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Nursing 4 Exam 1

spinal cord trauma

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
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