Ch 16 Spinal Cord Injury Flashcards Preview

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Flashcards in Ch 16 Spinal Cord Injury Deck (47):
1

What do spinal cord injuries involve

The loss of motor function, sensory function, reflexes, and control of elimination.

2

Injuries in the cervical region result in what

Quadriplegia

3

What is quadriplegia

Paralysis/ paresis of all 4 extremities and trunk.

4

What is SCI

Spinal cord injury

5

Injuries below T1 results in what

Paraplegia/ paresis of the lower extremities

6

Truncal instability also results if the injury SCI occurs where

If the injury is in the upper thoracic region

7

What dictates the level of SCI

The level of cord involved

8

Complete lesions ( injuries) results in what

The loss of all voluntary movement below the site of injury

9

Hyper flexion injuries are caused by what

Acceleration injuries that cause sharp forward flexion of the spine

10

Give example of hyper flexion injuries

Head on collision, fall, diving.

11

What are hyper extension injuries caused by

By a backward snap of the spine

12

Give examples of hyper extension injuries

Rear end collision, downward fall onto the chin.

13

What are objective physical assessment findings of a SCI

Inability to feel light touch by a cotton ball, inability to discriminate between sharp and dull pain, hot and cold.
Absent deep tendon reflexes, flaccidity of muscles,
Hypotension that is more severe when sitting in the upright position
Shallow respirations
Dependent edema
NEUROGENIC SHOCK, which accompanies spinal injury
Loss of temp regulation

14

When does neurogenic shock occur

After an SCI, and can cause total loss of voluntary and autonomic function for several days to weeks. Hypotension, dependent edema, and loss of temperature regulation are common symptoms, and paralytic ileus... It occurs due to the loss of autonomic function

15

When in an upright position, ppl in neurogenic shock experience what

Hypotension, transfer to a wheelchair should occur in stages, if the client reports dizziness, recline the back of the wheelchair

16

Clients who have upper motor neuron injuries ( above L1 and L2) will have what type of muscle tone

They will convert to a spastic muscle tone after neurogenic shock

17

Paraplegics who have lower motor neuron injuries ( below L1 and L2 ) will have what type of paralysis

They will convert to a flaccid type of paralysis

18

Will clients who have complete SCIs regain mobility

NO

19

Spastic neurogenic bladder

Clients who have upper motor neuron injuries will develop a spastic bladder after the neurogenic shock resolves.

20

What are bladder management options for males

Condom catheters and stimulation of the micturition reflex by tugging on the pubic hair

21

Flaccid neurogenic bladder

Client who have lower motor neuron injuries will develop a flaccid bladder

22

What is bladder treatment for a flaccid neurogenic bladder

Intermittent catherization for males and females.

23

Credes method

Downward pressure placed on the bladder to manually express the urine

24

What is nursing care for bowel regulation with neurogenic shock

It does not differ much between upper and lower motor neuron injuries... Daily use of stool softeners or bulk forming laxatives are recommended.

25

Why are glucocorticoids given after a SCI

Adrenocortical steroids such as methylprednisolone (solu-Medrol) aid in decreasing edema of the spinal cord, which can cause spinal cord compression and areas of ischemia

26

Why are vasopressors given during a SCI

Norepinephrine and dopamine are given to treat hypotension, particularly during neurogenic shock

27

Why would antimuscarinics be given during SCIs

Atropine sulfate may be given to treat bradycardia

28

Why would plasma expanded be given during a SCI

Dextran ( volume expander) may be given to treat hypotension secondary to spinal shock.....
OBSERVE CLIENT FOR SYMPTOMS OF FLUID OVERLOAD

29

Why would baclofen and dantrolene sodium be given during a SCI

They will be given to clients who have severe muscles spasticity. Muscle spasticity can be so severe that clients develop pressure ulcers, which can make sitting in a wheel chair very difficult

30

What should the nurse monitor for when administering baclofen and dantrolene sodium

Drowsiness
Muscle weakness

31

How may baclofen be administered to reduce sedative effects

Intrathecally

32

Why may cholinergics be administered following a SCI

Bethanechol ( Urecholine) decreases muscle spasticity of the bladder, allowing for easier bladder training and fewer accidents ......OBSERVE FOR URINARY RETENTION MEASURE RESIDUALS PERIODICALLY...

33

Why is the vasodilator hydralazine ( Apresoline) administered

It is used PRN to treat episodes of hypertension during autonomic dysreflexia

34

Clients who have cervical fracture may be placed in what type of immobilization device

Clients who have cervical fractures may be placed in a halo fixation device or cervical tongs.

35

What is the purpose of a halo fixation or cervical tong

To provide traction and or immobilize the spinal column

36

What are nursing actions for cervical tongs

Maintain body alignment and ensure the weights hang freely

37

What are surgical interventions for SCI

Spinal fusion is commonly done when a spinal fracture cera Es an area of instability of the spine.

38

How are spinal fusions of the cervical area performed

They are usually done using an anterior approach through the front of the neck.

39

How are spinal fusions in the thoracic or lumbar regions performed

Using a posterior approach and can be combined with a decompressive laminectomy

40

How are decompressive laminectomies performed

By removing a section of Latina, accessing the spinal canal, and removing bone fragments, foreign bodies, or hematomas that may be placing pressure on the spinal cord. Donor bone is often obtained from the iliac crest and be used to fuse together the vertebrae that are unstable. Application of paravertebral rods can be used to mechanically immobilize several vertebral levels.

41

What are complications of SCI

Orthostatic hypotension
Neurogenic shock
Autonomic dysreflexia

42

Why and when does autonomic dysreflexia occur following a SCI

It occurs secondary to the stimulation of the sympathetic nervous system and inadequate compensatory response by the parasympathetic nervous system.

43

Injuries below what level do not experience autonomic dysreflexia

Injuries below T6 do not experience autonomic dysreflexia because the parasympathetic nervous system is able to neutralize the sympathetic response.

44

What does stimulation of the sympathetic nervous system cause

Extreme hypertension,
sudden severe headache,
pallor below the level of the spinal cords lesion dermatome,
blurred vision
Diaphoresis
Restlessness
Nausea
Piloerection(goosebumps)

45

What does stimulation of the parasympathetic nervous system cause

Bradycardia
Flushing above the corresponding dermatome to the spinal cord lesion ( flushed face and neck)
Nasal stiffness

46

A nurse is caring for a client who experienced a cervical spine injury 24 HR ago, what medications should the nurse expect to be administered

Glucocorticoids
Plasma expanders
H2 antagonists

47

What medication would a nurse question if a dr prescribes it for a person who suffered a cervical spine injury 24 HR ago

Muscle relaxants because the client will still be in spinal shock 24 HR following the injury the client will not experience muscle spasms until after the spinal shock has resolved, making muscle relaxants unnecessary at this time.