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*Spinal Cord Injury*

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