3.3- Spinal Cord Complications Flashcards Preview

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Flashcards in 3.3- Spinal Cord Complications Deck (82):
0

What complication occurs almost immediately after injury due to decreased innervation of muscles?

respiratory complications

1

_____-______ controls the diaphragm?

C3-C5

2

What is the leading respiratory issue following a spinal cord injury? Why?

pneumonia- because lower or incomplete injuries may weaken the respiratory muscles

3

What may limit patients ability to exercise?

decreased respiratory

4

Early ________ to ________ is extremely important

acclamation to upright

5

What can be used to help respiration?

1. abdominal binders/corsets
2. assistive cough techniques
3. spirometry
4. diaphragmatic strengthening

6

What is at greatest risk the first 2 weeks due to immobility and medically fragile?

DVT

7

What percent can get a DVT?

up to 60%

8

Where does a DVT usually from and dislodge? What can happen?

usually in calf. Death

9

Why are DVT's difficult to discover?

Because the patient lacks sensation, will need to look for swelling and redness

10

What can be used to prevent DVT's?

1. Coumandin/Heparin porphylatic
2. TET hose/pressure devices to promote venous return

11

Early return to ______ and transfer to W/C is important

upright

12

What causes orthostatic hypotension?

venous pooling causes blood to collect in LE's-without good muscle pumping and LE vasoresponse the BP decreases during positional changes-pass out.

13

What BP level is a dangerous level-below can cause cardiac arrest?

70/40

14

T/F Orthostatic hypotension is the worst after the person is positioned upright.

FASLE-it is worse at first, but gets better as the person gets used to upright

15

What 2 things can we use to help with orthostatic hypotension?

abdominal binder and TET hose

16

What is also another common problem of spinal cord complications?

Pressure Ulcers

17

Name all 12 spinal cord complications

1. Respiratory
2. DVT
3. Orthostatic hypotension
4. Pressure ulcers
5. Autonomic dysreflexia
6. Heterotopic ossificans
7. Pain
8. Contractures
9. Osteoporosis
10. Bowel/Bladder
11. Sexual dysfunction
12. Spasticity

18

What can occur during spinal shock but gets worse during stastic stage?

pressure ulcers

19

What is caused by lack of blood flow, especially in the bony area?

pressure ulcers

20

Why are pressure ulcers difficult for spinal cord injuries?

Can no longer feel the discomfort we feel that would cause them to change positions.

21

Early on, pressure ulcers develop around the _______ from being in bed. When moved to WC they tend to develop around the _______________

coccyx, ishial tuberosity

22

Patient must be taught to do _______ of pressure relief for every ________ of sitting

1 minute for every 15-30 minutes of sitting

23

Who must be taught to do skin inspections?

family/patient

24

Descending inhibitory input from the brain that usually modulates autonomic function is lost, works on a reflex basis.

Autonomic dysreflexia

25

What only occurs with injuries above T6 and can occur at any time but is usually the first 6 weeks?

autonomic dysreflexia

26

The autonomic response is set off by a noxious stimuli below the level of lesion and reflex continues until the stimuli is removed-dangerous and cas cause death.

automomic dysreflexia

27

What are the symptoms of autonomic dysreflexia? There are 7

1. severe headache
2. profuse sweating
3. vasoconstriction below level of lesion
4. vasodilation (flushing) above lesion
5. runny nose
6. pilierection
7. severe increases in BP (can cause seizure, stroke, detached retina)

28

What are some causes of autonomic dysreflexia?

1. full bladder/catheter kink
2. bowel distension
3. pressure sores
4. noxious stimulation
5. environmental temp change
6. passive hip stretch

29

What treatment can we do when we see a patient experiencing autonomic dysreflexia?

1. look for and eliminate source of stimulation
2. lower patient BP by raising the head (use orthostatic hypotension)
3. return patient to their hospital floor level and contact nurse/MD immediately

30

Bone formation in soft tissue below level of lesion around a large joint. Knees, hips, shoulders

heterotopic ossificans

31

Doesn't show well on early xrays and could be due to neurologic trauma-its not well understood.

heterotopic ossificans

32

What are the signs/symptoms of heterotopic ossificans?

1. decreased ROM
2. swelling
3. redness (looks like DVT)

33

heterotopic ossificans- some believe in aggressive ________, some feel it is contraindicated and may require ______

ROM, surgery

34

Is common despite loss of sensation. May be due to irriatation or damage to sensory pathways.

pain

35

Common-poorly localized mumbness, tingle, burning, shooting and aching pain is known as?

Phantom pain

36

What treatment can be used for pain?

1. meds-NSAIDS, antidepressants (may increase spasticity)
2. psych mamagement-pain clinics
3. acupuncture, biofeedback, TENS
4. narcotics (try to avoid) nerve blocks

37

What is caused by spasticity and decreased movement?

Contractures

38

Most common contracture is _______?

PF

39

___________ creates a problem for ambulation and keeping feet flat on pedals of chair.

PF contracture

40

_______ and ______ contractures are common from sitting

knee and hip

41

For contractures try to get ________ on a regular basis

prone

42

Why should you not stretch the back out too much?

spasticity helps to hold them up

43

What causes osteoporosis?

decreased WB causes demineralization of bones

44

What mineral collects in the kidneys and can cause kidney stones?

CA

45

What is the best treatment for osteoporosis?

weightbearing asap

46

What function is controlled by S2-S4?

bowel/bladder

47

Initially the bladder is ______ from _____________

flacid, spinal shock

48

What is reflexive neurogenic bladder?

when the bladder reflexively empties when pressure reaches a certain level

49

If the injury is above S2 what happens to the bladder?

reflexive neurogenic bladder

50

T/F Maunal pressure to the bladder can help empty it if the injury is above S2?

True

51

What is Non-Reflexive Bladder?

bladder is flaccid and needs a catheter to empty

52

If the injury is to the cauda equina or conus medullaris you will have ____________ bladder

non-reflexive bladder

53

What is generally not under volunatry control, but can be self managed on a regular schedule?

bowel

54

T/F can use fiber and stool softeners and lots of fluid and a stimulus either manual or suppository to aid in bowel movement

True

55

Sexual dysfunction, _______ motor neuron injury with sacral reflex arch intact. Can get an errection but no ________

upper, ejaculation

56

T/F With sexual dysfunction, there is a good chance of having kids without help

False- poor chance of having kids without help

57

With sexual dysfunction, women have ______ and can get _______ usually hospitalized last _______-______ week because they don't feel labor pain.

menstruation, pregnant 4-6 weeks

58

Is greater with cervical and incomplete injuries and exacerbated by noxious stimulation

spasticity

59

Spasticity can be helpful in what areas?

1. muscle pumps of venous system
2. may help with functional activities (transfers, bed mobility)

60

When the spinal cord injury is accute what is the best treatment to start with?

Respiration-depends on level
*maximize anything available to increase diaphragm strength

61

What are ways to help with respiration strength and keeping mucous under control?

1. increase lateral expnsion, incentive spirometry, chest wall stretching
2. postural drainage, assistive cough techniques

62

Initially ______ may be limited by halo or back brace

ROM

63

When should you limit hip flexion to 90 degrees?

patient in a back brace
**don't pull against an ustable area

64

________ tight areas, but sometimes it is more ________ to leave tight

stretch, functional

65

What is a tenodesis grip?

keeping finger flexors tight, extending the wrist will cause the fingers to flex into a grasp

66

Tight _______ extensors help keep _____ back-helps with sitting balance and respiratory function.

cervical, head

67

Tight ______ _______ helps with rolling, transfers, and maintain sitting

low back

68

What flexibility should we work on for long sitting, hip flexors/extensors, hip rotators and ankle DF?

hamstring

69

Strength-start in ______ _______ and increase as possible (contraindicated in fx areas)

gravity neutral

70

Bilateral use of ______ is helpful for strength

UE's

71

Focus strength on anterior delts, shoulder extensors, and bicpes

quadraplegic

72

Strength focus on shoulder depressors, tricpes and lats

Paraplegic

73

Acclimation to upright, start by raising ______ of ______
***watch vitals

head of bed

74

Accclimation to upright can be progressed to ______ with elevating leg rests and tilt table

WC

75

What prevents osteoporosis, helps bladder/bowel and decreases abnormal tone

WB on LE's ASAP

76

Beyond accute phase we can start working on what 5 things?

1. bed mobility
2. pressure relief
3. WC propulsion
4. transfer training
5. gait training (para-using bracing)

77

Bed Mobility: give 4 things they can do to be mobile in bed

1. rolling (pressure relief)
2. transfer to prone (good hip stretch)
3. prone on elbows (good for head/nect control, GH stabilization)
4. supine on elbows (work on long sitting)

78

What bed mobility is good for pressure relief?

rolling

79

What bed mobility is good for hip stretch?

transfer to prone

80

What bed mobility is good to work on long sitting?

supine on elbows

81

What bed mobility is good for head/neck control, GH stabilization?

prone on elbows