Chapter 43

Question 1

Herniated nucleus pulposes

Answer 1

Can press on adjacent spinal nerve causing sever burning and stabbing pain down leg or foot

Question 2

Promoting low back pain

Answer 2

Good posture, exercise, ergonomics, proper lifting, equipment, good shoes, no prolong standing or sitting, wt within 10% of ideal, Ca intake, no smoking

Question 3

Non/Surgical

Answer 3

Non- Williams position, Tylenol, NSAIDs, muscle relaxants, steroids, injections, diskectomy, laminectomy, spinal fusion
Post op- watch drsg, Meds, exercise, prevention, strength in LE, ability to void, pain Ctrl, CSF check, log roll, report any drainage to PCP, halo

Question 4

Spinal cord injury

Answer 4

Loss of motor fxn, sensory, perception, reflex activity, B&B control
Complete- s.c. Damaged that eliminates all innervation below level of injury
Incomplete- injuries that allow some fxn below level of injury

Question 5

Primary mechanism of SCI

Answer 5

Hyperflexion: head forcefully moved fwd, head on collision
Hyperextention: head suddenly forced fwd then back, vehicle collision
Axial loading: vertical compression, diving/falling
Excess rotation: turn head beyond normal, boxers
Penetrating trauma: knife or bullet

Question 6

SCI facts

Answer 6

Trauma is leading cause of SCI
35% vehicle crashes
12,000 SCI/year
80% males- euro American 
Cervical spinal cord injury more common

Question 7

Nursing care for SCI

Answer 7

Assessment: ABGs, airway, Glasgow, LOC, level of injury, bleed
Sensory: dermatomes, neuro checks, decrease in sensation from baseline is urgent
Cardio: bradycardia, hypotension, hypothermia
Resp: assess breath sounds Q2H, report adventitious/diminished
GI/GU: abd bleeding, distention, swallowing difficulties, I&O

Question 8

Managing SCI

Answer 8

Halo, Dextran, atropine, muscle relaxant, surgery, case managers

Question 9

Multiple sclerosis

Answer 9

Inflammatory disease affecting brain and spinal cord
Autoimmune, viral, genetic, env causes
Assessment: muscle weakness and spasticity, fatigue, numbness, ataxia, dysphagia, Diplopia, nystagmus, tinnitus, B&B dysfxn, cognitive changes, depression
Interventions: modify effects, prevent exacerbations, manage sx with Meds, improve fxn
Give interferons

Question 10

Amyotrophic lateral sclerosis

Answer 10

Progressive weakness
Death within 3 years of dx
Men 40-60 y.o.
Muscle atrophy, weakness, creatinine kinase increased, tongue atrophy, face twitching, emotional incontinence, dysarthria, dysphagia
Rilutek can extend survival time
Priority problems- respiratory, swallowing, musculoskeletal concerns

Question 11

Monitor pt hourly with acute SCI for :

Answer 11

Pulse ox < 90% or sx aspiration
Symptomatic bradycardia, decreased LOC, decrease output
Hypotension with systolic <90

Question 12

Autonomic dysreflexia

Answer 12

Life threatening condition
Stimuli cause uninhibited reflex sympathetically
Assessment: rise in BP, bradycardia, profused sweating above lesion, goose bumps, flushing, blurred vision, nasal congestion, throbbing HA

Question 13

Emergency care for autonomic dysreflexia

Answer 13

Sitting position or previous safe position
Page PCP
Assess and tx cause
Check for urinary retention
Check bladder distention
Fecal impaction
Examine skin for ulcers
Monitor BP Q 10-15 min
Give nifedipine or nitrate as ordered

Question 14

Postop complication of ACD and fusion

Answer 14

Hoarseness 
Dysphagia
Wound infection
Injury to spinal cord
Dura mater tears
Graft and screw loosening