Exam 3: SCI part 2 of 3 (from Spring 2015) Flashcards Preview

Bringman class fall 2015 > Exam 3: SCI part 2 of 3 (from Spring 2015) > Flashcards

Flashcards in Exam 3: SCI part 2 of 3 (from Spring 2015) Deck (58):
1

what is autonomic dysrelexia?

  • ~it can kill your pt!!
  • ~systemic
  • ~massive autonomic system flare up

2

what level is of SCI is autonomic dysrelexia not a concern?

  • ~By t6 the sympathetic trunk has desiccated
  • ~if you are injured below T6 you should not have to worry about this (you can be safe and educate pts with SCI down to T10)

3

causes of autonomic dysrelexia

  • ~Stimulus that is below the level of the lesion that the autonomic system picks up on (that the system normally does not pickup on)
  • ~Noxious stimuli: Wrinkles in cloths, Infection, UTI, ingrown toenail, bug bit, pulling on catheter, a pebble in your shoe, kink in catheter, block in B/B

4

Details about c1/2 fractures

  • ~there is a lot of space at C1/2
  • ~there may be no s/s of a SCI at these level
  • ~can just fracture the dens

5

s/s of autonomic dysreflexia

  • ~Temp will increase
  • ~blood vessels will dilate
  • ~BP will increase (SHEPHERD CENTER)
  • ~runny nose
  • ~dizziness
  • ~sweating below the level of lesion (will sweat both, but normally will only be able to sweat above) SHEPHERD CENTER SAID it is above level of injury
  • ~HR will increase
  • ~headache
  • ~redness

Shepherd Center Reference: http://www.myshepherdconnection.org/sci/autonomic-dysreflexia

6

What to do when you think a pt is going into autonomic dysrelexia?

  • ~Find out the cause
  • ~DON’T LAY THEM DOWN!!! It looks like orthostatic hypotension; if you lay them down, you can kill them! Keep them sitting or standing.
  • ~Get them nude and look for the cause

Number one cause is full bladder (Shepherd Center: http://www.myshepherdconnection.org/sci/autonomic-dysreflexia)

7

what will occur when a SCI occurs (the docs first do this)

  • ~Give them something to decrease inflammation
  • ~What to prevent more SC from getting injured
  • ~SAID/ steroid (not NSAID)
  • ~Use intravenous cooling to allow body to decrease inflammation (to research to back)

8

Braces

  • ~CO
  • ~TO
  • ~LO
  • ~SO
  • ~TLSO
  • ~LSO
  • ~HALO
  • ~Minerva
  • ~Soma
  • ~cervical collar
  • ~aspen CO/CTO
  • ~Jewett
  • ~Knight Taylor

9

CO stands for

cervical orthotics

10

TLSO

thoracic lumbar sacral orthotic

11

HALO

  • ~Very heavy CO
  • ~Will drill hole into the skull, 4 bars the come down, will stop all movement of the cervical spine; weight a ton; very restrictive; but people with high level of cervical fractures
  • ~c1,2 fracture
  • ~Will be wearing this for 6-8 normal or 12 weeks for comorbidities (this is how long it takes bone to heal)

12

Minerva

  • ~Prefabricated orthosis
  • ~Has a chest plate; Will have a bar that comes up to the chin
  • ~limits flexion

13

SOMA

  • ~sterno-occipital mandibular immobilizer
  • ~will stop flexion

14

Cervical collar

  • ~Miami J and Philadelphia have a hole in the from so that there can be a trachea; soft collar doesn’t
  • ~The collars are annoy to you and the pt
  • ~Stopping flexion (a little roation and lat flexion)

15

Aspen CTO

the cervical collar with the thoracic extension

16

Jewett

  • ~Has 3 points of contact
  • ~Will allow extension (one point in the back and 2 point of contact in the back
  • ~Good for osteoporosis, compression fracture, forward flexion injury, MVA with lots of force

17

Knight Taylor

Good for posture

*he said don't worry about this one

18

LSO/ SO

~normally not for SCI; more for normal SC repairs

19

Problems when a person has SCI

  • ~respiratory conditions
  • ~decubitus ulcers
  • ~orthostatic hypotension
  • ~LE edema
  • ~DVT
  • ~PE
  • ~apneic bradycardia
  • ~autonomic dysflexia
  • ~thermoregulation
  • ~spasticity UMN lesion
  • ~flaccidity LMN lesion
  • ~pain
  • ~DJD
  • ~UTI
  • ~heterotopic ossification
  • ~contracture
  • ~osteoporosis
  • ~scoliosis/ kyphosis
  • ~GI
  • ~metabolic/ endocrine change

20

SCI- respiratory problems:

  • ~pneumonia
  • ~vent failure
  • ~atelectasis
  • ~C1-C4 vented
  • ~coughing

*can lead to pulmonary emboli

21

SCI- help with respiratory

  • ~need to use accessory muscle
  • ~teach to breath deeply
  • ~Frog breathing
  • ~Sniff breathing
  • ~segmental breathing
  • ~clearing secretions (what we did in shappy's class)
  • ~abdominal binder
  • ~quad cough

22

SCI- quality coughing levels

  • ~functional cough
  • ~weak functional cough
  • ~nonfunctional cough

23

Functional cough

  • ~loud forceful
  • ~2 or more coughs with 1 breath
  • ~independent in respiratory secretion clearance

24

Weak functional cough

  • ~soft, less forceful
  • ~one cough per breath
  • ~independent for clearing throat and small amount of secretion (need help with larger amounts)

25

Nonfunctional cough

  • ~sigh or throat clearing as a sound
  • ~no true cough
  • ~assistance needed for airway clearance

26

Quad cough

they will lift arms up and let their arms fall/ throw as they cough

27

S/S of decubitus ulcer

  • ~Immobility
  • ~lack of sensation
  • ~incontinence
  • ~weight loss

28

how often to SCI pts have skin break down?

60%

29

Decubitus ulcers increases the risk of

infections

30

Treatment/ help prevent decubitus ulcers

  • ~positioning
  • ~specialty wheelchair/ bed
  • ~have a chair that will tilt/ recline so that you can reposition
  • ~keep up with skin checks
  • ~make sure that pt is rotating in bed every 2 hours

31

Treatment for orthostatic hypotension/ LE edema

  • ~wrapping
  • ~tilt table
  • ~ted hose
  • ~abdominal binding

32

What are pts with orthostatic hypotension/ LE edema at risk for?

dehydration

  • ~they don't want to have to go pee (they would have to cath themselves and they don't want to)
  • ~difficult for a person with limited UE or no UE function to drink from a cup (need a straw)

33

DVTs s/s

  • ~the pt can not feel the pain that is normally associated with a DVT (worried most about DVTs in the 1st 3 months)
  • ~redness
  • ~swollen
  • ~warmth

34

DVTs increase the risk of

~stroke

35

ways to help prevent DVTS

  • ~ted hose
  • ~meds

36

SCI: apneic bradycardia (details)

  • ~drop in HR
  • ~don’t know why it happens
  • ~Educate patient and family that this may happen and not to freak out unless it keeps happening after suctioning is complete

37

what is the typical pt for apneic bradycardia?

  • ~typically a vented patient when we go to do deep suction
  • ~some sort of vagal response occurs that lowers heart rate
  • ~Usually returns to normal after suction is completed

38

SCI: thermoregulation

  • ~pt cannot shiver
  • ~normally does not sweat
  • ~much harder for the pt to control body temp
  • ~some can be autonomic (vasodilation/constrict)
  • ~education is BIG here

39

SCI: Spasticity (positives and negatives)

Positive:

  • ~Can use it to move (hit yourself in a certain area)
  • ~can use it for a mechanical advantage
  • ~Learn what causes it then you can learn to avoid it or to use it; what direction it goes into Negatives:
  • ~Contractures
  • ~skin break downs (extensor can dig into the bed with heals)
  • ~scissor spasticity (more in stroke and CP)

40

If there is any motor below the SCI level and no sensory, the ASIA grade would be

at least a C

*B has no motor!

*a C can still have sensory; this was just an ex he used in class

41

SCI: flaccidity (can cause)

  • ~Skin breakdown
  • ~respiratory issue
  • ~joint instability
  • ~could dislocate the joint
  • ~no muscle return
  • ~trunk control is next to none

42

Is spasticity or flaccidity more of a problem normally?

normally flaccidity; you can use spasticity, but not flaccidity to your adv at times

43

SCI: Pain

  • ~Pts will have pain
  • ~may be from injury
  • ~may need to educate on types of pain 1) muscle pain (DOMS is big) 2) radicular pain (nerve root imp, etc) 3) Joint pain (pts may need to get into positions that they need more ROM for)

44

need __ for true hamstring flexibility

110*

don't want them to curve their back- TFL (want to keep it tight!)

45

SCI: DJD

  • ~arms (from transferring in and our of bed/ wheelchair/ toilet/ etc
  • ~spine (where the surgery was and if the person is hypermobile)

46

What's the % of pts with SCI that will have a UTI?

80%

47

SCI: UTI s/s

  • ~not will have urgency or the pain with urinating
  • ~fatigue
  • ~blood in urine,
  • ~fever
  • ~spasticity
  • ~can lead to autonomic dysreflexia

48

SCI: UTI (avoiding!)

  • ~front to back whipping
  • ~make sure that they are as sterile as possible when using a catheter
  • ~wash hand
  • ~keeping up with catheter (don't let the urine stay in too long)

49

Suprapubic catheter

  • ~used more in females
  • ~harder to find the urethra and harder for females to get the cath into the urethra into with little hand function

50

SCI: Heterotopic ossification (what is it)

  • ~Bone showing up where it is not supposed to be
  • ~in the joint (typically hip and sometimes knee)
  • ~we don't know why our body decides to do this to ourselves

51

SCI: Heterotopic ossification (s/s)

  • ~sudden decrease in ROM
  • ~swelling
  • ~fever
  • ~heat
  • ~inflammation

52

SCI: contracture- loose

  • ~hamstrings- want 110*
  • ~ankles- want at least neutral, but hopefully can get to 10* DF (pt will be in a wheel chair so we want them to be able to have their foot be able to get flat so that the pt does not slide out)

53

SCI: contracture- tight

  • ~TFL- need to be tight to be able to sit up easier (also the spine can start to stretch out if the TFL is loose)
  • ~adaptive shortening of the finger flexors (get flexors at C8); this will help with a tendodesis grip (if you have wrist ext at C6)- you can have a very tight grip to be able to grab things/ put in a cath/ etc

54

SCI: Female pts/ pregnancy

  • ~females are typically the same age as typical male patient
  • ~can still become pregnant just as easy as before
  • ~Body changes: have relaxin (relax joint); major body change (weight, can’t fit into wheel chair any more)

55

SCI: osteoporosis

  • ~Not moving around any more
  • ~at a year and a ½ will have 2/3 of the bone mass
  • ~so will have higher risk of fractures

56

SCI: scoliosis/ kyphosis

  • ~They are seated / laying most of the time
  • ~In a flexed posture- kyphosis
  • ~Don’t have any of our posture muscles any more- can cause scoliosis
  • ~Harder for respiratory

57

SCI: GI

  • ~Don’t have the correct movement/ posture for GI (standing is helpful for GI system)
  • ~Have blockage, decrease in hydration, increase risk of autonomic dysreflexia

58

SCI: metabolic/ endocrine changes

  • ~Weight gain
  • ~Hard to burn calories
  • ~hard to get exercise, like to eat when your sad