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Spinal Quiz
Chpter 61. Med Surg
| Question | Answer |
|---|---|
| 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
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