Exam 3 - SCI

Question 1

what are the 4 components to the spinal cord

Answer 1

cervical (C1-8)
thoracic (T1-12)
lumbar (L1-5)
sacral (S1-5)

Question 2

SCI above __ causes paralysis of respiratory muscles AND all 4 extremities (quadriplegia)

Answer 2

C4

Question 3

primary SCI is caused by cord compression d/t

Answer 3

bone displacement
interruption of blood supply
traction from pulling on cord

Question 4

what is secondary SCI

Answer 4

ongoing, progressive damage that occurs after initial injury

Question 5

secondary SCI: permanent damage may occur within __ hours d/t ___

Answer 5

24 hours; edema

Question 6

extent of SCI damage and prognosis is not determined until __ hours or more after injury

Answer 6

72 hours

Question 7

greatest improvement of SCI occurs in the first __ to __ months after injury

Answer 7

3-6 months

Question 8

3 measures to classify SCI

Answer 8

mechanism of injury
level of injury
degree of injury

Question 9

what are the 5 major mechanisms of SCI

Answer 9

flexion
hyperextension
flexion-rotation
extension-rotation
compression

Question 10

tetraplegia is aka ___ and occurs d/t injury in which area

Answer 10

quadraplegia; cervical

Question 11

paraplegia occurs d/t injury in which areas

Answer 11

thoracic
lumbar

Question 12

complete vs. incomplete (partial) injuries

Answer 12

c: total loss of sensory and motor function below level of injury

i/p: mixed loss; some tracts intact

Question 13

what is central cord syndrome

Answer 13

damage to central spinal cord, commonly cervical

older adults
motor weakness
sensory loss - low extremities not affected
dysesthetic

Question 14

what is dysesthetic

Answer 14

burning pain in upper extremities

Question 15

what is anterior cord syndrome

Answer 15

damage to anterior spinal artery (compromised blood flow)

resulted from flexion injury
motor paralysis, loss of pain + temp sensation below level of injury

Question 16

what is brown-sequard syndrome

Answer 16

damage to 1/2 of cord
resulted from penetrating injury

Question 17

what is conus medullaris syndrome

Answer 17

damage to conus medullaris (lowest portion of spinal cord)

leg: preserved, weak or flaccid
decrease, loss of sensation in perianal
areflexic (flaccid) bladder, bowel
impotence

Question 18

what is cauda equina syndrome

Answer 18

damage to cauda equine (lumbar, sacral nerve roots)

flaccid paralysis of lower extremities
complete loss of sensation in saddle area
areflexic bladder, bowel
severe, radicular, asymmetric pain

Question 19

injuries above __ lead to dysfunction of sympathetic nervous system

Answer 19

T6

Question 20

neurogenic shock

Answer 20

bradycardia
peripheral vasodilation
hypotension

Question 21

acute phase: urinary system function

Answer 21

retention
bladder atonic, over distended, fails to empty
indwelling catheter

Question 22

postacute phase: urinary system function

Answer 22

bladder can become hyperirritable
loss of inhibition from brain
reflex emptying, failure to store urine

Question 23

GI s/sx

Answer 23

gastric distention
paralytic ileus
delayed gastric emptying
stress ulcers
dysphagia

Question 24

integumentary s/sx

Answer 24

skin breakdown potential
piokilothermia

Question 25

NG suctioning puts the pt at risk for which acid-base imbalance

Answer 25

metabolic alkalosis

Question 26

what is of concern the first 3 months after a SCI

Answer 26

DVT, PE

Question 27

nociceptive pain

Answer 27

musculoskeletal: dull, ache; worse with movement visceral: thorax, abdomen, pelvis

Question 28

neuropathic pain location

Answer 28

at or below level of injury hot, burning, tingling, pins + needles, cold, shooting

Question 29

when is spinal immobilization not recommended

Answer 29

penetrating trauma

Question 30

you want to maintain SBP > __ mmHg

Answer 30

90

Question 31

surgery within __ hours is associated with improved neurological outcome

Answer 31

24 hours

Question 32

why are vasopressors given

Answer 32

maintain MAP > 85-90 mmHg

Question 33

S/E of vasopressor agents

Answer 33

tachycardia VT, afib elevated troponin metabolic acidosis

Question 34

C1-3 will have ___ and inability to ___

Answer 34

apnea; inability to cough

Question 35

C4 will have a poor ___ and ___

Answer 35

poor cough; hypoventilation

Question 36

C5-6 will have a ___ ___ reserve

Answer 36

decrease respiratory

Question 37

what to auscultate with a T5 injury

Answer 37

bowel sounds

Question 38

overall goal of SCI

Answer 38

optimal level of neurologic functioning

Question 39

pin site care

Answer 39

cleanse with 1/2 strength peroxide and NS BID apply abx ointment

Question 40

what is kinetic therapy

Answer 40

continual side-to-side rotation prevent pulmonary complications prevent pressure ulcers

Question 41

nutrition should be started within __ hours. it should be what

Answer 41

72 hours high protein, high calorie

Question 42

what occurs during intermittent catheterization program

Answer 42

4-6 times daily monitor for s/sx of UTI increase fluid intake

Question 43

what is daily rectal stimulation

Answer 43

suppository or small-volume enema dulcolax, colace

Question 44

when does stress ulcers commonly occur after injury

Answer 44

6-14 days

Question 45

what are some meds that can be given to help with neuropathic pain

Answer 45

gabapentin lyrica cymbalta amitriptyline

Question 46

return of ___ may complicate rehab

Answer 46

reflexes hyperactive exaggerated responses penile erection spasms

Question 47

what are some antispasmodic meds that can be given

Answer 47

baclofen dantrium xeniflex botox injections