Advanced spinal surgical nursing Flashcards by Larissa May

List the nine conditions that can be seen in the spinal patient

degenerative 
developmental 
anomalous (cysts)
neoplastic 
nutritional 
inflammatory (discospondylitis/empyema)
trauma fractures/luxations 
vascular

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List the four types of degenerative spinal disease and what the characteristics of each

Disc extrusion
Small breeds, annulus tears and degenerative nucleus squirts out
Disc protrusion
Large breeds, annulus bulges compressing the cord
Cervical spondylomyelotpathy
canal stenosis, facet hypertrophy, disc protrusion, flaval ligament hypertrophy-compress the cord (rotties)
Lumbosacral disease
disc protrusion, facet hyperplasia, soft tissue proliferation possible subluxation
impinge on cauda equine/nerve roots directly affecting the blood supply (labs GSD)

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List the types of neoplasia that can occur in the spine

Primary (from neurological tissues)
Secondary (from surrounding neurological tissues )
Tertiary metastasised

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What are anomalous cysts?

Sub arachnoid diverticula
an abnormal adhesion between layers of meninges which causes a collection of csf that compresses the cord or inflammation/odema in the cord

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What is disconsponylitis?

Infection of the intervertebral discs and the end plates of the surrounding vertebra
compresses cord lead to instability with a compressive /dynamic disease component

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What pathological actions can cause spinal cord damage?

laceration 
compression 
contusion 
ischaemia 
inflammation

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How do i medically manage the 
laceration 
compression 
contusion 
ischeamia 
infiltration and dysfunction

Laceration 
not solvable but preventable, immobilise area, maintain blood supply
Compression 
no medical management 
contusion 
not solvable 
ischaemia (BP, HR, SV, CO, hypoxaemia) 
Infiltraion/ dysfunction 
treated with drugs or radiation

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How do you immobilise a laceration spinal patient?

Spinal board
bandaging materials
spinal brace

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When a primary spinal patient presents what do i need to control?

Ischaemia
ensure ventilating
appropriate blood supply
ensure CO is sufficient (arrythmias, shock)
Ensure blood volume and blood pressure is appropriate

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what clinical parameters should be monitored in a spinal patient?

Resp rate and effort 
HR, PQ
Pulse oximeter
blood gas
blood pressure 
fluid volume status

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What is a dorsal laminectomy?

Removal of the laminae of the dorsal vertebral arch +/- the spinous process (access to dorsal spinal column)
CSM, lumbar sacral disease, SAD, disc diseases

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What is a facectectomy?

Removal of the articular facet

lumbar sacral disease CSM

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What is a Foraminotomy?

Enlargement of an intervertebral foramen to relive pressure on a nerve root
Lumbosacral disease

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What is a hemilaminectomy?

Removal of one half of the lateral vertebral arch ( includes pedical and facets)
allows access to lateral and partial access to the ventral or dorsal spinal column
Tumours SAD

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What is a corpecomty?

Lateral approach with removal of part of the vertebral body and endplates either side of the IVD
Allows for removal of compression from the ventral cord in thoracic and lumbar cord without going through the thorax or abdomen
dangerous in the cervical cord do not use at the lumbosacral junction

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What is a ventral slot?

Slot like opening from a ventral approach in endplates of the vertebral body and removal of part of the disc in the cervical spine
access to ventral aspect of the spinal column

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What is stabilisation of the spine and what is it used for?

removing the motion between adjacent vertebrae using implants and boe grafts
consider distraction-fusion for CSM and LS

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List the retractors that are useful in spinal surgery

Gelpis and odd legs

mckee retrators

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List the equipment useful for bone and soft tissue removal in the spinal surgery

Spinal burr 
Kerrisons rongeurs 
Bone punch forceps 
Friedman microrongeurs 
compound action spinal rongeurs

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List the equipment useful in tissue, periosteal or tissue retraction

freer periosteal elevatro 
dandy nerve hook 
sheas curette 
Rosen mobiliser 
younger scaler 
jaquette scaler 
Adsons nerve hook

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List the equipment useful for haemostasis in spinal surgery

Study These Flashcards

Bone wax 
srugicell 
spongistan 
surgisnow 
PVA
Duragen 
Codman surgical patties

Areas to implement nursing specific to the spinal patient

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Manage urinary incontinence
prevent pressure sores
detect and control pain support and monitor the resp rate
promote motor recovery

What is important in physical therapy of the spinal patient?

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Prevent pressure sores 
maintain motor fuction 
reduces pain 
supports the respiratory tract 
improves bond

Why is it important to carry out physical therapy?

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plasticity of cells changing the way that they work
Nervous system re-learning movements only possibly whilst generating the movement
START EARLY

What does physical therapy do?

``` improves lymph and venous drainage promotes motor function improves bond relaxes patient Pain relief ```

What does physical therapy do for the motor system?

Maintains joint health limits muscle wastage prevents limb muscles spasticity/contracture/ flaccidity Retrains gait patterns

What does physical therapy do for the sensory system?

improve core stability retrain gait patterns stimulates proprioception

What actions do we perform for physical therapy?

``` Massage Passive range of motion Active assisted exercises Active exercises proprioceptive exercises ```

What is massage important for?

``` Lymph and venous return minimises pain limits muscle spaciticy Dermal stimulation Warms up muscles ```

What is passive range of motion important for?

joint health flexibility/elasticity gait patterning

What are active assisted exercises?

``` assistance during muscular contraction assisted walking walking with a sling physio-rolls water treadmill ```

what are active exercises?

``` Unassisted movement of a joint static exercises (standing on one leg) walking (straight line,figure of 8) specific exercises (sit to stand) ```

What are proprioceptive exercises?

``` Body recognition of limb position standing wobble board uneven surfaces walking over poles weaving through cones ```

What other modalities can be use in physical thearpy?

Cold therapy Hot therapy Neuromuscular electrical stimulation laser therapy

What do you need to consider when making a physical therapy plan?

``` Previous activity environment temperament client expectations client involvement physical examination neuro exam disease process concurrent orthopaedic conditions ```

What physical therapy should be included in the firs 48-72 hours post-surgery?

Massage full body light massage cold compress

What physical therapy should be included when the dog is able to support weight with no limb movements?

``` Massage limb muscles Light full body massage Passive range of motion (15 cycles of each joint) Standing exercises Weight shifting exercies ```

What physical therapy should be included when the dog has initial limb movement?

``` Passive range of motion standing exercise weight shifting assisted walking hydrotherapy ```

What physical therapy should be included when the dog has good limb movements?

``` Sit to stand circles and figures of 8 wobble board walking over poles hydrotherapy ```

Why is skin and wound management important?

infection pain poor quality of life

Why does skin disease occur?

``` Boredom sensory dysfunction (neuropathic pain) recumbencey bladder/faecal dysfunction ```

How do pressure sores develop?

``` Lack of movement lead to mechanical load in one area ischaemia reduced pulsatile blood flow reduced venous return reperfusion tissue injury blood pressure abnormalities Deep tissue first then skin ```

What are the pressure points where pressure sores are most likely to form?

Ischial tuberosities lateral condyles of the humerus perianal

What are the risk factors of pressure sores?

``` Dogs with long fur diarrhoea weather age concurrent ortho condition heating of the floor ```

How are pressure sores prevented?

``` Turn every 2 to 4 hours Appropriate bedding sling bed porous bedding non-slippery floor absorbent pads use of lower cages Physical therapy to promote circulation Skin inspection once a day Drying the skin (waterproof barrier cream) Manage bladder Avoid unnecessary dressing care with tape on skin ```

How do you treat pressure sores?

Clean debride antibiotics bandaging

If a spinal patient is unable to urinate what can this lead to?

UTI Bladder distension (lead to atony) Distension of the ureters predisposition to skin sores

How can you manage the bladder in the spinal patient?

Manual expression (3x daily) Intermittent catheterisation Indwelling catheter drug therapy

What can lack of pain management lead to?

Self mutilation | reduced rate of rehab

What are the types of pain?

Inflammatory-tissue damage Neuropathic- dysfuction in transmission of noiciception Acute- sudden onset localised chronic- intense and unrelenting and persists

Why should the respiratory tract be managed in spinal patients?

``` prone to hypoventilation atelectasis pneumonia Monitor respiratory parameters Turn regularly Physical therapy propping into sternal appropriate drug and o2 therapy ```

Advanced spinal surgical nursing Flashcards

(51 cards)