Chpter 61. Med Surg
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| Top 4 causes of Spinal Injuries and percent? | MVA: 42%. Falls: 27%. Violence 15%. Sports 7%.
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| Premature death of Spinal injury is due to? | Respiratory Function
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| Who are at greatest risk for Spinal injury? | Men between ages 16-30. The average is 19 year old males
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| Paralysis? | loss or impairment of voluntary movement in a body part caused by injury
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| Tetraplegia/quadriplegia? | paralysis of all four extremities
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| Paraplegia? | usually in the legs results if thoracic or lumbar cord is damaged.
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| Spinal Shock? | temporary neurological syndrome that can last days or months. Only 50% of people with SCI experience it.
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| S/S of Spinal Shock?(3) | Decrease reflexes, loss of sensation, flaccid paralysis
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| Neurogenic Shock? | loss of vasomotor tone(circulation of blood) caused by injury
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| Vasomotor? | relating to the nerves and muscles that cause blood vessels to constrict or dilate.
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| S/S of Neurogenic Shock?(5) | decrease B.P, decrease HR, decrease cardiac output, venous pooling, loss of Sympathetic Nervous System.
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| Complete Cord Involvement? | total loss of sensory and motor function below level of lesion/injury
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| Incomplete(Partial) Cord Involvement? | mixed loss of voluntary motor activity and sensation and leaves some motor and sensory tracts intact.
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| Central Cord Syndrome? | partial cord involvement, caused by damage to the central spinal cord(C1-C7). common in older adults.
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| S/S of Central Cord Syndrome?(2) | motor weakness and sensory loss in both upper and lower extremities. effects upper more than lower.
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| Anterior Cord Syndrome? | partial cord involvement, caused by damage to anterior spinal artery resulting in compromised blood flow to the anterior spinal cord.
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| S/S of Anterior Cord Syndrome?(2) | loss of pain and temperature sensation. The touch, position vibration and motion remain intact.
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| Common type of Anterior Cord Syndrome injury? | Flexion Injury, for example whiplash
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| Brown-Sequard Syndrome? | damage to 1/2 of spinal cord by penetrating injury.
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| S/S of Brown-Sequard Syndrome?(3) | loss of motor function, position and vibration sense that occurs on the same side as the lesion.
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| Posterior Cord Syndrome? | compression or damage to the posterior spinal artery. its a very rare condition
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| S/S of Posterior Cord Syndrome?(1) | loss of proprioception. Pain, temperature and motor function below lesion are intact.
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| Common type of Posterior Cord Syndrome injury? | damage to dorsal columns
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| Conus Medullaris Syndrome? | damage to low portion of spinal cord
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| Cauda Equina Syndrome? | damage to lumbar and sacral nerve roots.
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| S/S of Conus Medullaris Syndrome and Cauda Equina Syndrome?(3) | Flaccid Paralysis to lower limbs, bowel and bladder.
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| Flaccid Paralysis? | weakening or loss of muscle tone
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| What are the three immediate goals to maintain after an SCI? | 1.Airway. 2.Ventilation. 3.Circulating Blood Volume
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| What Drug Therapy for SCI should be used immediately? | Methylprednisolone, used as treatment to stop swelling that can make an injury worse. Only beneficial if admin is early and in large doses, no benefit after 8hrs post injury.
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| What Drug Therapy for SCI should be used during acute phase? | Vasopressor Agents, is used to maintain mean arterial pressure
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| Poikilothermism? | means the patient is unable to regulate body heat, could be a dysfunction to the Hypothalamus.
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| Expected findings with Neurogenic Shock? | warm dry skin below level of injury
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| Respiratory concerns above the C4?(6) | apnea,inability to cough, labored breathing, endotracheal and tracheostomy. Mechanical Ventilation is REQUIRED!
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| Respiratory concerns below the C4?(5) | Hypoventilation, no cough, atelectasis, pneumonia, neurogenic pulmonary edema.
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| Injury below C4 why Hypoventilation? | because of respiratory insufficiency
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| Injury below C4 why no cough? | due to paralysis to abdominal muscles
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| Injury below C4 why Atelectasis or pneumonia? | unable to remove secretions because no cough which leads to Neurogenic Pulmonary Edema(fluid overload in the lungs)
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| Cardiovascular concerns with lesions above T5?(3) | Bradycardia, Hypotension and hypovolemia. Cardiac monitoring, vasopressor and IV fluids are necessary to support B.P
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| Injury above T5 why Hypotension? | peripheral vasodilation
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| Injury above T5 why Hypovolemia? | increase capacity in dilated veins
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| GI findings in SCI above T5? | decreased or absent bowel sounds
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| Urinary findings in SCI between T1-L2(2) | retention, flaccid bladder
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| What is a late indicator of respiratory deficiency? | O2 sat
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| Any injury above C1-C3, what should first be checked? | Respiratory
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| What is the worst possibility with injury above C3? | Respiratory arrest
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| Aggressive Chest Physiotherapy? | massage or beat on chest to keep mucus from causing pneumonia.
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| Maintaining proper pain management allows? | maximize respiratory function and gas exchange.
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| What are two vagal stimulation that can result in cardiac arrest with SCI patients? | Turning and Suctioning
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| What is drug therapy treatment for Bradycardia? | Atropine, Anticholinergic
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| Nursing interventions for cardiovascular instability?(2) | compression gradient stockings(remove q 8hrs) or lovanox to prevent blood clot or pooling
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| Why should a Electrolyte panel be needed?(2) | to manage potassium and avoid electrolyte build up
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| What diet should a SCI patient be put on? | High protein and high calorie diet.
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| What should be done before allowing PO food? | assess gag reflex, bowel sounds, and if patient flatus has passed.
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| Why should you ask patient the time of previous voidance? | for bladder over distention that can lead to renal failure
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| Catheterization can lead to? | UTI
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| What side effect occurs during Spinal Shock?(1) | Constipation, no voluntary or involuntary evacuation of bowels
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| Why would a rectal suppository be inserted daily? | to allow sphincter to relax on its own for evacuation.
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| Autonomic Dysreflexia? | the return of reflexes after the resolution of spinal shock. injury at the T6 or higher. occurs after spinal shock.
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| What causes Autonomic Dysreflexia? | distended bladder or rectum
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| S/S of Autonomic Dysreflexia?(4) | Headache, increased BP, sweating, flushed face
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| When a patient with a SCI complains of a headache what is the first thing to assess? | BP
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| Interventions for Autonomic Dysreflexia? | 1.Raise the HOB 45degrees.
2.Remove all stimuli to bladder/bowel.
3.call healthcare provider.
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| Intervention for Autonomic Dysreflexia when bladder irritation is the cause? | it is the most common cause, immediate catheterization with lidocaine to reduce stimulation
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| Interventions for Autonomic Dysreflexia when bowel impaction is the cause? | digital rectal examination with the use of anesthetic ointment to reduce stimulaiton
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| Neurogenic Bladder? | bladder dysfunction related to abnormal or absent bladder that occurs after spinal shock
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| Types of Neurogenic Bladder? | 1.Reflexic.
2.Areflexic.
3.Sensory
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| Reflexic? | type of neurogenic bladder; spastic or uninhibited. bladder empties in response to stretching of bladder wall
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| Reflexic S/S?(4) | Incontinence, urgency, unpredictable or incomplete voiding
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| Areflexic? | type of neurogenic bladder; Paralysis of all motor function, bladder fills without emptying
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| Areflexic S/S?(2) | over distention,hesitancy
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| Sensory? | type of neurogenic bladder; damage to sensory lib of bladder
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| Sensory S/S?(2) | poor bladder sensation, infrequent voiding
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| Drug Therapy for Neurogenic Bladder? | Anticholinergics, Adrenergic blockers, antispasmodics
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| How much fluid uptake should a patient with Neurogenic Bladder get? | 1800-2000ml/day
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| Voiding methods for patients with Neurogenic Bladder? | voluntary, intermittent and indwelling catheterization
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| Surgical Therapy for Neurogenic Bladder?(3) | Sphincterotomy, electrical stimulation, urinary diversion
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| These signs of neurogenic shock occur as a result of the loss of function of part of which nervous system? | Sympathetic
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