class 15 spinal cord injury Flashcards

1
Q

what is a spinal cord injury

A

insult to cord changing motor/sesnory function
-most common in ages 16-30 males

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2
Q

most common causes of spinal cord injury

A

-motor vehicle crashes
-unintentional falls
-recreational activites

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3
Q

types of spinal cord damage

A

-transient concussion
-contusion
-laceration
-compression
-complete transecion

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4
Q

most common vertebra damaged

A

C5
C6
C7
T12
L1

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5
Q

priority with suspected spinal cord injury

A

-#1 ABC’s
-neuro assessment, immobilize complete
-assess V/S for hypovolemic shock
-X-ray
-MRI
(cannot know the extend of damage without imaging unless cord is completely severed)

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6
Q

what is tetraplegia

A

-cervical region affected
-all 4 extremities

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7
Q

what is paraplegia

A

-thoracic
-lumbar
-sacral regions
-lower extremities

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8
Q

what is complete spinal cord injury

A

-loss of motor and sensory function below injury

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9
Q

what is incomplete spinal cord injury

A

-partial or complete sensory/motor fibres perserved

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10
Q

if someone has a C3 injury or higher:

A

require mechanical ventilation

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11
Q

acute phase management of spinal cord management

A

-immobilization, body alignment, skin integrity
-respiratory and CV support
-high dose IV corticosteroids (not used in Canada)
-skeletal fracture reduction and traction

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12
Q

what is a primary spinal cord injury

A

as a result from an injury

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13
Q

what is secondary spinal cord injury

A

caused by edema, inflammation, surrounding primary injury

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14
Q

acute complications of spinal cord injury

A

spinal shock
neurogenic shock

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15
Q

what is spinal shock

A

-decreased reflex activity below injury (bowel & bladder loss of control)
-loss of sensation
-flaccid paralysis
-hypotension
-bradycardia

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16
Q

what is neurogenic shock

A

may last up to 4 months post injury
-loss of autonomic nervous vasomotor tone
-hypotension
-bradycardia
-peripheral vasodilation
-venous pooling
-decreased cardiac output
-loss of sweating

17
Q

management of spinal and neurogenic shock

A

-vasopressors (dopamine, atropine)
-NG decompression (dec bowel distension)
-bladder and bowel management (foley + bowel program)
-temperature monitoring

18
Q

manifestations of thromboembolism

A

-chest pain
-anxiety
-SOB
-increased PaCO2
-decreased PaO2

19
Q

management of venous thromboembolism

A

-low dose
-anti-embolism stockings/sequential pneumatic compression device
-calf and thigh measurement
-indwelling filter invena cava

20
Q

what is autonomic dysreflexia

A

-life threatening emergency
-abnormal overeaction of the autonomic nervous system after a spinal cord injury (usually occurs in rehab phase)

21
Q

manifestations of autonomic dysreflexia

A

-hypertension
-severe H/A
-diaphoresis
-bradycardia
-piloerection
-flushing of skin
-nasal congestion
-nausea

22
Q

management of autonomic dysreflexia

A

-sit pt upright
-remove stimuli
-palpate/empty bladder
-digital rectal exam, removal of stool
-check skin for pressure/irritation
-monitor BP closely (may need antihypertensive)
-educate pt

23
Q

home care to prevent disuse syndrome

A

-ROM exercises QID
-frequent repositioning
-botox injections, baclofen pumps, tendon severing

24
Q

home care to promote skin integrity

A

-BID visual and tactile exam
-monitor ischia, trochanters, heelsm sacrum
-reposition Q2H
-pressure relieving cushions/mattresses
-high protein, calorie, vitamin, fluid diet
-shift weight every (15-30 min)

25
Q

home care bladder management

A

-identify appropriate drainage method
-surgical options
-anticholinergic drugs, adrenergic blockers, antispasmotic drugs

26
Q

home care bowel management

A

-high fiber/fluid diet
-suppositories or enemas with digital stimulation
-stool softeners
-valsalva and manual stimulation (for lower motor neuron lesions)
-time BM for 30-60 minutes after breakfast
-upright position with feet flat on floor or stool
-exercise

27
Q

home care sexuality

A

-can have reflex sexual fucntion if upper motor neuron lesion
-may be capable of psychogenic erection if lower motor neuron lesion
-medications/penile prosthesis
-open communication
-pregnancy is not contraindicated

28
Q

home care coping mechanisms

A

-promote self care
-counseling for patient, caregiver and family