class 15 spinal cord injury

Question 1

what is a spinal cord injury

Answer 1

insult to cord changing motor/sesnory function
-most common in ages 16-30 males

Question 2

most common causes of spinal cord injury

Answer 2

-motor vehicle crashes
-unintentional falls
-recreational activites

Question 3

types of spinal cord damage

Answer 3

-transient concussion
-contusion
-laceration
-compression
-complete transecion

Question 4

most common vertebra damaged

Answer 4

C5
C6
C7
T12
L1

Question 5

priority with suspected spinal cord injury

Answer 5

-#1 ABC’s
-neuro assessment, immobilize complete
-assess V/S for hypovolemic shock
-X-ray
-MRI
(cannot know the extend of damage without imaging unless cord is completely severed)

Question 6

what is tetraplegia

Answer 6

-cervical region affected
-all 4 extremities

Question 7

what is paraplegia

Answer 7

-thoracic
-lumbar
-sacral regions
-lower extremities

Question 8

what is complete spinal cord injury

Answer 8

-loss of motor and sensory function below injury

Question 9

what is incomplete spinal cord injury

Answer 9

-partial or complete sensory/motor fibres perserved

Question 10

if someone has a C3 injury or higher:

Answer 10

require mechanical ventilation

Question 11

acute phase management of spinal cord management

Answer 11

-immobilization, body alignment, skin integrity
-respiratory and CV support
-high dose IV corticosteroids (not used in Canada)
-skeletal fracture reduction and traction

Question 12

what is a primary spinal cord injury

Answer 12

as a result from an injury

Question 13

what is secondary spinal cord injury

Answer 13

caused by edema, inflammation, surrounding primary injury

Question 14

acute complications of spinal cord injury

Answer 14

spinal shock
neurogenic shock

Question 15

what is spinal shock

Answer 15

-decreased reflex activity below injury (bowel & bladder loss of control)
-loss of sensation
-flaccid paralysis
-hypotension
-bradycardia

Question 16

what is neurogenic shock

Answer 16

may last up to 4 months post injury
-loss of autonomic nervous vasomotor tone
-hypotension
-bradycardia
-peripheral vasodilation
-venous pooling
-decreased cardiac output
-loss of sweating

Question 17

management of spinal and neurogenic shock

Answer 17

-vasopressors (dopamine, atropine)
-NG decompression (dec bowel distension)
-bladder and bowel management (foley + bowel program)
-temperature monitoring

Question 18

manifestations of thromboembolism

Answer 18

-chest pain
-anxiety
-SOB
-increased PaCO2
-decreased PaO2

Question 19

management of venous thromboembolism

Answer 19

-low dose
-anti-embolism stockings/sequential pneumatic compression device
-calf and thigh measurement
-indwelling filter invena cava

Question 20

what is autonomic dysreflexia

Answer 20

-life threatening emergency
-abnormal overeaction of the autonomic nervous system after a spinal cord injury (usually occurs in rehab phase)

Question 21

manifestations of autonomic dysreflexia

Answer 21

-hypertension
-severe H/A
-diaphoresis
-bradycardia
-piloerection
-flushing of skin
-nasal congestion
-nausea

Question 22

management of autonomic dysreflexia

Answer 22

-sit pt upright
-remove stimuli
-palpate/empty bladder
-digital rectal exam, removal of stool
-check skin for pressure/irritation
-monitor BP closely (may need antihypertensive)
-educate pt

Question 23

home care to prevent disuse syndrome

Answer 23

-ROM exercises QID
-frequent repositioning
-botox injections, baclofen pumps, tendon severing

Question 24

home care to promote skin integrity

Answer 24

-BID visual and tactile exam
-monitor ischia, trochanters, heelsm sacrum
-reposition Q2H
-pressure relieving cushions/mattresses
-high protein, calorie, vitamin, fluid diet
-shift weight every (15-30 min)

Question 25

home care bladder management

Answer 25

-identify appropriate drainage method
-surgical options
-anticholinergic drugs, adrenergic blockers, antispasmotic drugs

Question 26

home care bowel management

Answer 26

-high fiber/fluid diet
-suppositories or enemas with digital stimulation
-stool softeners
-valsalva and manual stimulation (for lower motor neuron lesions)
-time BM for 30-60 minutes after breakfast
-upright position with feet flat on floor or stool
-exercise

Question 27

home care sexuality

Answer 27

-can have reflex sexual fucntion if upper motor neuron lesion
-may be capable of psychogenic erection if lower motor neuron lesion
-medications/penile prosthesis
-open communication
-pregnancy is not contraindicated

Question 28

home care coping mechanisms

Answer 28

-promote self care
-counseling for patient, caregiver and family