Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Nursing 4 Exam 1
spinal cord trauma
| Question | Answer |
|---|---|
| spinal cord injury is | any person w/a head injury until proven otherwise |
| spinal cord injury can result from | fracturing/dislocating one or more vertebrae |
| approximately how many people sustain spinal cord injuries annually | 7000-10000 |
| what percentage are tetraplegic | 57% |
| what percentage are below the age of 25yrs | 50% |
| tetraplegia is also known as | quadriplegia |
| what is the largest nerve in the body | spinal cord |
| what do nerve fibers do | carry signals to & from brain |
| where is the spinal cord extended from | base of brain-level to waist |
| ascending tracts are | nerves in spinal cord that send messages for pain, temp and touch from the body to the brain |
| ascending tracts carry | subconscious information such as body position |
| descending tracts are responsible for | muscle movements and transmit impulses from cortex ot periheral nerves |
| upper neurons are a | voluntary motor system |
| upper motor neurons start in | cerbral cortex, cross over in brain stem and end in the spinal cord |
| upper motor neurons synapse with | lower motor neurons |
| damage to the upper motor neurons causes | spastic paralysis and hyperreflexia |
| upper motor neuron damage can be caused by | lesions at T11 and above |
| lower motor neurons are | final pathway for descending motor tracts to cause skeletal muscle innervation |
| lower motor neurons are found | in anterior horn of corresponding areas of spinal cord |
| lower motor neuron damage can cause | flaccid paralysis |
| lower motor neuron damage can be caused by | lesions at or below T12 |
| Central Nervous System | brain and spinal cord |
| peripheral nerves | sensory nerves outside of the CNS |
| sympathetic/parasympathetic nervous system control | blood pressure, temperature regualtion |
| Spinal cord is surrounded by | rings of bone called vertebra |
| vertebra named according to | location |
| the higher the injury to vertebra and spinal cord the | more disability in a person |
| cervical vertebrae | 7 |
| thoracic vertebrae | 12 |
| lumbar vertebrae | 5 |
| sacrum vertebrae | 5 fused into 1 |
| coccyx vertebrae | 4 fused into 1 |
| cervical nerves | head & neck, diaphragm, deltoids, biceps, wrist extenders, triceps, hands |
| thoracic nerves | chest muscles and abd muscles |
| lumbar nerves | leg muscles |
| sacral nerves | bowel, bladder and sexual function |
| acceleration | hyperextension-whiplash, rear-end collision |
| deceleration | hyperflexion- front-end collision |
| accleration-deceleration | hyperextension and hyperflexion |
| excessive rotation | hanging |
| axial loading | vertical compression- dive, falls |
| penetrating wound | open injury- knife,missile |
| concussion of spinal cord | temp loss of function 254-48 hrs b/c of inflammation(edema) |
| contusion | bruising and bleeding |
| necrosis occurs from | compromised capillary circulation and venous return |
| complete cord transection | total loss of motor, sensory, and primary reflex activity below the level of the lesion |
| tetraplegia CCT | C 1-8 (respiratory compromise) |
| paraplegia CCT | T1-L2 |
| cauda equina CCT | L2 and below |
| sacral CCT | loss of bowel, bladder, & sexual function |
| Incomplete Transection | anterior cord, central cord and brown-sequard syndrome |
| anterior cord syndrome | loss of motor, pain & temp below the level of injury. Intact touuch, position & vibration (50%>40;50-70yo-hyperflexion) |
| central cord syndrome | motor paralysis of upper ext & lower ext but uper ext affected more than lower- hyperextension injuries |
| brown-sequard syndrome | hemisection; ipsilateral(same side) motor loss, proprioception, vibration, deep touch; contralateral loss of pain, temp light touch, penetrating trauma |
| emergency care & tx | establish & maintain open airway |
| emergency care & tx | jaw thrust maneuver, cervical collar,sandbag, C1-4 require constant ventilatory support, C5 requires intermittent support, C5 and below-independent resp function, log roll pt |
| emergency care & tx | IV line, possible Dopamine(to prevent muscle tremors)foley, methylprednisolone-gold standard b/c to decrease inflammation-give w/in 8 hrs |
| diagnostic tests | spinal x-rays, ct scan, MRI(changes in cord and tissues surrounding), ABG levels of O2, cystogram, CXR(atelectasis), EMG, peripheral nerves stimulated |
| neurogenic bladder | lacks bladder control due to a brain or nerve condition--bladder can explode-need foley |
| kinetic therapy | movement |
| nursing assessments | assessment of sensation & motor function, cardiovascular & resp assessment, GI/GU assessment(ileus,distention,areflexic bladder, stasis, overflow), psychosocial assessment(dependence,support,role,self-esteem,body image,family,financial) |
| paralytic ileus | no movement causes air to be there which causes distention & impaction |
| nursing outcomes | no further deterioration in neuro status, no complications of immobility(kinetic therapy), stool & urine output maintained, maintain VS's r/t neurogenic shock, resolution of spinal shock, no incidence of autonomic dysreflexia |
| care of client in halo device | inspect for tightness, pin sites inspect for infection, bleeding, skin integrity-turn client, inspect skin, assess muscle function, ROM |
| effects of injury: Resp paralysis is common in | C1-4 |
| injuries here may have edema above the injury causing temporary repsiratory compormise-ventilator. | C5-T1 |
| when does edema usually subside in which client wont need a ventilator | several weeks |
| neurogenic shock occurs when injury form this level and above occur | T6 |
| neurogenic shock | decreased heart rate, hypotension |
| what is given for neurogenic shock | atropine |
| what does atropine do in a pt with neurogenic shock? | increase heart rate |
| vasopressors (dopamine) | rasie BP |
| what tx is used in a pt with neurogenic shock | atropine, **fluids and dopamine |
| effects of injury: GI/GU | decreased motility, stress ulcers, foley until resolution of spinal shock(30-60mins after injury, paralytic ileus |
| bethanechol chloride (urecholine) | bladder tone |
| long term nursing interventions | oxygenation, suctioning, prevent pressure sores, contractures, DVT, PE, prevent Ortho hypotension, promote self care, establish bowel/bladder retraining program, assess for resolution of spinal shock |
| complications of injury | spinal shock, neurogenic shock, autonomic dysreflexia |
| long term complications | spasticity, bladder & bowel dysfunction |
| spinal shock | temp suppression of function below the level of injury, occurs 30-60 mins after injury, flaccid paralysis, loss of tendon reflexes, loss of sensation(called areflexia) |
| recovery from spinal shock takes | 2 wks, average 1-6 wks |
| what signifies that spinal shock is resolved | appearance of involuntary reflexes |
| neurogenic shock occurs at level | T6 and above |
| neurogenic shock s/s | decreased BP(systolic <80), decreased Pulse(<60), decreased RR (apnea r/t cervical injury), decreased temp, immediate areflexia, flaccid paralysis, loss of skin sensations, priapism in males(erection that lasts for 4 hrs or more b/c of pulling of blood) |
| life-threatening complication is | autonomiv dysreflexia that occurs w/upper motor neuron involvement |
| autonomic dysreflexia | visceral stimuli in pt's w/injuries above T6, occurs after the spinal shock is over, trigger:visceral distention |
| autonomic dysreflexia s/s | HTN, h/a, flushed, bradycardia, pilomotor spasm(goosebumps), nasal stuffiness |
| complications of autonomic dysreflexia | stroke, seizures, hemorrhage, blindness |
| interventions for autonomic dysreflexia | HOB up, sitting, loosen clothing, call MD, find & remove cause immediatedly-check foley-last BM, impaction-nupercaine |
| interventions for autonomic dysreflexia | nifedipine(procardia), Nitropursside Sodium(nipride)-IV to lower BP quickly |
| long term complications spasticity | occurs after spinal shock-UMN, physical activity: stretching exercises, whirlpool, warm tub baths, baclofen, flexeril, diaxepam |
| s/e of spasticity | drowsiness, diplopia, GI upset |
| baclofen | muscle relaxant & effective on involuntary spastic movement |
| bowel retraining | consistent time for bowel elimination, high fluid intake(at least 2L daily)/high fiber diet, supository program(UMN injury-above T12-use lidocaine coated supp prior), stool softener |
| bowel retraining LMN | flaccid-manual disimpaction; optimize gastrocolic reflex, valsalva, massaging L to R, privacy, nonstressful, sitting position |
| bladder retraining | as soon as stable, d/c foley; intermittent cath q4 hrs |
| bowel retraining UMN | spastic-stroking the inner thigh, pullin on hair, warm water poured over perineum, tapping the bladder/detrusor muscle, bethanechol(urecholine) |
| bowel retraining LMN | flaccid-valsalva, tightening the abd muscles, cath for residual urine |
| sexuality UMN injuries for men | reflexogenic erections; orgasm & ejaculation absent; poor sperm quality |
| sexuality LMN injuries for men | complete lesion absent psychogenic or reflexogenic erections |
| incomplete lesion LMN | psychogenic erections w/ejaculation |
| sexuality women | meses may cease for 6 months, orgasms possible, fertility intact-loss of lubrication, pregnancy complications-autonomic dysreflexia in UMN injuries |
Created by:
jbittner
Popular Nursing sets