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Flashcards in Spinal Cord Injury Deck (42)
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1
Q

What are common traumatic causes of spinal cord injury?

A

motor vehicle accidents, falls (31% of all SCIs), violence, sports accidents

2
Q

What are common nontraumatic causes of spinal cord injury?

A

Diseases like cancer and MS, congenital disorders like spina bifida

3
Q

What are the two most significant physical impairments of spinal cord injury?

A

Mobility loss, sensory loss

4
Q

What are important areas of significance to remember about spinal cord injury?

A

psychological impact, financial burden, quality of life, resource intensive care

5
Q

What does primary injury refer to with spinal cord injury?

A

The initial trauma / damage

6
Q

What does secondary injury refer to with spinal cord injury?

A

Damage that occurs after initial injury

7
Q

What are some examples of secondary spinal cord injury?

A

Ischemia, hypoxia, edema -> compression, hemorrhage of spinal cord blood flow

8
Q

Above what level does spinal cord injury turn from paraplegia to tetraplegia / quadraplegia?

A

T1 and above

9
Q

What are the four classifications of mechanism of spinal cord injury?

A

Flexion, hyperextension, compression, flexion rotation

10
Q

What are the two classifications of level of spinal cord injury? (level = “at what level of anatomy”)

A

Skeletal and neurologic

11
Q

What are the two classifications of degree of spinal cord injury?

A

Complete and incomplete

12
Q

What is the difference in effects between complete and incomplete spinal cord injury?

A

Complete results in total loss of sensory and motor function. Incomplete results in mixed and varying levels of loss of sensory and motor function.

13
Q

What nerve function can allow quadriplegics to be ventilator-independent?

A

Phrenic nerve

14
Q

What is the difference between upper and lower motor neurons?

A

UMNs reside in the brain and axons descend into the spinal cord. LMNs reside in the spinal cord and axons descend into muscle fibers.

15
Q

Which kind of paralysis does upper motor neuron injury result in?

A

Spastic paralysis

16
Q

What kind of paralysis does lower motor neuron injury result in?

A

Flaccid paralysis

17
Q

Describe central cord syndrome

A

Damage to central region of cervical SC, usually caused by hyperextension injury. Results in motor weakness, sensory loss, and burning pain in upper extremities.

18
Q

What is hematomyelia?

A

Focal hemorrhage in the spinal cord, usually a result of cord destruction

19
Q

What is a cord contusion?

A

Injury to the spinal cord that does not destroy axons. Function will gradually return as the contusion heals.

20
Q

What is treatment like for central cord syndrome?

A

Strict bed rest with cervical collar in place for 4 to 6 weeks.

21
Q

Describe anterior cord syndrome

A

Damage to the anterior SC (handles motor movement, pain, and temp sensation) without damage to the posterior SC (sense of touch, vibration, and motion unaffected). Often caused by flexion injuries.

22
Q

Which of the four cord syndrome types has the poorest prognosis?

A

Anterior cord, only 10-20% recover functional motor control.

23
Q

Describe Brown-Sequard Syndrome

A

Spinal cord hemisection, usually from penetrating trauma.

24
Q

Describe the presentation of Brown-Sequard Syndrome

A

On the ipsilateral (same) side, weakness and paralysis, loss of vibration and proprioception.

On the contralateral (opposite) side, loss of pain & temp sensation.

25
Q

What spinal cord syndrome has the best prognosis?

A

Brown-Sequard Syndrome, with 90% regaining ability to walk independently.

26
Q

Describe cauda equina syndrome

A

Compression of nerves at the lowest areas of the spinal cord, causing lower extremity motor & sensory loss, incontinence. Requires emergency decompression.

27
Q

Describe neurogenic shock

A

Loss of sympathetic and vasomotor tone, lasting 1-3 weeks after initial injury. Most common in injuries above T6.

28
Q

What are the symptoms of neurogenic shock?

A

Hypotension due to massive vasodilation

Bradycardia due to unchecked parasympathetic stimulation

Hypothermia with warm, dry skin due to loss of sympathetic tone

29
Q

Describe spinal shock

A

Nervous system signaling is impeded, usually be cord edema, resulting in loss of reflex response, sensation, and a flaccid paralysis.

30
Q

What life-threatening condition can spinal shock cause due to independent operation of sympathetic nerves below an SCI?

A

Autonomic dysrefelxia

31
Q

Describe autonomic dysreflexia

A

After a SCI at of above T6, stimulation of lower nerves can cause an over-reaction of the sympathetic nervous system.

32
Q

What are the symptoms of autonomic dysreflexia?

A

Severe hypertension, bradycardia, headache, nausea, sweating above injury level, spasiticity, anxiety, piloerection

33
Q

Describe treatment for autonomic dysreflexia

A

HOB elevated to lower blood pressure, benzos to reduce spasticity, BP meds, identify source of noxious stimulus and eliminate it. Check elimination needs, pain, constriction, infection

34
Q

What are some important nursing interventions for a patient with autonomic dysreflexia?

A

Enforce a bowel care regimen, frequently assess skin, edu re: recognizing symptoms

35
Q

What medications would you expect to be ordered for a patient with a new SCI?

A

High dose corticosteroids, particularly methylprednisolone.

VTE prophylaxis w/ LMWH

Vasopressors to maintain blood pressure in neurogenic shock

36
Q

At what level does a spinal cord injury require are ventilator?

A

C3 and above

37
Q

What nerve enervates the diaphragm?

A

Phrenic nerve

38
Q

Injuries above T6 have significant effect on what critical body system? What is the significance of this?

A

Cardiovascular system. Reduces heart rate and contractility, increasing risk for hypovolemia and DVT.

39
Q

Describe neurogenic bladder

A

Bladder dysfunction related to abnormal or absent bladder innervation. Can result in incontinence and urine reflux

40
Q

Describe neurogenic bowel

A

Loss of voluntary bowel function. Results in stool retention (constipation) and incontinence.

41
Q

What body system can SCI above T5 affect? What is a notable complication?

A

Gastrointestinal system. Impaired peristalsis and delayed gastric emptying.

42
Q

What is an autonomic concern with higher level SCI?

A

Thermoregulation.