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CJA > Spinal cord injury > Flashcards

Spinal cord injury Flashcards

1
Q

upper motor neurons

A

descend through brainstem and spinal cord to control LMNs

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2
Q

lower motor neurons

A

extend from CNS to PNS to voluntary movements

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3
Q

afferent

A

away

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4
Q

efferent

A

descending

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5
Q

paralysis

A

loss of movement

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6
Q

plegia

A

suffix for paralysis

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7
Q

paresis

A

motor weakness

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8
Q

hypotonia

A

decrease on muscle tone

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9
Q

flaccidity

A

absent muscle tone, end result of lower motor neuron disorders

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10
Q

hypertonia, rigidity, spasticity, tetany

A

increase muscle tone
muscle continuously or repeatedly contracted

end result of upper motor neuron disorders

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11
Q

fasciculation

A

involuntary tiny muscle movements

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12
Q

what is the most common cause of spinal cord injuries

A

motor vehicle accidents

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13
Q

other causes of spinal cord injury

A

-falls
-violence
-sports injuries

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14
Q

non-traumatic disorders that cause SCI

A

congenital, tumors, bone disease

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15
Q

what ages do SCIs typically occur?

A

16-30, typically male

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16
Q

mortality causes of SCI

A

-pneumonia
-PE
-sepsis
-acute respiratory failure in high cervical spine injuries

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17
Q

complete SCI

A

-severed
-total loss of sensation and voluntary muscle control below the level of injury in the spinal cord

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18
Q

incomplete or partial SCI

A

-damaged
-some sensory or motor fiber connections are preserved

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19
Q

Horner’s syndrome

A

-can happen after SCI
-pupilar changes
-facial droop in one eye
-facial sweating, can’t sweat

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20
Q

primary injury

A

-result in initial trauma, -irreversible
-manifestaions related to cord level and degree of injury

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21
Q

secondary injury

A

-results of ischemia, edema, hypoxia, &/or hemorrhage that destroys surrounding nerve issue
-may be reversible or preventable during first 4-6 hours of primary injury
-STABILIZING SPINE IS IMPORTANT
-happens after primary injury
-usually going to be an OR patient

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22
Q

SCI C4 & above

A

need ventilation for the rest of life

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23
Q

SCI C5-C8

A

limited arm, hand, and finger control, paraplegia

swelling can go up and affect C4, worry about airway

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24
Q

T1-T12

A

full UE control, limited full intercostal control & paraplegia

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25
Q

L1-L5

A

full intercostal and and muscle control, limited LE control

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26
Q

S1-S5

A

limited to full foot control, limited full bowel/bladder/sexual function

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27
Q

ASIA assessment

A

used to assess neurological function in SCI patients

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28
Q

why should you be very diligent about vital signs?

A

patients are very liable

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29
Q

why should SCI patients have continuous telemetry monitoring?

A

risk of dysrhythmias with higher level injuries

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30
Q

do you get an MRI right away with SCI patients?

A

no, CT then OR. Not enough time for MRI

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31
Q

when should neuro/SCI assessments be done?

A

as prescribed & at change of shift with both nurses

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32
Q

how do acute SCI patients have to be positioned at all times?

A

flat and straight

no pillows unless between legs

person cannot twist

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33
Q

what should you do if you believe a patient has a SCI?

A

c-collar, log rolls, use backboard

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34
Q

what should you always be prepared for with an SCI patient?

A

intubation

35
Q

log rolling

A

turn a patient as a single unit to prevent the movement of spine

person at head is director

36
Q

if a person comes into the ED with a suspected SCI what are your concerns?

A

-airway/breathing
-vomiting aspiration
-skin integrity
-elimination (urine)
-patient fear and anxiety

37
Q

leading cause of death in patient with C4 and above SCI

A

acute respiratory failure

38
Q

can T12 and above impact respiratory function?

A

yes

39
Q

what part of respiration does T1-T6 affect

A

intercostals

40
Q

what part of respiration does T6-T12 affect

A

abdominals

41
Q

why is hypotension so bad in SCI patients

A

cord needs perfusion, want 95% and above

42
Q

what are prevention techniques of early SCI complications

A

-keep MAP above 85
-spinal stabilization and realignment
-ongoing neurological and spinal assessments

43
Q

spinal shock

A

-SUDDEN, complete loss of motor, sensory, reflex, and ANS function below injury

-flaccid paralysis, no sensation, no DTSs (areflexia)

-loss of bowel/bladder function

-spinal shock can last hours, days, or weeks after initial injury

-KEEP MAP ABOVE 85 TO PREVENT FURTHER DAMAGE TO SPINAL CORD

44
Q

does spinal shock involve vital signs?

A

no, just motor

45
Q

neurogenic shock

A

-cardiovascular collapse can develop as a result of loss of sympathetic nervous system (SNS) tone

-injury at T6 & above is at greatest risk

46
Q

does neurogenic shock have tachycardia or Bradycardia?

A

only shock with bradycardia

47
Q

what does neurogenic shock look like in a person?

A

-bradycardia
-hypotensive
-pass out right away
-drowsy/confused

48
Q

how do you help neurogenic shock?

A

bunch of fluids

49
Q

stabilization and realignment SCI

A

-early interventions are crucial to decrease secondary injuries

-surgeries: reduce (set/realign) fractures, decrease spinal cord compression, and increase overall vertebrae stability

50
Q

how long does traction stay on for SCI

A

24/7 for six weeks

51
Q

what happens if traction is dislodged?

A

stabilize the head in a neutral position and call for help

52
Q

can nurses do pin care for traction?

A

yes

53
Q

Halo vest

A

-used with or without traction to stabilize C-spine injuries
-pin care: clean daily, prevent infections
-skin care under and around vest
-change liner periodically
-patient/ family teaching and demonstrations

54
Q

ongoing neuro/spinal assessments

A

-LOC
-establish baseline of motor, sensation, and circulation
-motor: ROM & strength
-do not attempt to assess head ROM in acute cervical injury
-tactile sensation: test with patients eye closed
-report any new decrease in neurologic function immediately

55
Q

can you do chest PT in acute phase of SCI?

A

no, but you can in chronic phase

56
Q

why do you want to suction with caution in people with SCI?

A

creates a vagal nerve response and decreases heart rate

fix it by stopping

57
Q

why will SCI patients be at a higher risk of DVT and PE?

A

immobility, decrease in vasomotor tone, hyper coagulability (esp, in acute phase, and stasis of blood in LE

58
Q

what interventions do you anticipate to prevent DVTs?

A

-pneumatic compression boots/stocking
-elevate LE for venous return
-herparin or warfarin
-adequate hydration
-passive ROM if possible
-neuromuscular electrical stimulation

-almost impossible to diagnose in this patient

59
Q

how will you assess DVT?

A

-cannot assess pain in legs, redness may be absent
-check edema (esp. unilateral, calf/thigh measurements
-edema may be absent; US can confirm/deny

60
Q

a patient is diagnosed with an acute large right femoral DVT, what priority interventions do you anticipate?

A

-place limb alert, remove compression boot to right leg (confirm with provider)
-initiate therapeutic anticoagulant
-surgery to place IVC filter

61
Q

how will you assess for PE?

A

-pleuritic chest pain (ripping pain)
-anxiety
-SOB
-abnormal blood gases (increased CO2 and decreased O2)

62
Q

gastric dilation

A

-enlargement of the stomach due to a lack of blood flow/obstruction
-need to decompress stomach with NGT

63
Q

temp regulation below level of injury

A

loss of vasoconstriction, piloerection (“goose bumps”), sweating, shivering

can’t regulate body temp cause cannot feel

64
Q

poikilothermy

A

temperature control is largely external to the patient

65
Q

do patients with SCI have a high risk for heatstroke and hypothermia?

A

yes, nurse needs to ensure body temperature and environment is okay

teach family about this

66
Q

skin integrity

A

-can begin within hours of acute SCI
-exacerbated by decrease in peripheral circulation
-move patient from spinal backboard as soon as possible
-braces and collar also pose risk for skin breakdown
-can progress to osteomyelitis, sepsis, death

67
Q

interventions for pressure injuries

A

-turn/reposition at least every 2 hours in bed, 30 minutes in chair
-clean and dry skin
-very carefully inspect skin
-utilize cushion/foam dressing to bony prominences
-put patients on a high protein diet

68
Q

neurogenic bladder

A

-loss of bladder sensation, reflex contraction, and urination control –> urinary retention

-can have a spastic bladder where it’s overactive (associated with urgency and frequency)

-happens with most SCI above sacrum

-flaccid bladder is underachieve & happens with SCI starting at sacrum (infection risk & hyronephroesis (bakcking up of urine), associated with over filling of bladder)

69
Q

what interventions should you do for a patient with w neurogenic bladder?

A

get good routine, give 2.5L of fluid a day, straight Cath every 6 hours

monitor for UTI cause huge risk

70
Q

what complications can occur from urinary retention

A

-hydronephritis (urine reflux to kidney) –> kidney failure
-high UTI risk –> pylenephritis –> bloodstream
-severe overdistension –> bladder rupture

71
Q

what interventions do you anticipate with a neurogenic bladder?

A

-indwelling Cath in acute phase then intermittent
-timed bladder training
-urostomy
-teaching and recording I/O & voiding pattern, teaching for smell of urine
-bladder scan cause even someone with a wet pad can retain

72
Q

nutrition/elimination

A

-decrease in Gi motility (esp in 1st 72 hours and injuries at T5 or above), can lead to paralytic ileus and gastric distention

-NG tube to decompress stomach, prevent vomit/aspiration

-IV fluids and nutrition (e.g., TPN) until GI motility returns

-advance to high calorie, high protein, high fiber diet (as tolerated) with food amounts gradually increased

73
Q

neurogenic bowel

A

-loss of bowel sensation, defecation reflex, tone, and/or voluntary control, can lead to Gi constipation

-may have both incontience and constipation

-both internal and external anal sphincters control the anal canal

-can do anal sphincter massage once daily to stimulation pooping

74
Q

elimination

A

-usually develop bowel program routine

75
Q

if you’re assisting a provider with fecal disimpaction, what concerns do you have?

A

worry abut nasal response

76
Q

autonomic dysreflexia (AD)

A

-a massive sympathetic (SNS) over-stimulation that can occur in injuries at T6 or above

-cannot occur until after spinal shock has resolved

-most unpredictable during first year of injury, but can occur throughout lifetime

-can occur after recovery from neurogenic shock

-acute life-threatening emergency; can lead to status epileptics (ongoing seizures), MI, stroke

77
Q

most common cause of AD

A

full bladder

78
Q

causes of AD

A

full bladder, distended rectum, stimulation of skin or pain receptors, erection, uterine contractions

pretty much any stimulation below injury

79
Q

signs and symptoms of AD

A

-HTN
-POUNDING HEADACHE
-flushed skin above injury
-piloerection (goosebumps) below injury
-anxiety
-bradycardia
-profuse sweating above injury
-pale, cool skin below injury
-nasal congestion

80
Q

AD interventions

A

-immediately sit patient up with legs dependent to decrease BP
-remove constricting clothing or support stockings/boots to increase venous pooling in legs
-rapid assessment to identify cause (bladder >bowel>skin)
-immediate urinary Cath if indicated
-notify provider
-treat persistent HTN
-teach family

81
Q

concerns with SCI patient on sildenafil?

A

vasoconstriction, leads to hypotension

AD prolonged erection

82
Q

concerns of females with SCI

A

-decrease in vaginal lubrication
-menses return 3-5 months post injury
-can carry baby (usually c-section delivery)
-concerned about DVT if on birth control

83
Q

baclofen

A

-can be given orally or intrathecal pump

-adverse effects of CNS depression, fatigue, dizziness, confusion, headache, insomnia

-inrathecal: seizures and life-threatening CNS depression possible

-never drink with them

-never withdrawal abruptly or let pump go dry

CJA (31 decks)

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