peripheral vasodilation
Injury above T5 why Hypovolemia? increase capacity in dilated veins
GI findings in SCI above T5? decreased or absent bowel sounds
Urinary findings in SCI between T1-L2(2) retention, flaccid bladder
What is a late indicator of respiratory deficiency? O2 sat
Any injury above C1-C3, what should first be checked? Respiratory
What is the worst possibility with injury above C3? Respiratory arrest
Aggressive Chest Physiotherapy? massage or beat on chest to keep mucus from causing pneumonia.
Maintaining proper pain management allows? maximize respiratory function and gas exchange.
What are two vagal stimulation that can result in cardiac arrest with SCI patients? Turning and Suctioning
What is drug therapy treatment for Bradycardia? Atropine, Anticholinergic
Nursing interventions for cardiovascular instability?(2) compression gradient stockings(remove q 8hrs) or lovanox to prevent blood clot or pooling
Why should a Electrolyte panel be needed?(2) to manage potassium and avoid electrolyte build up
What diet should a SCI patient be put on? High protein and high calorie diet.
What should be done before allowing PO food? assess gag reflex, bowel sounds, and if patient flatus has passed.
Why should you ask patient the time of previous voidance? for bladder over distention that can lead to renal failure
Catheterization can lead to? UTI
What side effect occurs during Spinal Shock?(1) Constipation, no voluntary or involuntary evacuation of bowels
Why would a rectal suppository be inserted daily? to allow sphincter to relax on its own for evacuation.
Autonomic Dysreflexia? the return of reflexes after the resolution of spinal shock. injury at the T6 or higher. occurs after spinal shock.
What causes Autonomic Dysreflexia? distended bladder or rectum
S/S of Autonomic Dysreflexia?(4) Headache, increased BP, sweating, flushed face
When a patient with a SCI complains of a headache what is the first thing to assess? BP
Interventions for Autonomic Dysreflexia? 1.Raise the HOB 45degrees. 2.Remove all stimuli to bladder/bowel. 3.call healthcare provider.
Intervention for Autonomic Dysreflexia when bladder irritation is the cause? it is the most common cause, immediate catheterization with lidocaine to reduce stimulation
Interventions for Autonomic Dysreflexia when bowel impaction is the cause? digital rectal examination with the use of anesthetic ointment to reduce stimulaiton
Neurogenic Bladder? bladder dysfunction related to abnormal or absent bladder that occurs after spinal shock
Types of Neurogenic Bladder? 1.Reflexic. 2.Areflexic. 3.Sensory
Reflexic? type of neurogenic bladder; spastic or uninhibited. bladder empties in response to stretching of bladder wall
Reflexic S/S?(4) Incontinence, urgency, unpredictable or incomplete voiding
Areflexic? type of neurogenic bladder; Paralysis of all motor function, bladder fills without emptying
Areflexic S/S?(2) over distention,hesitancy
Sensory? type of neurogenic bladder; damage to sensory lib of bladder
Sensory S/S?(2) poor bladder sensation, infrequent voiding
Drug Therapy for Neurogenic Bladder? Anticholinergics, Adrenergic blockers, antispasmodics
How much fluid uptake should a patient with Neurogenic Bladder get? 1800-2000ml/day
Voiding methods for patients with Neurogenic Bladder? voluntary, intermittent and indwelling catheterization
Surgical Therapy for Neurogenic Bladder?(3) Sphincterotomy, electrical stimulation, urinary diversion
These signs of neurogenic shock occur as a result of the loss of function of part of which nervous system? Sympathetic
Created by: aneshia