Unit 7 Chapter 40 Spinal Cord Injury Flashcards

1
Q

Causes of Spinal Cord Injury

A
  • Trauma
  • Violence
  • Falls
  • Tumors
  • Cervical Spondylosis
  • Herniated intervertebral disk issues(compression)
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2
Q

What is an Incomplete spinal cord injury

A

Injuries that allow some function or movement below the level of the injury are described as an incomplete SCI.

Able to convey some messages to or
from the brain

-more common

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3
Q

What is complete spinal cord injury?

A

A complete SCI is one in which the spinal cord has been damaged in a way that eliminates all innervation(nerve function) below the level of the injury

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4
Q

Complications of SCI

A

Loss of or decreased mobility, sensory perception, and bowel and bladder control often result from an SCI.

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5
Q

Your patient has sustained a thoracic spinal injury in T5, Where would you assess complications?
A. C1
B. C2
C.T3
D.T6

A

D.T6

ALWAYS ASSESS THE SITE BELOW THE INJURY

Below the level of injury functions lost are: Voluntary movement Sensation of pain, temperature, pressure & proprioception Bowel & bladder function Spinal & autonomic reflexes

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6
Q

Would your patient with a C1 spinal cord injury require mechanical ventilation?
A. No
B. Yes

A

B. Yes

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7
Q

How many vertebraes are in the spine (cervical+thoracic+lumbar)
A. 7
B. 15
C. 20
D. 24

A

D. 24

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8
Q

How many vertebraes are in the cervical collum

A

7

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9
Q

How many vertebraes are in the thoracic collum

A

12

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10
Q

How many vertebrates are in the lumbar collum

A

5

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11
Q

What is Quadriplegia

A

Quadriplegia – also called tetraplegia
* Paralysis of all 4 extremities
* Quadriparesis is weakness affecting all 4 limbs

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12
Q

What is Paraplegia

A

Paraplegia * Paralysis involving only the lower extremities * Paraparesis is weakness of lower extremities

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13
Q

If the cervical collum is damaged, What assessment should you initiate first?

Cardiovascular assessment or Respiratory investment?

A

RESPIRATORY ASSESSMENT

CERVICAL COLLUM DAMAGE IS A MEDICAL EMERGENCY

The higher the damage the patient will not be able to raise shoulders or shake their head, swallow.

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14
Q

ABC’S

A

The initial and priority assessment focuses on the patient’s ABCs ( a irway, b reathing, and circulation). After an airway is established, assess the patient’s breathing pa ern. The patient with a cervical SCI is at high risk for respiratory compromise because the cervical spinal nerves (C3-5) innervate the phrenic nerve controlling the diaphragm.

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15
Q

Spinal Injuries above C4 , Patients become?
A. Tetraplegic
B. Paraplegic

A

A. Tetraplegic

Injury above C4 causes tetraplegia and may be fatal because pt. cannot breathe independently

NO MOVEMENT OF HANDS OR LEGS , WILL MOST LIKELY CANNOT BREATHE ON THEIR OWN AND WILL NEED A MECHANICAL VENTILATOR

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16
Q

Injury to C7–pt. usually…

A

Injury to C7 usually can lift shoulders, elbows, wrists and has some hand function

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17
Q

Will patient with a C4 and above spinal injury need intubation with a mechanical ventilar?
A. No
B. Yes

A

B. Yes

18
Q

Nursing Intervention for mechanical ventilator?

A

-GI prophylaxis
-monitor for high and low-pressure alarms
-Immediately provide nutrition through TPN
-Get Post intubation ABG’s

19
Q

Medical tx

A
  • steroid to decrease inflammation
    -pantoprazole to prevent stress ulcers
20
Q

Nursing Care for SCI?

A

-stabilize patient
-move as one unit especially clients with Halo devices

21
Q

What occurs immediately after spinal injury?
A. spinal shock
C. neurogenic shock

A

A. spinal shock

22
Q

What is Spinal Shock

A

*Shock associated with acute injury to the spinal cord.
* Occurs immediately of spinal injury.
* Immediate loss of sympathetic cord function below the point of injury.
EVERYTHING SLOWS DOWN

Can last days to 1-6 weeks or may continue 3 months

23
Q

S/s of Spinal Shock

A

Characteristics:
* Paralysis
* Hypotension
* Bradycardia
* Hypothermia
* Respiratory Failure—if cervical or upper thoracic
* Bladder/bowel distention
* No perspiration below level of injury—*Temperature impairment

  • Spinal shock often last less then 48 hrs. but may continue for several weeks until body adjusts.
  • MRI or CT to determine level of injury. Cord edema peaks 2-3 days & subsides usually within 7 days of injury.
24
Q

Sympathtic function(speed)

A

Sympathetic
*fight or flight response.
*Involved in maintaining homeostasis and also,
*The sympathetic system prepares the body for any potential danger.
*Increases heartbeat, muscles tense up. *The pupil dilates to let in more light.
*Saliva secretion is inhibited.

25
Q

Parasympathetic function (poor)

A

Parasympathetic
*permits the rest and digest response.
*The parasympathetic system aims to bring the body to a state of calm.
Has comparatively longer neuron pathways, hence a slower response time.
*Reduces heartbeat, muscles relaxes.

  • Saliva secretion increases, and digestion increases.
    No such functions exist in “fight or flight” situations.
    *rest and digest
26
Q

Complications of Spinal shock

A

Effect causes temporary (transient) depression of all reflexes =
- paralysis (flaccid) - loss of sensation - loss of autonomic function - loss of B & B control (Sometimes priapism)

27
Q

What would your patient report when spinal shock is coming to an end neurogenic shock is starting?
A. low heart rate
B. hypothermia
C. muscle weakness
D. hyperreflexia

A

D. hyperreflexia

Spasticity or hyperreflexia signals end of this shock

28
Q

drug class of choice to decrease inflammation in the spine?

A

corticosteroids

EMS treatment starts with ( A/c-spine BC’s) and steroid drugs to reduce
inflammation and help to prevent further damage to cellular membranes that can
cause nerve death.

29
Q

When does neurogenic shock occur

A

after injury has occured

30
Q

Medical Managament

A

Decrease inflammation - Corticosteroids * Prevent Hypotension – Dextran * Treat Hypotension if not prevented - Dopamine * Prevent Bradycardia - Atropine sulfate * Reduce Pain – Opioids * Reduce Spasms – Skeletal muscle relaxant
*stool softner

31
Q

Injury T6 or above are at risk for Autonomic Dysreflexia?
A. No
B. Yes

A

B. Yes

32
Q

What is autonomic dysreflexia

A

This condition can occur suddenly (at any time) after spinal shock subsides. It is an exaggerated sympathetic response to spinal injury above T6. The patient’s body cannot counteract the sympathetic response.
-caused by any pressure on spine

RAPID EMERGENCY

33
Q

s/s of Autonomic Dysreflexia

A

Severe hypertension
* Bradycardia
*headache
* If injury in cervical area—respiratory failure and death (diaphragm paralyzed)
* Numbness/paralysis
* If cord completely severed, permanent paralysis
Sudden, significant rise in systolic and diastolic blood pressure, accompanied by bradycardia
* Profuse sweating above the level of lesion—especially in the face, neck, and shoulders; rarely occurs below the level of the lesion because of sympathetic cholinergic activity
* Goose bumps above or possibly below the level of the lesion
* Flushing of the skin above the level of the lesion—especially in the face, neck, and shoulders
* Blurred vision
* Spots in the patient’s visual field
* Nasal congestion
* Onset of severe, throbbing headache
* Flushing about the level of the lesion with pale skin below the level of the lesion
* Feeling of apprehension

34
Q

Why is managing BP imprtant

A

to prevent Autonomic dysrexia

35
Q

Nursing intervention for Autonomic dysreflexia

A

SIT PATIENT UP
INCREASE HOB
FREQUENT PRESSSURE RELEIVE
STAY FAITHFUL TO BOWEL REGIMEN
**EAT A WELL BALANCED DIET
STAY CONSISTENTT WITH DIET

36
Q

Patient teaching for autonomic dysreflexia GU AND GI

A
  • you need to straight cath yourself multiple times a day
    -you need a stool softner DAILY TO PREVENT SPINAL PRESSURE
37
Q

PATIENT TEACHING

A

Frequent pressure relief in bed/chair Avoid sun burn/scalds (avoid overexposure, use of
#15 sunscreen, watch water temperatures) Faithful adherence to bowel program Keep catheters clean and remain faithful to
catheterization schedule
Well balanced diet and adequate fluid intake Compliance with medications

38
Q

Emergency Care Autonomic Dysreflexia

A

Emergency Care Autonomic Dysreflexia
Immediate elevate head of bed to a high Fowler’s which lowers BP through blood pooling in lower extremities
 Check sheets for wrinkles
 Check for urinary or gastrointestinal retention/impaction lower BP?)

Notification
Call RRT and MD but stay with patient
Look for cause of increased pressure.
May need to medicate to lower BP (which meds lower BP , Beta blockers)

39
Q

What is the first nursing intervention for automatic Dysrexia

A

SIT PATIENT UP

40
Q

Family teaching and goal of rehan

A

Massive task to teach about neuro status, reflexes, activity, equipment, therapies, surgeries, etc.

  • Will need to relearn self care – usually transferred to a rehab hospital for extended stay after acute hospital care
  • Goal of spinal cord rehab. is to prevent further loss of function in these patients
41
Q

Key highlights of spinal cord injury

A

High cervical spine injury (C1 to C5) quadriplegia

  • Thoracic injury (T1 to T12) + paraplegia (lower extremities)
  • Injuries higher then C4 is paralysis of respiratory muscles=need mechanical vent
  • Remember: Do not move a person with a spinal injury unless their head, neck, spine has been properly supported and immobilized.
  • Damage to the spinal column could also progress to spinal cord causing:
  • Immediate complications—Respiratory distress, spinal shock
  • Long-term complications—Autonomic dysreflexia and the disorders of
    immobility
42
Q

Patients with sustained SCI suffer from role changes, it is important to empathize with client and offer therapeutic communication, What is an example of therapeutic communication?

A
  • how do you feel about this
    -i can only imagine
    -what concerns you the most
    -i am free to talk when you are ready
    -what do you know about the injury
    -what is bothering you