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*Spinal Cord Injury*
| Question | Answer |
|---|---|
| Complete injury | spinal cord is severed or severely damaged, prevents all innervation below injury |
| Incomplete injury | some function or movement below injury |
| Primary mechanisms of injury | (1) hyperflexion, (2) hyperextension, (3) axial loading/vertical compression, (4) excessive rotation |
| Anterior cord syndrome (Cervical) | loss of motor function, px and temp sensation; intact tough, position, vibration sensation |
| Posterior cord syndrome (Cervical) | loss or vibration, crude tough, position sensations; intact motor function |
| Brown-Sequard syndrome (Cervical) | ipsilateral loss of motor function, proprioreception, vibration, deep touch sensation; contralateral loss of px, temp, light touch sensation |
| Central cord syndrome (Cervical) | loss of motor function pronounced in upper extremities; variable degrees/patterns |
| Conus medullaris syndrome | T11 to L1; neurogenic bladder & bowel |
| Cauda equina syndrome | L2 to S5; neurogenic bladder & bowel |
| Assess of C4 to C5 | apply downward pressure while client shrugs shoulders |
| Assess of C5 to C6 | apply resistance while client pulls up arms |
| Assess C7 | apply resistance while client straightens arms |
| Assess C8 | client able to grasp object & form fist |
| Assess L2 to L4 | apply resistance while client lifts legs of bed |
| Assess L5 | apply resistance to dorsiflexion |
| Assess S1 | apply resistance to plantar flexion |
| C3 to C5 | phrenic nerve |
| Tetraplegia | paralysis of all 4 extremities |
| Quadraparesis | weakness in all 4 extremities |
| Paraplegia | paralysis of lower extremities |
| Paraparesis | weakness in lower extremities |
| Spinal Shock (etiology) | disrupted communication between upper and lower motor neurons |
| Spinal Shock (s/s) | flaccid paralysis, loss of reflex activity below injury level, bradycardia, hypotension |
| Spinal Shock (indication of reversal) | return of reflex activity |
| Autonomic dysreflexia (s/s) | severe hypertension, bradycardia, headache (sudden onset, severe), stuffiness, flushing (above injury), pale (below injury) |
| Autonomic dysreflexia (etiology) | noxious stimulus (i.e. bladder distention, constipation) |
| Autonomic dysreflexia (Meds) | nitrates, hydralazine |
| Lower motor neuron injury | flaccid paralysis |
| Upper motor neuron injury | muscle spasticity |
| Heterotopic ossification | bony overgrowth; AEB swelling, redness, warmth, decreased ROM |
| Neurogenic shock (s/s) | hypotension, bradycardia |
| Halo fixator | static traction; 4 pins in skull; halo attached to vest/cast when spine is stable |
| Dextran (plasma expander) | improve capillary blood flow, prevent treat hypotension |
| Decompressive laminectomy | removal of laminae to allow cord expansion from edema |
| Cough assist | hands on lower rib cage below diaphragm, as client inhales push upward to expand lungs and cough |
| Assess vulnerability to skin breakdown | press on reddened area, no blanching |
| DVT prevention | combo LMWH & rotational bed, SCDs, PCBs |
| Stimulate voiding w/ spastic bladder | stroke inner thigh, pull pubic/upper thigh hair, warm water over perineum, tap bladder area (stimulates detrusor muscle) |
| Bethanechol chloride (Urecholine) | cholinergic used to stimulate voiding, given 1 hr before attempt to void |
| Voiding w/ spastic bladder | Valsalva maneuver and tighten ABD muscles; assess for effectiveness by cath. for residual urine |
| Bowel retraining | consistent time, high fluid & fiber, rectal stimulation (w/ or w/o suppositories) |
| Teaching for SCIs | physical mobility & activity skills; ADL skills; bowel/bladder training; medications; sexuality education |
| Nsg. Intervention: Get flu shots, tetanus (q10y), and pneumonia vaccine | Rationale: respiratory complication is most common cause of death after SCI |
| Nsg. Intervention: Annual PAP smear/mammogram | Rationale: movement limitations make self exam difficult |
| Nsg. Intervention: Preventative measures for osteoporosis | Rationale: women >50yrs loose bone density |
| Nsg. Intervention: Meticulous skin care | Rationale: Aging decreases elasticity and increases dryness |
| Nsg. Intervention: Constipation prevention | Rationale: most SCI pts have constipation, more likely in older people |
Created by:
jlee12406
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