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final-review 20

neuro24 SCI comps

Autonomic dysreflexia is perhaps the most dangerous complication of spinal cord injury and can occur in patients with lesions above T6.
Autonomic dysreflexia A noxious stimulus below the level of the lesion triggers the autonomic nervous system causing a sudden elevation in blood pressure.
Common causes Autonomic dysreflexia include distended or full bladder, kink or blockage in the catheter, bladder infections, pressure ulcers, extreme temperature changes, tight clothing, or even an ingrown toenail.
If not treated Autonomic dysreflexia, this condition can lead to convulsions, hemorrhage, and death.
Autonomic dysreflexia Symptoms: High blood pressure, severe headache, blurred vision, stuffy nose, profuse sweating, goose bumps below the level of the lesion, and vasodilation (flushing) above the level of injury.
Autonomic dysreflexia Treatment: The first reaction to this medical crisis is to check the catheter for blockage. The bowel should also be checked for impaction.
Autonomic dysreflexia Treatment A patient should remain in a sitting position. Lying a patient down is contraindicated and will only assist to further elevate blood pressure.
Autonomic dysreflexia Treatment The patient should be examined for any other irritating stimuli. If the cause remains unknown, the patient should receive immediate medical intervention.
Deep vein thrombosis results from the formation of a blood clot that becomes dislodged and is termed an embolus. This is considered a serious medical condition since the embolus may obstruct a selected artery.
A patient with a spinal cord injury has a greater risk of developing a DVT due to the absence or decrease in the normal pumping action by active contractions of muscles in the lower extremities.
Prevention of a DVT should include prophylactic anticoagulant therapy, maintaining a positioning schedule, range of motion, proper positioning to avoid excessive venous stasis, and use of elastic stockings.
DVT Symptoms: Swelling of the lower extremity, pain, sensitivity over the area of the clot, and warmth in the area.
Treatment DVT : Once a DVT is suspected there should be no active or passive movement performed to the involved lower extremity. Bed rest and anticoagulant drug therapy are usually indicated.
Ectopic bone or heterotopic ossification refers to the spontaneous formation of bone in the soft tissue. It typically occurs adjacent to larger joints such as the knees or the hips.
Theories Ectopic bone regarding etiology range from tissue hypoxia to abnormal calcium metabolism.
Ectopic bone Symptoms: Early symptoms include edema, decreased range of motion, and increased temperature of the involved joint.
Treatment Ectopic bone : Drug intervention usually involves diphosphates that inhibit ectopic bone formation. Physical therapy and surgery are often incorporated into treatment.
Orthostatic hypotension or postural hypotension occurs due to a loss of sympathetic control of vasoconstriction in combination with absent or severely reduced muscle tone.
Venous pooling is fairly common during the early stages SCI of rehabilitation. A decrease in systolic blood pressure greater than 20 mm Hg after moving from a supine position to a sitting position is typically indicative of orthostatic hypotension.
Orthostatic hypotension Symptoms: Complaints of dizziness, light-headedness, nausea, and “blacking out” when going from a horizontal to a vertical position.
Orthostatic hypotension Treatment: Monitoring vital signs assists with minimizing the effects of orthostatic hypotension.
Orthostatic hypotension treatment The use of elastic stockings, ace wraps to the lower extremities, and abdominal binders are common. Gradual progression to a vertical position using a tilt table is often indicated. Drug intervention may be indicated in order to increase blood pressure.
A pressure ulcer is caused by sustained pressure, friction, and/or shearing to a surface.
The most common areas susceptible to pressure ulcers are the coccyx, sacrum, ischium, trochanters, elbows, buttocks, malleoli, scapulae, and prominent vertebrae.
Pressure ulcers require immediate medical intervention and often can significantly delay the rehabilitation process.
Symptoms of pressure ulcers: A reddened area that persists; an open area.
Treatment of pressure ulcers: Prevention is of greatest importance. A patient should change position frequently, maintain proper skin care, sit on an appropriate cushion, consistently weight shift, and maintain proper nutrition and hydration
Spasticity can occasionally be useful to a patient with a spinal cord injury, however, more often serves to interfere with functional activities. Spasticity can be enhanced by internal and external sources such as stress decubiti infection bowel bladder obstruction temperature change
Symptoms of spasticity: Increased involuntary contraction of muscle groups, increased tonic stretch reflexes, excessive deep tendon reflexes.
Treatment of spasticity: Medications are usually administered in an attempt to reduce the degree of spasticity (Dantrium, Baclofen, Lioresal). Aggressive treatment includes phenol blocks, rhizotomies, myelotomies, and other surgical intervention.
Physical therapy intervention for spasticity includes positioning, aquatic therapy, weight bearing, functional electrical stimulation, range of motion, resting splints, and inhibitive casting.
Created by: micah10



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