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Spinal Cord Flashcards

1
Q

SCI: Top Causes

A

MVC
Falls
Violence (street and veterans)
Sports Injuries

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2
Q

SCI: Level of Injury (Skeletal vs. Neurologic)

A

skeletal level: injury is at the vertebral level, where there is most damage to vertebral bones and ligaments

neurologic level: lowest segment of spinal cord w/ normal sensory and motor function on both sides of the body

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3
Q

SCI: Level of Injury

A

C4 Injury: tetraplegia, results in complete paralysis below the neck

C6 Injury: results in partial paralysis of hands and arms as well as lower body

T6 Injury: paraplegia, results in paralysis below the chest

L1 Injury: Paraplegia, results in paralysis below the waist

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4
Q

SCI: Complete vs. Incomplete

A

complete: total loss of sensory and motor function below the level of injury
incomplete: results in mixed loss of voluntary motor activity and sensation and leaves some tracts intact

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5
Q

Two Functions of Nerves

A
  1. Motor: starts from head down

2. Sensory: starts from feet up

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6
Q

Deficits that can occur w/ Level of Injry

A 
C4: Diaphragm
C5: Elbow flexion
C6: Wrist flexion
C7: Elbow and wrist extension
C8-T1: Fingers
T2-T7: Chest muscles
T9-T12: Abdominal muscles
L1-L5: Leg muscles
S2-S5: Bowel, bladder and sexual fx
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7
Q

Parasthesia

A

numbness

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8
Q

Quad (tetraplegic)

A

paralysis of all four extremities

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9
Q

Quadriparesis

A

numbness of all four extremities

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10
Q

Paraplegic

A

paralysis of lower extremities

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11
Q

Paraparesis

A

numbness of two extremities

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12
Q

Diaphragmatic Breathing

A
  • occurs when intercostal muscles are paralyzed (C4 or above)
  • abnormal in adults and considered using accessory muscles (common in children under 3YO)
  • crucial to re-assess often
  • diaphragm will wear out and pt won’t breath so need to secure airway before they get fatigued and go into respiratory failure

*hypoxia increases cerebral edema!

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13
Q

SCI: Types of Injuries

A

Hyperflexion and Hyperextension Injuries:

  • damage to ligaments, discs, cord
  • accompany coup/contracoup injuries

Compression Injuries:
-shattered vertebrae, disc/cord compression

Rotation Injuries:
-torn ligaments, fractures

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14
Q

Neurogenic Shock

A
  • systemic
  • fx w/ pressure on cord at thoracic level
  • affects sympathetic NS - can’t vasoconstrict > running on PSNS
  • decreased BP and pulse
  • tx: fluids
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15
Q

Spinal Shock

A
  • local: below level of injury
  • decreased reflexes
  • loss of sensation
  • flaccid paralysis below the level of the injury
  • loss of thermoregulation
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16
Q

Dermatomes

A

illustration of the areas where sensory and motor nerves cause loss of sensation or pain (innervation) as a result of nerve root compression

the offending nerve root can often be identified by the distribution (dermatomes) of symptoms

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17
Q

SCI: Primary vs. Secondary Injury

A

primary:

  • immediate effect of the trauma on spinal cord itself
  • flexion, compression, rotation
  • complete or partial transection of spinal cord

secondary:

  • further injury in minutes/hours/days following primary injury
  • ischemia, hypoxia, inflammation, edema (of cord from primary injury)
  • neuro deterioration can occur in the first 8-12 hours
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18
Q

SCI Clinical Manifestations: Motor and Sensory

A

ASIA recommends classification for severity of SCI according to sensory deficits

Sensory regions are called dermatomes

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19
Q

SCI Clinical Manifestations: Respiratory

A

cervical injuries above C4 result in total loss of respiratory muscle function

will require mechanical ventilation for the rest of their life

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20
Q

SCI Clinical Manifestations: Cardiovascular

A

any cord injury above T6 leads to dysfunction of the SNS (neurogenic shock)

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21
Q

SCI Clinical Manifestations: Urinary

A

neurogenic bladder:

  • flaccid or hypotonic
  • or spastic
  • or dyssynergia

urinary incontinence

22
Q

SCI Clinical Manifestations: GI System

A

neurogenic bowel:

  • incontinence
  • or retention
23
Q

SCI Clinical Manifestations: Integumentary

A

risk for skin breakdown over bony prominences

24
Q

SCI Clinical Manifestations: Thermoregulation

A

poikilothermic: adjustment of body temperature to room temperature

decreased ability to sweat or shiver below the level of the injury

25
SCI Clinical Manifestations: Metabolic Needs
monitor Na+ and K+, especially when NGT suction increased nutritional needs d/t increased metabolism
26
SCI Clinical Manifestations: Peripheral Vascular
elevated risk for VTE and DVT > PE b/c they aren't moving, no venous return back to heart, blood pools in legs
27
SCI Clinical Manifestations: Pain
- differs in type and severity following injury - nociceptive pain (phantom pain) - neuropathic pain
28
Stages of SCI
1. Prehospital 2. Acute Care 3. Rehabilitation and Home Care
29
Methylprednisolone
- evidence as to its efficacy to improve neurological outcomes is limited, inconclusive, or conflicting so its use/utility is debated - clinicians concerned about complication of glucocorticoid use, esp. infections - contraindicated w/ a pt who has both SCI and TBI
30
Nursing Management: Respiratory Problems
- respiratory failure is leading cause of death in acute and chronic phases - signs of impending respiratory failure = RR > 30 and/or decreasing vital capacity - prevent atelectasis and pneumonia (deep breathing and incentive spirometer q2hrs)
31
Nursing Management: Hemodynamics
neurogenic shock hypovolemic shock: - may receive IVF but excess fluids can cause further cord swelling and increase damage - careful I&O and electrolyte monitoring - MAP goal: 85-90 - fluids, transfusion, vasopressors as needed Orthostatic or Postural Hypotension: - develops cerebral hypoxia and loss of consciousness if moved too fast - change position slowly - adequate fluids, elastic stockings, tilt table DVTs: - can lead to PEs - heparin/lovenox
32
Nursing Management: Thermoregulation
Poikilothermia - avoid temperature extremes - person w/ a fever may need a cooling blanket
33
Nursing Management: Nutrition
- for the immobilized pt, nutritional needs are greater than one would expect - high calorie, high protein diet to prevent infection, promote wound healing if pt doesn't have gag reflex: - feed via Dobhoff - move to PEG if missing gag reflex becomes permanent if pt gut doesn't work: -TPN people w/ SCIs are 4x more likely to develop diabetes b/c of difficulty w/ glucose metabolism
34
Nursing Management: Mobilization and Skin Care
- big risk for pressure ulcers and foot drop so use splints - risk of flaccidity and/or spasticity d/t can't stand or walk > osteoporosis > fractures - tx for spasticity = ROM and meds (dantrolene, baclofen, tizanidine hydrochloride) PT/OT
35
Alteration in Urinary Elimination
- failure to empty > urinary retention | - failure to store > urinary incontinence
36
Failure to Empty
d/t flaccid bladder or areflexic bladder can lead to UTIs and then renal failure tx: - continuous catheterization early on - intermittent catheterization later (every 3-4 hours)
37
Failure to Store
d/t spastic bladder or reflexic bladder may happen once spinal shock subsides tx: - pads - condom catheters - urinary diversion (such as a urostomy) - meds to suppress bladder contractions (oxybutynin, tolterodine)
38
Neurogenic Bowel
loss of voluntary neurological control over bowel - early stage of SCI: bowel is areflexive (sphincter tone is decreased and pt is constipated) - later stage of SCI: if reflexes return, bowel becomes reflexive as sphincter tone is increased (pt has fecal incontinence)
39
Nursing Management: Alteration in Bowel Elimination
- good hydration and nutrition - stool softeners and fiber - elimination planned for 30 min after breakfast to utilize peristalsis - rectal stimulation and/or suppository may be needed to trigger defecation
40
Sexual Activity and Fertility
males: - fewer erections - tx: ED meds, devices, surgical implants females: - lubrication issue - risk of autonomic dysreflexia
41
SCI: Meds
- methylprednisolone - vasopressors or vasodilators - muscle relaxants/antispasmodics - analgesics - antidepressants - anticoagulatns - stool softeners - laxative suppositories - PPIs
42
Cord Syndromes
3 major cord syndromes Central Cord Syndrome: - paralyzed upper extremities - some motor loss of chest (including diaphragm) Anterior Cord Syndrome: - paralysis from nipple line down - position sense and touch intact in extremities Brown-Sequard Syndrome: - hemiplegic on one side - loss of sensation on opposite side
43
Nelson's Phases of Reintegration
buffering transcending toughening launching
44
Surgical Options for Fx of Vertebrae
fusion: attach metal hardware to the spline to keep alignment laminectomy: removal of a portion of the vertebrae that's damaged and pinching nerves discectomy: removes damaged portion of disk that's compressing nerve root, decompresses nerve root rods: can be inserted to correct curvature of spine
45
Autonomic Dysreflexia
massive uncompensated cardiovascular reaction mediated by SNS occurs in response to visceral stimulation once spinal shock is resolved in pts w/ spinal cord lesions life threatening
46
Autonomic Dysreflexia: Causes
- full bladder - full bowel - local pressure, pressure ulcers - tight clothing - catheterization - labor
47
Autonomic Dysreflexia: S/Sx
- paroxysmal HTN (BP 280/14) - major HA - visual changes (d/t vasoconstriction) - decreased HR - cool/pale below lesion level - vasodilation above lesion
48
Autonomic Dysreflexia: Tx
- raise HOB - legs dangle - tx cause (check catheter, impaction, loosen clothing) - call providder - check BP q2-5min - vasopressors as needed (Nipride, captopril) - stay w/ pt
49
Best Way to Manage Airway
- head tilt/chin lift - modified jaw-thrust/chin lift - tracheostomy
50
SCI: Imaging
- c-spine plain films (before c-collar is removed) - thoracic/lumbar imaging - CT scan - MRI if pt is stable enough

Critical Care (14 decks)

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