mobility NUR 212 TLO 2.3.8
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| def anesthesia | absence of sensation
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| def parathesia | alteration in sensation
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| def hyperesthesia | unusual or pathological sensitivity of the skin in a particular sense
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| ipsilateral | on the same side
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| contralateral | on the opposite side
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| plegia | paralysis- no movement
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| paresis | partial paralysis/weakness
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| quadri: what is the new norm for med term; def | tetraplegia; 4
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| hemi | one side
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| para | lower half of bofy and areas of the trunk
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| spinal cord injuries: what is most common cause; other causes; do males or females have this more; what age is common; | MVA; falls, violence, sports injuries; males; 19 (16-20)
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| initial injury to spinal cord: the cord is first compressed by displacement of what; the bone squishes what; the compression of the cord can impede what; what can penetrating trauma do to the cord; | the bone; the spinal cord; circulation; tear or transect it
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| primary injury to the spinal cord: what is the first thing that is disrupted; | axons- ex the broken bones that fragment and pierce the cord causing ongoing progressive damage
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| secondary injury to the spinal cord: def; cell death can occur for how long; why is there ischemia; | the ongoing progressive damage to the cord; weeks to months after initial injury from ischemia, hypoxia, hemorrhage, edema of the spinal cord; b/c blood flow is restricted to that area;
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| def apoptosis | cell death
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| secondary injury to the spinal cord: permanent cord damage may occur with in how many hours due to edema; edema is 2ndary to inflammation and the response is very harmful why; complete cord damage in severe trauma is r/t what; | 24 hours; due to lack of space for swelling; autodestruction of the cord;
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| secondary injury to the spinal cord: when are hemorrhagic areas in the center of the spinal cord visable on scans; why does care and management of the pt with an SCI need to be initiated asap; | with in an hour; to limit further destruction of the cord;
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| secondary injury to the spinal cord: at what time after injury is extent of injury and prognosis evident | after 72 hours or more
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| classifications of spinal cord injuries: what are the 3 things it is classified by; ex of mechanism of injury; ex of neurological level of injury; | mechanism of injury, skeletal and neurologic level of injury, completeness or degree of injury; where car was hit; fx at c2 they will need a vent;
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| classifications of spinal cord injuries: mechanisms of injury- flexion is what direction; flexion damages what in cord | forward and backwards; ruptures the posterior ligaments;
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| classifications of spinal cord injuries: mechanisms of injury- hyperextension ruptures what in cord; flexion rotation does what to the ligaments; | the anterior ligaments; tearing of ligamentous structures that stabilize the spine;
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| classifications of spinal cord injuries: mechanisms of injury- what mechanism of injury has the most unstable outcome | the flexion rotation bc the torn ligaments cause severe neurological deficits
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| classifications of spinal cord injuries: mechanisms of injury- what injury occurs from extension rotation; what injury does compression do; what can cause this injury | can disrupt support ligaments, rupture intervertebral disks,and fx one or more pedicles; force bony fragments into the spinal canal; diving
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| classifications of spinal cord injuries: degree of injury- def complete; def of incomplete; what syndrome is associated with incomplete injury | total loss of sensory and motor function below the level of injury; results in a mixed loss of voluntary motor activity and sensation and leaves some tracts intact; brown sequard syndrome
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| brown sequard syndrome: what is damaged; loss of motor, position, biratory sense and vasomotor paralysis is on the same or opposite side as the lesion?; same sided is aka; | one half of the spinal cord; same; ipsilateral side
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| brown sequard syndrome: loss of pain,temp,and sensation is located on what side; recap syndrome; cause; what are interventions | the opposite side of the injury; movement loss on same side, sensation loss on opposite side; penetrating injuries; ROM on same side of injury bc no movement
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| classifications of spinal cord injuries: what is the skeletal level on injury; def neurologic level on injury; | the most damage to vertebral bones and ligaments; the lowest segment of the spinal cord with normal sensory and motor function on both sides of the body;
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| American spinal injury association impairment scale: A- complete; B- incomplete; C-incomplete; | non motor or sensory function is preserved in the sacralsegments S4-S5; sensory but no motor function is preserved below the neurological level; motor function is preserved below the neurological level and more then 1/2 the key muscles below the neuro;
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| American spinal injury association impairment scale: c- incomplete; e-normal | motor function is preserved below the neurological level and at least half of key muscles below the neurological level; motor and sensory function are normal
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| cervical injury: ___plegia; what is paralyzed; what part of spine; what nerve ends of dominating; what does vagus nerve do; | tetraplegia; partial to complete paralysis of all 4 limbs; C 1-8; vagus nerve; decreases HR, BP, RR, organ motility;
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| cervical injury: C1-3- why is this often fatal at the scene; there is a total loss of ___ muscle function; is mechanical ventilation needed; what can move; can they live independently; what kind of wc; | pt cannot breath; resp muscle function; yes; only head and neck and only mildly; no; electric
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| cervical injury: C4-8- can they breath independently; where whould they have movement; what else may they be able to do; | maybe; in back, arms and hands; use computer, drive, feed self;
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| cervical injury: these pt at high risk for what | depression
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| thoracic injuries: T1-6: what nerve dominates all vessels and organs below the injury; there is full innervation where; what will these pt still have issues with; full independence with what; can they have a standing frame; | vagus nerve; the upper extremities, back, intrinsic muscles of hand, full strength and dexterity of grasp; resp reserve; self care and in wheel chair; yes
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| thoracic injuries: these pt are ____ plegia | paraplegia
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| thoracic injuries: T 6-12: vagus nerve only dominates what; is resp reserve there in these pt; what can they do with crutches; can they climb stairs | the leg vessels, GI and GU; yes - functioning intercostals with increased resp reserve; ambulate with swing through and braces; no
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| lumbar injury: L 1-2: vagus nerve dominates what; there is varying control of what; can pt sit well; do they have full use of wc; can they ambulate | leg vessels; legs and pelvis; yes; yes; yes
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| lumbar injuries: L 3-4: vagus nerve dominates what; what does not function; how is there ambulation; what can they not do when standing | leg vessels, GI and GU; hamstring function and flail ankles; completely independent ambulation with short leg braces and cames; stand for long periods of time
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| diagnostic studies for spinal injuries: what is the gold standard in emergent Dx; CT scan can do what; when are cervical xrays done; | CT scan; diagnose stability of injury, location and degree of bony injury and spinal canal compromise; when CT scans are not readily available;
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| diagnostic studies for spinal injuries: why are MRIs not done in emergent; what are MRIs used for; what are vertebral angiographies used for; | they take too long to assess; to assesss soft tissue and neural changes with unexplained neurologic deficits or worsening neural status; to rule out damage to vertebral artery with cerical injuries for altered mental status
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| immediate post injury care: what is the proper maneuver to maintain a proper airway; what do we want to do to insure oxygenation; how should we check for circulation; what will cause circulation to slow done; how do we maintain adequate BP; | jaw thrust to open airway- do not tilt head; ventilate; BP, HR and rhythm; the vagus nerve; give fluids;
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| immediate post injury care: what position should head be in; what should head be alined with and immobilized with; how should pt be rolled; how many ppl to transfer; what basics in neuro assessment should be done; | a neutral position; cervical; log roll; min 2; push pulls, grips, PERRLA, smile orientation;
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| immediate post injury care: what med is given within 8 hours; what class is methylprednisone; why is methylprednisone given; what may be required to stabilize injury | methylprednisone; steroid; decreases edema; traction or surgery
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| CMs of spinal cord injury: resp system- injury above ___ results in mechanical ventilation and total loss of resp function; injury below __ results in what kind of breathing; why is there hypoventilation with diapgragmatic breathing; | C4(c1-C3); below C3 -diaphragmatic breathing; due to impairement of intercostal muscles;
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| CMs of spinal cord injury: resp system- cervical and thoracic injuries cause paralysis of ___ muscles; where can blood shunt; the shunting of blood to lungs can cause what; pulmonary edema is in response to what | abdominal and often intercostal muscles; to lungs; neurogenic pulmonary edema; fluid overload
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| CMs of spinal cord injury: CV system- any cord injury above ___ decreases the sympathetic nervous system; decrease in SNS can cause what; hypotension due to what; hypovolemia due to what; ___ monitoring is needed; what med is used for bradycardia; | T6; bradycardia, hypotension, hypovolemia; vasodilation; increase in venous capacity secondary to vasodilation; cardiac; atropine;
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| CMs of spinal cord injury: CV system- what is given to help BP | iv fluids or med vasopressor drug
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| CMs of spinal cord injury: urinary system: what is common retention or flaccidity post SCI; why is bladder overdistended; def atonic; what is needed with atonic bladder; | retention; it is atonic; with out tone; foley;
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| CMs of spinal cord injury: urinary system: why would the pt have reflex emptying; when should foley be removed; ____ catheterization should begin when; why is intermittent caths done | due to large volumes of urine sitting in the bladder; when large amount of IV fluids are not longer needed; intermittent-asap; maintain bladder tone and decrease risk of infection
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| CMs of spinal cord injury: GI system: ppl with injuries above ___ are most effected; what is common GI prob; what common Dx can it lead to; what can be given for delayed gastric emptying; what can be implemented for ileus; | T5; hypomotility; paralytic ileus and gastric distention; reglan; NG tube;
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| CMs of spinal cord injury: GI system: why are histamine receptor blockers given; we are proton pump inhibitors given; why are ulcers diff to dx; what labs to monitor | for stress ulcer prevention; used to prevent ulcers during initial phase; due to no pain or abdom guarding; Hgb, hct- bleeding;
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| CMs of spinal cord injury: GI system: neurogenic bowel- def; what is intervention for this; regular bowel programs reduce what | spinal shock with T12 or below; regular bowel program; untimely incontinency
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| CMs of spinal cord injury: Integumentary system: lack of movement increases risk for what; pressure ulcers can lead to what; what kind of specialty beds are used; how often should position be changed; what should be checked with each position change; | skin breakdown; infection or sepsis; rotation or sand; every 2 hours; skin
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| CMs of spinal cord injury: thermoregulation: what does body temp adjust to: so should room temp be high or low; why does bod adjust to room temp; what is poikilothermism; | to room temp; high; peripheral temp sensations do not reach hypothalamus; inability to regulate body temp;
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| CMs of spinal cord injury: thermoregulation: there is a decreased ability to ___ below the level of injury; what injury has the least ability to regulate temp; what should room temp be; | sweat or shiver; high cervical injuries; warm;
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| CMs of spinal cord injury: metabolic needs: NG suctioning can lead to what; decreased tissue perfusion can lead to what; what lyte levels are altered with Ng suctioning; what is usual weight loss; what is nutrition need; | alkalosis; acidosis; Na+ and K+; >10%; nitrogen balance and high protein;
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| CMs of spinal cord injury: metabolic needs: why is there a need for high protein; what labs to monitor; | aids in prevention of skin breakdown, infections and decrease muscle atrphoy; lytes;
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| CMs of spinal cord injury: peripheral vascular: DVT is common w/in how many months; what should be done to prevent DVT; why is DVT difficult to detect; are they able to do homan's sign; what is the leading caused of death with these people; stockings | 3; ROM; due to lack of sensation; no; PE; yes
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| spinal shock: __% with acute spinal cord injury experience this; what happens to the reflexes; are sensation lost or gained; where is there flaccid paralysis; how long can this last | 50%; decreased; lost; below the level of injury; days to months
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| spinal shock: this can mask what; what is a common cause of this; why does the bladder become overdistended; an atonic overdistended bladder can develop ___ emptying; what type of catheterization; | post injury neurologic function; urinary retention; b/c it is atonic; reflex; intermittent;
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| neurogenic shock: this happens to SCI at ___ or above; this is due to a loss of ____; these pts should be where; what happens to bp; what happens to pulse; | T5; vasomotor; in the ICU; hypotension; bradycardia;
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| neurogenic shock: there is a loss of ___ nervous system innervation; since there is bradycardia what happens to the periphery; the vasodilation causes what to pool; when blood pools what happens to CO; what is not regulated | sympathetic nervous system; it vasodilates; blood; it is decreased; temp
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| spinal shock vs neurogenic shock: what one loses all voluntary and reflexactivity below level of injury; what is the diff between spinal shockand autonomic dysreflexia; | spinal shock; autonomic dysreflexia has severe hypertension;
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| spinal shock vs neurogenic shock: what one loses vasomotor tone; what one loses SNS tone; what one has decreased reflexes, loss of sensation and flaccid paralysis; what one has hypotension, bradycardia, poikilothermic; | neurogenicshock; neurogenic; spinal; neurogenic;
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| spinal shock vs neurogenic shock: what one occurs with in 30 min of cord injury; what one lasts days-weeks; what one last up to 6 wks; what one is transient; what one happens T5 or above; | w/in 30 min; spinal; neurogenic; spinal; neurogenic
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| spinal shock vs neurogenic shock: what one needs airway support; | neurogenic;
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| neurogenic shock: what is given for bradycardia; what is given for decreased bp; | atropine; vasopressors
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| autonomic dysreflexia: this is reaction of what system; the reaction is mediated by what system; this occurs in response to what stimulation; this happens after___ shock is resolved; occurs with ___ SCI or higher; is it life threatening; | Cv system; SNS; visceral; spinal; T6; yes;
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| autonomic dysreflexia: if not resolved it can lead to what; what is the most common precipitating cause; | status epilepticus, stroke, mi, death; distended bladder;
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| autonomic dysreflexia: s/s- what happens to BP; why is there a massive Ha; there is diaphoresis and flushing above ___; what happens to pulse; what happens to vision; GI s/s; | up to 300s; due to HTn; the legion; bradycardia; blurry; N/V;
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| autonomic dysreflexia: number one nursing intervention; what should be assessed; what is common cause; who should be called; who and what should be taught; when do s/s go away | elevate HOB; cause; bladder distention; MD; fam s/s of this; when stimulation is resolved
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| Sacral sparing: is there a complete interruption of the cord; what can they have control of; this is possible with what areas; | no; bladder control, bowel control and sexual function; T6 or lower;
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| Sacral sparing: how many areas assessed demonstrate sacral sparing; what are the 3 areas to assess for this; ___ training is possible with this; | 3; perianal sensation, rectal montor function, great toe flexor activity; bladder;
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| what might be the only finding to indicate an imcomplete cord lesion; | preservation of sacral function
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| IM injections with SCI: where should IMs be given; what muscle then should it be given in; how many mls can the deltoid have; why are ims given above the level of injury; | aboe the level of injury; the deltoid; no more then 2 ml; b/c there is a reduced use of and reduced blood flow to muscles in buttons and vastus lateralis;
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| IM injections with SCI: decreased blood flow to a muscle group can cause what in regards to absorbtion of the drug; giving ims below level of injury increases the risk of what; this can result ___ of the tissue; | impaired absorption; local irritation and trauma; ulceration
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