Chapter 43 Spinal Flashcards Preview

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Flashcards in Chapter 43 Spinal Deck (46)
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1

Describe acute pain.

due to trauma or injury. Muscle strain or spasm, ligament sprain or disc degeneration/herniation - less than 3 months

2

What is a herniated disc?

nerve pressure ( usually sciatic nerve- burning, stabbing, radiating pain)

3

What is a spinal stenosis>

narrowing of the spinal cord or nerve root

4

What is spondyloisthesis?

Defect in one of the vertebrae

5

What is Spondylolisthesis

vertebrae slips onto the one below itself

6

What is spondylosis?

degenerative changes in the spine

7

How do you assess for lower back pain?

pain, mobility, paresthsia (tingling), urinary and bowel incontinence

8

Describe interventions for acute lower back pain.

Position (Williams); Frequent position changes
Medications: NSAIDs acetaminophen, opioid/non opioid, analgesics, steroids
Epidural-corticosteroid/anesthetic

9

Describe interventions for chronic lower back pain.

Antidepressants
Heat/cold application
PT
Weight restrictions

10

What is phonophresis?

topical drug and 10 minutes of ultrasound (provided by PT)

11

What is lontophoresis?

toical drug and electrical current (provided by PT)

12

Describe surgical management for lower back pain

Minimally invasive
Patients will go home the same day
Conventional open- discectomy, laminectomy, fusion (p. 889)

13

What are some post-op considerations for lower back pain?

Conventional surgery- first 24-48 hours are the most critical
VS (fever& hypotension may indicate bleeding and pain)
Neurologic assessment
Ability to void
Pain ( PCA/ Oral medication)
Drains/ drainage (clear drainage usually indicates meningeal tear. Patients with meningeal tear and CSF leak are placed in a supine position and strictly on bed rest. Notify physician immediately if you suspect a CSF leak.)
Moving/mobility
VTE prevention

14

Explain failed back surgery syndrome (FBSS)

Usually due to the combination of organic, psychological and socioeconomic factors
Nerve blocks/ spinal cord stimulators
Repeated surgery
Intrathecal (spinal) injections with Ziconotide (Prialt)- N-type calcium channel blocker.

15

Describe cervical neck pain.

Often due to bulging or herniated disc. (nerve compression)
Radiating pain
Contributing factors: aging, poor posture, lifting, tumors, rheumatoid arthritis, osteoarthritis, infection

16

Describe nonsurgical pain management for cervical neck.

Position
Medication
PT

17

Describe surgical management (anterior and posterior approach) for cervical neck pain management.

Postoperative management : airway, breathing, circulation
VS; bleeding/drainage; swallowing; I&O
Ability to void
Pain
Mobility

18

What are some cervical neck pain surgical complications?

Hoarseness
Dysphagia
Esophageal, tracheal or vertebral artery injury
Wound infection
CSF leak
Hardware problems

19

What is a complete spinal cord injury?

there is no innervation below the injury

20

What is an incomplete spinal cord injury?

some function or movement belove thw injury is present

21

List the primary injuries

hyperflexion
hyperextension
axial loading
rotation injuries
penetrating injuries

22

What is hyperflexion mechanism of injury

extreme flexion of the neck; car accidents; injury to thorax and lumbar spine if due to fall on buttocks.-primary

23

What is hyperextension mechanism of injury

rapture of longitudinal ligament- primary

24

What is axial loading mechanism of injury?

vertical compression (vertebrae shatters) primary

25

What are the secondary mechanisms of injury?

Hemorrhage
Ischemia
Hypovolemia
Impaired tissue perfusion
Local edema

26

Describe an assessment for spinal cord injury.

History
Airway; Breathing; Circulation (Cardiovascular and respiratory assessment)
Airway may be compromised; C3-5 controls breathing; pulse, BP, bleeding
Level of Consciousness (Glasgow coma scale)
Spinal shock
Sensory assessment
GI & GU assessment

27

What are some interventions for SCI?

Airway and breathing
Intubation
Coughing, pulmonary hygiene and suctioning
Neurogenic shock
Maintain hydration
Monitor blood pressure (VS)
Preventing secondary injuries
Immobilization
Body alignment
Motor function & pain

28

What are some interventions for SCI?

Pressure ulcers
Frequent position change
Surgery
To stabilize the spine
Urinary and bowel elimination
Foley catheter
Intermittent emptying
Stool softeners
Increased fluid intake

29

What are some drug therapy for SCI?

Dextran- plasma expander
Atropine sulfate – bradycardia tx
Dopmine – hypertension
Tizanidine- skeletal muscle relaxant
Celebrex- heterotopic ossification
Calcium & phosphate- prevent osteoporosis

30

Autonomic Dysreflexia

know :) It is the idea that you could be sitting on a tac and a paralyzed patient may not recognize it but the body will and will respond by a shooting blood pressure. Caused by bladder, bowel, skin irritation