Question | Answer |
Most common locations of spinal cord injuries | cervical (1, 2, 4-7), and T1–L2 lumbar vertebrae
Locations reflect most mobile portions of vertebral column and the locations where the spinal cord occupies most of the vertebral canal |
Degenerative Disorders of the Spine are | Degenerative disk disease (DDD)
Spondylolysis
Spondylolisthesis
Spinal stenosis
Low back pain
Herniated intervertebral disk |
S&S of injury at the level of L 4 – 5 | pain in hip, groin, post-lateral thigh, dorsal surface of foot
Difficulty walking on heels |
S&S of injury at the level L 5 – S 1 | pain mid gluteal, post thigh, calf down to heel, outer surface of foot
Difficulty walking on toes |
Sensory deficits in affected areas
Diminished or lost reflexes
Back movement restricted
Spastic paravertebral muscles
Difficulty, pain with straight leg raise
Aggravated by cough, sneeze or strain
Are all S&S of..... | LUMBAR AREA |
Stiff neck
Radiating shoulder pain down arm into hand
Paresthesias and sensory disturbances in hand Are all S&S of..... | CERVICAL |
POST OPERATIVE ASSESSMENT | CSF leakage
Acute urinary retention & paralytic ileus
Arachnoiditis, diskitis
Larngeal and tracheal edema with anterior cervical laminectomy
Donor site for autologous graft for spinal fusion |
Progressive weakness of lower extremities
Loss of sphincter control, anal numbness
Urinary retention
Notify MD; may require emergency decompression | CAUDA EQUINA SYNDROME |
NURSING DIAGNOSES FOR DISC DISEASE | Acute and chronic pain
Deficit knowledge
Risk for perioperative
positioning injury
Disturbed sensory perception |
NIC LABELS FOR INTERVERTEBRAL DISC DISEASE | Pain management, analgesic administration
Teaching disease process
Positioning, intraoperative
Health education |
MECHANISMS OF INJURY | Hyperflexion
Hyperextension
Vertical compression or axial loading
Excessive rotation |
IMMEDIATE CARE & ASSESSMENT | Respiratory pattern & airway (use jaw thrust)
Determine circumstances of injury
Correct immobilization & transport |
DEGREE OF INJURY Complete | permanent loss of motor & sensory function below level of injury |
DEGREE OF INJURY Incomplete | some nerve fibers preserved distal to point of injury |
Ischemia and edema
Within 1 hour calcium flood accompanies dying cells
Free radicals scavenge oxygen from healthy cells
In 6 to 12 hours secondary wave of immune cells clear injured cells & also destroy live nerve | SECONDARY INJURY CASCADE |
occurs immediately after injury | Spinal shock
also can lead to Neurogenic shock too |
occurs after spinal shock resolves in injuries above T-6 | Autonomic dysreflexia |
SPINAL SHOCK Below level of injury: | Loss of sensation to
Pain, touch, temperature & pressure
Absence of all voluntary activity (flaccid paralysis) and reflex neurologic activity
Bowel and bladder dysfunction |
Loss of ability to shiver and retain heat or perspire to release heat
Body temperature varies with
the environment
Monitor for temperature extremes | POIKILOTHERMIA |
Flaccid paralysis
Bradycardia
Hypotension
Occasional paralytic ileus
Priapism | SCI above T6SIGNS & SYMPTOMS |
Loss of vasomotor tone (hypotension)
Generalized vasodilation in PVS
Interruption of sympathetic NS
Decreased cardiac output
Rx with sympathomimetic drugs phenylephrine, dopamine
atropine for bradycardia | Neurogenic Shock |
Medical emergency – severe hypertension up to 240-300 mm Hg
Occurs with SCI above T-6
Exaggerated sympathetic response to noxious stimulus (usually full bladder)
Complimentary parasympathetic system unable to balance below level of injury | AUTONOMIC DYSREFLEXIA |
S/S OF DYSREFLEXIA | Hypertension
Bradycardia
Flushing & diaphoresis above SCI level
Severe headache
Nasal stuffiness
Blurred vision |
DYSREFLEXIA MANAGEMENT | Sit upright to produce orthostatic hypotentsion (First action)
Monitor BP every 5 minutes
Check Foley Catheter for patency or bladder for distension (Empty bladder)
Assess for fecal impaction using local anesthetic
Notify MD |
MEDICAL TREATMENT | Order to irrigate catheter, use only 30 mL
Obtain order for anesthetic gel (Lidocaine or Nupercaine)
Medications if needed: nitropaste, nifedipine (Procardia), hydralazine (Apresoline)
Key treatment – Prevention!! |
Nursing Diagnoses in Subacute Phase | Risk for ineffective breathing pattern
R/T Neuromuscular impairment
Ineffective tissue perfusion: peripheral R/T interruption of venous flow
DVT occurs in 80% SCI patients |
PULMONARY COMPLICATIONS C4 and higher affects | all muscles controlling breathing |
PULMONARY COMPLICATIONS C4 – T6 | diaphragm function preserved; different degrees of accessory muscle function |
PULMONARY COMPLICATIONS T6 – T12 | ability to cough impaired |
NURSING MANAGEMENT IN SUBACUTE PHASE | Risk for impaired skin integrity R/T decreased sensation, immobility & vasodilation
Altered urinary elimination and constipation R/T neurogenic bowel and bladder
Risk for nutritional deficit R/T hypermetabolism & high caloric needs |
Intermittent catheterization
Force fluids to 2500 mL/ day
Fluids to acidify urine
Limit milk, dairy products, carbonated beverages | BLADDER RETRAINING INTERVENTIONS |
Constipation can trigger dysreflexia
Establish consistent time for elimination 30 min to 1 hour after eating
High fluid intake & high fiber diet
Rectal stimulation with or without suppositories
Stool softeners | BOWEL RETRAINING INTERVENTIONS |
Key is prevention
Weight shift every 15 min
2 hour turning schedule
Back tilt position 60 - 65 degrees | DECUBITUS ULCERS |
MALE SEXUALITY & SCI | Sexual function controlled S 2 – 4
Men with UMN: 70% with complete injury & 80% with incomplete able to have intercourse
Reflex erection
Loss of psychogenic or fantasy responses
Psychogenic erection present 19% incomplete UMN |
MALE SEXUALITY Three performance factors | Erection
Function of parasympathetic NS
Requires intact sacral reflexes
Ejaculation
Function of sympathetic NS
Fertility
Decreased sperm quality and motility |
FEMALE SEXUALITY & SCI | Lack sensation during intercourse,Childbearing age–can become,pregnant,Hormonal BCP’s increase,Vaginal delivery possible,Risk of autonomic dysreflexia in labor,Pregnancy
Complicated by loss of sensation,increases in BP,& possible precipitation of AD |
MEDICAL PROBLEMS Heterotrophic ossification | HO calcification around a joint, most often hip. 20% TBI or SCI exhibit within 12 weeks after injury |
_______ cord syndrome is manifested by motor and sensory loss greater in the upper extremities than the lower extremities. | Central |
_________ cord syndrome results in motor and sensory loss but not reflexes. | Anterior |
_________ syndrome is characterized by ipsilateral loss of motor function and contralateral loss of sensory function. | Brown-Séquard |
_________is related to reflex stimulation of the sympathetic nervous system reflected by hypertension, bradycardia, throbbing headache, and diaphoresis. | Autonomic dysreflexia (Autonomic reflexia is a massive, uncompensated cardiovascular reaction mediated by the sympathetic nervous system) |
________is the most important goal for a patient with a high cervical fracture. | Maintaining a patent airway |
the most common cause of autonomic dysreflexia is | bladder irritation/constipation |
__________ is a common problem accompanying spinal cord injury during the first 3 months | Deep vein thrombosis |
What is most important action for a patient who has a suspected cervical spinal injury? | A patient with a suspected cervical spine injury should be immobilized with a hard collar and placed on a firm surface. |
About 50% of people with acute spinal cord injury experience a temporary loss of reflexes, sensation, and motor activity that is known as... | spinal shock |
Look under the Slide tab for autonomic dysreflexia and spinal cord pic | slide tab |
C5 spinal cord injury highest priority? | airway |
Rehabilitation goals for a patient with a spinal cord injury at the C6 level include ability to assist with: | transfer and perform some self-care; feed self with hand devices; push wheelchair on smooth, flat surface; drive adapted van from wheelchair; independent computer use with adaptive equipment; and needing attendant care only for 6 hours per day. |
A patient with a C7 spinal cord injury undergoing rehabilitation tells you he must have the flu because he has a bad headache and nausea. What is your initial action? | It is important to measure blood pressure when a patient with a spinal cord injury complains of a headache. You must monitor blood pressure frequently during the episode. An α-adrenergic blocker or an arteriolar vasodilator may be administered. |
A positive Brudzinski’s sign is seen in | meningitis |