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Most common cause of spinal cord injuries



Nursing issues for spinal cord injuries include

rehab and community care and acute admissions for event and complication


You are in the ED. A patient is brought in due to a spinal cord injury, what are your first actions?

Assess respiratory pattern and airway


Once respiratory pattern and airway is assessed, what is also important to assess?

mental and psychological status, check for autonomic dysreflexia


What are s/s of Autonomic dysreflexia?

HTN, bradycardia, flushed face and neck, dilated pupils, nasal congestion, blurred vision, SWEATING & NAUSEA


Meds commonly given for spinal cord injury include

stool softeners, H2 antagonists or antacids, low-dose anticoagulant therapy, vasopressor drug if hypotensive, corticosteroids, antispasmotic, NSAID or analgesics, and/or antidepressants


How do you prevent and treat autonomic hyperflexia?

prevent fecal impaction, bladder distention, or other triggering stimuli by raise HOB immediately and remove SEQ if pt. experiencing s/s. Straight cath and remove impaction. Give HTN med and then monitor BP.


How often should you do a neuro check on a patient with spinal cord injury?

Check motor and sensory level hourly or as prescribed. Sensory level may be marked on client's skin


Major problems associated with immobility

skin breakdown (pressure sores), muscle atrophy, bone density, UTIs, constipation, respiratory infection, venous stasis (ulcers), and hypercoagulability (DVT & PE)


To prevent contractures and physical impairments, what should the nurse do?

reposition Q 2 h, P-ROM ( teach family too)


What can nurses do to prevent PE/DVT?

low-dose anticoagulation therapy and SEQ/Stockings


What can nurses do to prevent skin breakdown?

Inspect skin, lubricate bony prominences, reposition Q 2 h. apply skin barrier ointment to perineum before irritation starts. Teach family and patient how to prevent pressure ulcers


How can we optimize bowel function/prevent constipation?

offer a high-calorie, high-protein, high-fiber diet as tol. Initial a bowel retraining program (use stool softeners, rectal suppositories with digital stimulation prn after meals)


Outcomes for Impaired physical mobility; self care deficit

Free from complications (pressure ulcers, venous thrombosis, contractures, and fractures) and able to perform basic physical tasks, ADLs with or without assistive devices


What meds would you expect a patient with impaired mobility to be on?

anticoags (long-term= Coumadin), aspirin, muscle relaxants (baclofen), stool softeners, pain meds, antibiotics


Major care needs of immobilized patient?

risk of infection, discomfort, ineffective airway, hyperthermia, fluid deficits, social isolation, muscle atrophy


What will you do if patient develops a pressure ulcer?

change position, maintain dressing, monitor the progress, and appropriate skin treatment


Outcomes for impaired urinary elimination and/or constipation

voids > 150 ml each time, empties bladder completely, no urinary incontinence, no urinary infections (urine culture neg, voids clear & yellow urine), bowel control and ease of stool


Interventions for impaired elimination and/or constipation

foley (intermittent straight cath at regular intervals), bladder training, stimulate voiding (e.g. run water, warm compress to abdomen), drink 2-2.5 L/day, valsalva maneuver, massage, rectal stimulation, manual disimpaction, stool softener


Impaired adjustment, body image, self-esteem Outcomes

set realistic goals, reports feeling useful, verbalizes optimism regarding future, and identifies effective coping strategies


Interventions for impaired adjustment of body image

encourage pt. to discuss perceptions and feelings, answer questions openly and honestly, refer to provider for questions regarding prognosis/recovery, and refer to spiritual advisors, psychiatric personnel, support groups for pt. and family


What health teaching might a person with impaired immobility need?

teaching about mobility, activity, skin care, Ads skills, medication regimen, and sexuality education


Degeneration of substantia negra leads to a decrease in dopamine, a neurotransmitter that helps to control voluntary movements as a neuron impulse inhibitor describes what disease?

Parkinson's Dz? *remember, when you want to do DOPE you have to PARK?


True or False, more dopamine and normal acetylcholine (Ach) leads to more excitation of neurons

False, Less dopamine and normal Ach = more excitation of neurons. Which can also affect SNS and norepinephrine levels (Hypotension)


What is diminished in a patient with Parkinson's Dz?

substantia nigra


Etiology of Parkinson's Dz

Genetic , environment (toxins, agriculture, meds)


What drug constantly causes PD?

thorazine (chlorpromazine)


5 Cardinal signs of Parkinson's Dz

tremor (usually resting), rigidity (or muscle stiffness), akinesia (slow, sometime frozen movements), postural instability, cogwheeling (start and stop)


Other s/s of PD?

micrographia, drooling, constipation, excessive sweating, greasy skin, depression, slowness of thought (bradyphrenia), cognitive problems and dementia possible later


What med is given to a PD patient?

Levodopa- crosses the blood-rain barrier and presumably is converted to dopamine in the brain, which is how symptoms are relieved