Peripheral nerve And Spinal Cord Problems

Question 0

What are clinical manifestations of Trigeminal neuralgia?

Answer 0

Very painful, sharp electric-like spasms that last for a fee seconds of minutes.
Usually only on one side of the face, often around the eye, cheek, and lower part of the face
Pain may be triggered by touch or sounds

Question 1

What Cranial Nerve does Trigeminal Neuralgia effect?

Answer 1

5th CN (sensory & motor)

Question 2

When can pain triggers occur in Trigeminal Neuralgia?

Answer 2

Brushing teeth
Chewing
Drinking
Eating
Shaving

Question 3

What are some treatments for Trigeminal Neuralgia?

Answer 3

Relieve pressure on cranial nerve 5

Temporarily or permanently interrupt CN5

Use a nerve block
This is temporary

Question 4

What are the goals of a patient with Trigeminal Neuralgia

Answer 4

Will be pain free
Will maintain adequate nutrition and oral hygiene
Will have minimal to no anxiety
Will return to normal of previous socialization and occupational activities

Question 5

What is the nursing care for a patient with Trigeminal Neuralgia?

Answer 5

Assess I&O's
Assess hygiene 
Assist patient to manage triggers
If nerve function interrupted:
   Have patient chew on good side
   Monitor food temps (burns)
   Manual removal of pouched foods

Question 6

How do you diagnose Trigeminal neuralgia?

Answer 6

History and Physical examination
CT scan
To rule out other problems
MRI

Question 7

What is the collaborative therapy of Trigeminal Neuralgia?

Answer 7

Drug therapy
   Tegretol is the first choice
Local nerve blocking
Biofeedback
Surgical intervention

Question 8

What is Bell’s Palsy

Answer 8

Acute disruption of cranial nerve 7 (facial nerve)
Inability to move one side of face
Inability to move one eye, blink
Eye becomes dry, painful with excessive tearing
Requires patch for protection

Question 9

What are symptoms of Bell’s Palsy?

Answer 9

Forehead not wrinkled 
Eyeball rolls up
Eyelid does not close
Flat nasolabial fold
Paralysis of lower face

make sure to give them privacy

Question 10

What is the etiology of Bell’s Palsy?

Answer 10

Possible reactivation of herpes vesicles in and around the earl will proceed facial paralysis

Question 11

What is the treatment for Bell’s Palsy?

Answer 11

Corticosteroids
Antivirals
Time-85% Full recovery in 6 months

Moist heat
Gentle massage
Protect eye
Pain relief and social support

Question 12

How do you diagnose Bell’s Palsy?

Answer 12

Blood tests for sarcoidosis or Lyme Disease
MRI - not in all patients
Electromyography (EMG)-confirms the presence of nerve damage
Nerve conduction test

Question 13

What are the patient’s goals with Bell’s Palsy?

Answer 13

Will be pain free
Will not experience any complications
Will maintain optimal intake
Will have minimal side effects from corticosteroids
Will return to previous perception.of body image

Question 14

What are the clinical manifestations of Gullain-Barre’ Syndrome?

Answer 14

Muscle weakness or the loss of muscle function and it effects both sides of the body
Tingling foot or hand pain, clumsiness, increased drooling
Typical symptoms include: loss of reflexes in the arms and legs and muscle weakness or loss of muscle function
May get worse over 24-72 hours
May occur in the nerves of the head only
May start in arms and legs; will move up or down
May have respiratory distress and may need to be an advance airway

Question 15

What is the nursing management for Guillain-Barre’ Syndrome?

Answer 15

Assess- reflexes, respiratory status, watch their gait, push/pull and grips, for skin breakdown turn every 2 hours
Nursing Diagnosis-skin breakdown, risk for aspiration, ineffective breathing, fear
Watch for signs of infection because of foley

Question 16

How do you diagnose Guillain-Barre’ Syndrome?

Answer 16

A loss of reflexes

Look at titers

Question 17

How do you treat Guillain-Barre’ Syndrome?

Answer 17

High doses of sanuloglobbulin will help reduce the length and the extent of the symptoms

Question 18

How do you classify a spinal cord injury?

Answer 18

Mechanisms of injury: hyperextension, flexion, etc.
Level of injury-
Skeletal: vertebral level most damage
Neurologic: lowest level: cervical, thoracic and lumbar
Degree of injury: complete or incomplete

Question 19

What do the cervical spinal nerves control?

Answer 19

Diaphragm
Chest wall muscles
Arms
Shoulders

Question 20

What do the thoracic spinal nerves control?

Answer 20

Upper body

Gastrointestinal function

Question 21

What do the lumbar and sacral spinal nerves control?

Answer 21

Lower body

Bowel & Bladder

Question 22

What happens of the injury is above C-4?

Answer 22

Paralysis of respiratory muscles and all four extremities

The higher the injury the greater the loss of function

Question 23

What kind of paralysis would someone experience base on their injury?

Answer 23

C4 and C6 quad

T6 ANC L1 para

Question 24

What is central cord syndrome?

Answer 24

Damage to central spinal cord Occurs most commonly in cervical cord region More common in older adults Motor weakness and sensory loss are present in both upper and lower extremities The upper extremities are affected more than the lower ones

Question 25

What is anterior cord syndrome?

Answer 25

Caused by damage to the anterior spinal artery Results in compromised blood flow to anterior spinal cord Typically results from injury causing acute compression of anterior portion of spinal cord Often aw flexion injury Manifestations include motor paralysis and loss of pain and temperature sensation below the level of injury Because the posterior cord tracts are not injured, sensation of touch, position, vibration, and motion remain intact

Question 26

What is Brown-Sequard Syndrome?

Answer 26

Result of damage to one half of spinal cord Characterized by loss of motor function and position and vibration sense Vas improve paralysis on the same side as lesion The opposite (contra lateral) side has loss of pain and temperature sensation below the level of the lesion

Question 27

What is Posterior Cord Syndrome?

Answer 27

Results from compression or damage to posterior spinal artery Very rare condition Usually dorsal columns are damaged Results in loss of proprioception Pain, temperature sensation, and motor function below level of lesion remain intact

Question 28

What is Conus Medullaris Syndrome and Caude Equina Syndrome?

Answer 28

Results from damage to very lowest portion of spinal cord (conus) and lumbar and sacral nerve roots (cauda Equina). Injury to these areas produces flaccid paralysis of lower limbs and areflexic (flaccid) bladder and bowel

Question 29

What is the emergency care needed for a spinal chord injury?

Answer 29

Airway Breathing-phrenic nerve at C4 Circulation-prevent hypovolemia Mechanical stabilization of cord

Question 30

What clinical manifestations and complications can occur in a spinal cord injury?

Answer 30

Clinical manifestations-respiratory system Complications correspond with level of injury Below C4 can affect phrenic nerve function and cause respiratory insufficiency Cervical and thoracic injuries--paralysis of abdominal and intercostal muscles

Question 31

What are clinical manifestations having to do with the cardiovascular system in spinal chord injuries

Answer 31

Above T6 decreases influence of sympathetic nervous system Peripheral vasodilitation Relative hypovolemia

Question 32

What are clinical manifestations having to do with the gastrointestinal system I'm spinal cord injuries?

Answer 32

Above T5 - hypomotility Paralytic ileus and gastric distention NGO tube and Reglan to slow emptying Risk for ulcers Stress ulcers common, intraabdominal bleeding may occur Indications of bleeding: continued hypotension, decreased H&H and expanding girth Neurogenic Bowel

Question 33

What are clinical manifestations having to do with the integumentary system in spinal cord injuries?

Answer 33

``` Lack of sensation Potential for skin breakdown Pressure ulcers Sepsis Thermoregulation Decreased ability to sweat and shiver ```

Question 34

What are clinical manifestations having to do with the urinary system in spinal cord surgeries?

Answer 34

Urinary retention Atonic bladder Overdistention Insert an in dwelling catheter until large quantities of IV fluids are no longer required Then begin intermittent catheterization which will help maintain bladder tone and decreases the risk of infection

Question 35

What are complications of spinal cord injuries?

Answer 35

Metabolic needs Alkalosis from auctioning Decreased tissue perfusion may lead to acidosis Nutritional needs Patients need extra protein It prevents skin breakdown and infection and decreases rate of muscle atrophy Peripheral vascular issues DVT or PE More difficult to diagnose DVT because usual symptoms are pain and tenderness

Question 36

What diagnostic studies will you perform to diagnose a spinal cord injury?

Answer 36

CT MRI Complete neurological assessment

Question 37

What collaborative care would you perform with a spinal cord injury?

Answer 37

Non-operative stabilization Surgical therapy Drug therapy Solumedrol-decreases inflammation and motor function and sensation

Question 38

In a nursing Assessment what subjective data would you collect for a spinal cord injury?

Answer 38

``` Past medical history Health perception-health management Activity-exercise Cognitive-perceptual Coping-stress tolerance ```

Question 39

In a nursing assessment what objective data will you collect?

Answer 39

``` General: poikilothermism Integumentary: neurogenic shock Respiratory: lesions at C1-3 Cardiovascular: lesions above T5 GI: decreased or absent bowel sounds Urinary: retention, flaccid bladder ```

Question 40

In a nursing assessment for someone with a spinal cord injury what assessments do you perform?

Answer 40

Test muscle groups with and against gravity Note spontaneous movement Sensory examination Position sense and vibration Assessment involves testing muscle groups rather than individual muscles Ask the patient to move legs and then hands, spread fingers, extend wrists and shrug shoulders A sensory examination including touch and pain as tested by pinprick should be carried out, starting at the toes and working upward Brain injury may have occurred-assess history for: unconsciousness, signs of concussion, increased ICP Musculoskeletal injuries Trauma to internal organs Because there are no muscle, bone, or visceral sensations, the only clue to internal trauma with hemorrhage may be a rapidly falling hematocrit level Examine the urine for hematuria, which is also indicative of internal injuries

Question 41

What are some nursing diagnoses for a person with a spinal cord injury?

Answer 41

``` Depend on the severity of the injury and the level of dysfunction Impaired gas exchange Decreased cardiac output Impaired skin integrity Constipation Impaired urinary elimination Impaired physical mobility Risk for autonomic dysreflexia Ineffective coping Interrupted family process Ask them-why don't you give us your input on your plan of care ```

Question 42

What are goals for patients with a spinal cord injury?

Answer 42

Maintain optimal Neurologic functioning Have minimal or no complications of immobility Learn new skills, gain new knowledge, and acquire new behaviors to be able to care for self or direct others to do so Return to home and community with optimal functioning

Question 43

What are some acute interventions performed by a nurse when it comes to spinal cord injury?

Answer 43

``` Immobilization (cervical traction, sternal-occipital-mandibular immobilization, halo vest) Respiratory dysfunction Cardiovascular instability Fluid and nutritional maintenance Bladder and bowel management ```

Question 44

What are some health promotions performed by a nurse for a patient with a spinal cord injury?

Answer 44

Identify: high-risk populations Counseling Education Support legislation on seat belt use, helmets for motorcyclists/bicyclists, and child safety seats After injury, health-promoting behaviors can have a significant impact on the health and well-being of the individual with a spinal cord injury

Question 45

What are the nursing implementations of neurogenic shock? Acute Interventions Rehabilitation and home care

Answer 45

Temperature control - below site of injury Stress ulcers-physiologic response to severe trauma Sensory deprivation-stimulate patient above level of injury Reflexes-return of reflexes may complicate rehab Autonomic dysreflexia (be concerned) Respiratory rehabilitation Neurogenic bladder, bowel and skin Sexuality-multiple options

Question 46

What is autonomic dysreflexia?

Answer 46

A spinal cord injury at T6 or higher Return of reflexes without sensation causes life threatening hypertension Causes: distended bladder or rectum, skin irritant, stimulation of pain receptors Manifestations include hypertension, blurred vision, throbbing headache (take BP), marked diaphoresis above lesion level, bradycardia Below injury level will be pale, cool and no sweating Nursing Intervention: elevate HOB at 45 degrees or sit upright, notify physician, assess cause, provide immediate catheterization, teach patient and family causes and symptoms

Question 47

What are the reasons why grief occurs in a spinal cord injuries?

Answer 47

``` Loss of control over everyday functions Feeling of uselessness Sexuality Stages of Grief Shock and denial Anger Depression Adjustment ```

Question 48

What are some differences with the older population and spinal cord injuries?

Answer 48

More experience spinal cord injury due to work on the body More complications with longer healing time People are living longer so spinal cord injury is more frequent Issues with bowel and bladder with increase spinal cord injury Health promotion for the older population

Question 49

What is spinal shock?

Answer 49

Initial inflammatory & circulatory effect on the cord 50% of people with spinal cord injury have it Temporary and can last days to months Flaccid paralysis, loss of sensation Last days to months May require rehab

Question 50

What is neurogenic shock?

Answer 50

Loss of vasomotor tone from injury Neurogenic shock allows blood to pool in extremities Pressure down, pulse down