spinal cord trauma
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| spinal cord injury is | any person w/a head injury until proven otherwise
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| spinal cord injury can result from | fracturing/dislocating one or more vertebrae
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| approximately how many people sustain spinal cord injuries annually | 7000-10000
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| what percentage are tetraplegic | 57%
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| what percentage are below the age of 25yrs | 50%
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| tetraplegia is also known as | quadriplegia
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| what is the largest nerve in the body | spinal cord
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| what do nerve fibers do | carry signals to & from brain
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| where is the spinal cord extended from | base of brain-level to waist
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| ascending tracts are | nerves in spinal cord that send messages for pain, temp and touch from the body to the brain
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| ascending tracts carry | subconscious information such as body position
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| descending tracts are responsible for | muscle movements and transmit impulses from cortex ot periheral nerves
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| upper neurons are a | voluntary motor system
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| upper motor neurons start in | cerbral cortex, cross over in brain stem and end in the spinal cord
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| upper motor neurons synapse with | lower motor neurons
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| damage to the upper motor neurons causes | spastic paralysis and hyperreflexia
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| upper motor neuron damage can be caused by | lesions at T11 and above
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| lower motor neurons are | final pathway for descending motor tracts to cause skeletal muscle innervation
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| lower motor neurons are found | in anterior horn of corresponding areas of spinal cord
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| lower motor neuron damage can cause | flaccid paralysis
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| lower motor neuron damage can be caused by | lesions at or below T12
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| Central Nervous System | brain and spinal cord
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| peripheral nerves | sensory nerves outside of the CNS
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| sympathetic/parasympathetic nervous system control | blood pressure, temperature regualtion
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| Spinal cord is surrounded by | rings of bone called vertebra
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| vertebra named according to | location
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| the higher the injury to vertebra and spinal cord the | more disability in a person
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| cervical vertebrae | 7
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| thoracic vertebrae | 12
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| lumbar vertebrae | 5
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| sacrum vertebrae | 5 fused into 1
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| coccyx vertebrae | 4 fused into 1
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| cervical nerves | head & neck, diaphragm, deltoids, biceps, wrist extenders, triceps, hands
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| thoracic nerves | chest muscles and abd muscles
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| lumbar nerves | leg muscles
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| sacral nerves | bowel, bladder and sexual function
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| acceleration | hyperextension-whiplash, rear-end collision
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| deceleration | hyperflexion- front-end collision
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| accleration-deceleration | hyperextension and hyperflexion
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| excessive rotation | hanging
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| axial loading | vertical compression- dive, falls
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| penetrating wound | open injury- knife,missile
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| concussion of spinal cord | temp loss of function 254-48 hrs b/c of inflammation(edema)
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| contusion | bruising and bleeding
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| necrosis occurs from | compromised capillary circulation and venous return
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| complete cord transection | total loss of motor, sensory, and primary reflex activity below the level of the lesion
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| tetraplegia CCT | C 1-8 (respiratory compromise)
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| paraplegia CCT | T1-L2
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| cauda equina CCT | L2 and below
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| sacral CCT | loss of bowel, bladder, & sexual function
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| Incomplete Transection | anterior cord, central cord and brown-sequard syndrome
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| anterior cord syndrome | loss of motor, pain & temp below the level of injury. Intact touuch, position & vibration (50%>40;50-70yo-hyperflexion)
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| central cord syndrome | motor paralysis of upper ext & lower ext but uper ext affected more than lower- hyperextension injuries
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| brown-sequard syndrome | hemisection; ipsilateral(same side) motor loss, proprioception, vibration, deep touch; contralateral loss of pain, temp light touch, penetrating trauma
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| emergency care & tx | establish & maintain open airway
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| 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
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| 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
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| 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
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| neurogenic bladder | lacks bladder control due to a brain or nerve condition--bladder can explode-need foley
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| kinetic therapy | movement
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| 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)
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| paralytic ileus | no movement causes air to be there which causes distention & impaction
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| 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
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| 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
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| effects of injury: Resp paralysis is common in | C1-4
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| injuries here may have edema above the injury causing temporary repsiratory compormise-ventilator. | C5-T1
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| when does edema usually subside in which client wont need a ventilator | several weeks
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| neurogenic shock occurs when injury form this level and above occur | T6
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| neurogenic shock | decreased heart rate, hypotension
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| what is given for neurogenic shock | atropine
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| what does atropine do in a pt with neurogenic shock? | increase heart rate
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| vasopressors (dopamine) | rasie BP
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| what tx is used in a pt with neurogenic shock | atropine, **fluids and dopamine
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| effects of injury: GI/GU | decreased motility, stress ulcers, foley until resolution of spinal shock(30-60mins after injury, paralytic ileus
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| bethanechol chloride (urecholine) | bladder tone
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| 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
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| complications of injury | spinal shock, neurogenic shock, autonomic dysreflexia
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| long term complications | spasticity, bladder & bowel dysfunction
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| 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)
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| recovery from spinal shock takes | 2 wks, average 1-6 wks
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| what signifies that spinal shock is resolved | appearance of involuntary reflexes
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| neurogenic shock occurs at level | T6 and above
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| 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)
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| life-threatening complication is | autonomiv dysreflexia that occurs w/upper motor neuron involvement
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| autonomic dysreflexia | visceral stimuli in pt's w/injuries above T6, occurs after the spinal shock is over, trigger:visceral distention
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| autonomic dysreflexia s/s | HTN, h/a, flushed, bradycardia, pilomotor spasm(goosebumps), nasal stuffiness
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| complications of autonomic dysreflexia | stroke, seizures, hemorrhage, blindness
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| interventions for autonomic dysreflexia | HOB up, sitting, loosen clothing, call MD, find & remove cause immediatedly-check foley-last BM, impaction-nupercaine
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| interventions for autonomic dysreflexia | nifedipine(procardia), Nitropursside Sodium(nipride)-IV to lower BP quickly
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| long term complications spasticity | occurs after spinal shock-UMN, physical activity: stretching exercises, whirlpool, warm tub baths, baclofen, flexeril, diaxepam
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| s/e of spasticity | drowsiness, diplopia, GI upset
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| baclofen | muscle relaxant & effective on involuntary spastic movement
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| 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
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| bowel retraining LMN | flaccid-manual disimpaction; optimize gastrocolic reflex, valsalva, massaging L to R, privacy, nonstressful, sitting position
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| bladder retraining | as soon as stable, d/c foley; intermittent cath q4 hrs
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| bowel retraining UMN | spastic-stroking the inner thigh, pullin on hair, warm water poured over perineum, tapping the bladder/detrusor muscle, bethanechol(urecholine)
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| bowel retraining LMN | flaccid-valsalva, tightening the abd muscles, cath for residual urine
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| sexuality UMN injuries for men | reflexogenic erections; orgasm & ejaculation absent; poor sperm quality
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| sexuality LMN injuries for men | complete lesion absent psychogenic or reflexogenic erections
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| incomplete lesion LMN | psychogenic erections w/ejaculation
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| sexuality women | meses may cease for 6 months, orgasms possible, fertility intact-loss of lubrication, pregnancy complications-autonomic dysreflexia in UMN injuries
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