Spinal cord injury Flashcards by Brina Quintanilla Reyes

This following flashcard deck is going to discuss about spinal cord injury and will follow the recording that was taken in lecture class

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When a patient has a spinal cord injury, one of the biggest thing to know is that a patient clinical manifestation will depend on what?

where in the spinal cord the injury occurred

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She has this spinal cord injury and body system powerpoint, so the following flashcards are going to address those concerns

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spinal cord injury
respiratory system

anything above c3
what happens to your respiratory

anything between c3-c5
what happens to your respiratory

below c5
what happens to your respiratory

total loss of function, need immediate intubation

severe insufficiency, needs intubation

risk for aspiration, atelectatsis, pneumonia due to paralysis of abdominal muscles
hypoventilation and impaired intercostal muscles lead to decreased vital capacity and till volume
traumatic injury (lung contusion) causing comprised function
fluid overload or increase SNS activity at the time of injury can cause pulmonary edema

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what is our main goal in helping patients with the respiratory system with spinal cord injury?

maintain oxygen higher than 92% in order to reduce hypoxemia that causes bradycardia that can worsen secondary injury

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what is going to happen in cardiovascular? (2)

neurogenic shock
hemorrhagic shock

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how does neurogenic shock and hemorrhagic shock occur ?

neurogenic shock at t6 or above injury

other injuries and further decreased blood pressure

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remember neurogenic shock will cause the blood pressure to go what?

so what do we want to assess ?

down

any and all causes of hypotension

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in hemorrhagic shock tachycardia may not be present in patients who take beta blockers, are young and healthy and are older adults

however in neurogenic shock, its more than likely we are going to see

bradycardia !

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what is going to happen to our patients with spinal cord injuries with their peripheral vascular ?

they have an increase risk of venous thromboembolism (vte)

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why is VTE a common thing to occur with patients with spinal cord injury?

due to hypercoagualbility,venous status, and venous endothelia injury.

immobilization leading to venous statuses and thrombi in lower extremities

DVT can be very hard to detect and no pain or tenderness are usually present since remember, they end up getting paralysis

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what is happening in the urinary system with a patient with a spinal cord injury?

urinary dysfunction occurs to patients due to the loss of autonomic and reflex control of bladder and sphincter

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patients with spinal cord injuries end up getting a neurogenic bladder, which is ?

bladder dysfunction related to abnormal or absent bladder innervation

( impaired transmission between bladder muscles and micturition center in the brain )

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in GU you can two types of bladder conditions with spinal cord injuries patients, which are?

and describe the two

flaccid
- hypotonic muscles causing bladder distention - can lead to bladder rupture

( meaning you can fill up bladder and not feel it, then pee all over yourself (rupture))

spastic muscles causing incontincene
- meaning you can not control when you pee, like your bladder thinks you need to pee all the time

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at what spinal cord number can you get a spastic bladder?

above t12

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spastic bladder can cause lack of coordination between muscles (dyssynerga) leading to what ?

reflux into the kidneys

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what is happening in the GI system with patients with spinal cord injuries ?

delayed gastric emptying
constipation/impaction/
incontinence

intraabdominal bleeding

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within the first 24-48 hours, what is our main concern when GI system ?

paralytic ileus

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so within the first 24-48 hours in the GI system our main concern is a paralytic ileus, what should we do as nurses ?

NG tube for decompression and NPO

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what is our main concern when it comes to talking about the skin system for patients with spinal cord injuries ?

pressure injury
- skin breakdown due to inability to move

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what does pressure injury make patients at risk for when talking about skin for the spinal cord injury patients?
(2, they go hand and hand with each other )

infection - open wound
sepsis - infection enters the open wound and causes an systemic inflammation

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what is our main concern with patients who have spinal cord injuries when we are talking about thermoregulation system ?

poikilothermia : the inability to maintain a constant core temperature due to malfunction of SNS

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its important to note that patient who develop poikilothermia are usually those with a higher cervical injury number, but this also puts the ability for patients to not be able to do what to two things ?

sweat or shiver below the injury level

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what is our concern for patient who have spinal cord injuries when we are talking about metabolic system for them?

increase metabolism and increased protein breakdown

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with an increase in metabolism and increase protein breakdown, what does that put our patient at risk for ?

lean body mass, muscle atrophy, weight loss, and stress

how can we prevent metabolic increases in our patients with spinal cord injuries ?

start early feeding to prevent skin breakdown, reduce infection and decrease muscle atrophy

its important to note that a patient pain is also apart of the system. Reason why is because pain can vary due to the type and severity. patient can have nociceptive pain which is ? patient can have neuropathic pain which is ? this can continue for years even after recovery from the injury by the way!

musculoskeletal pain ; dull or aching, starts or worsens with movement damaged to cord or nerves, located at or below level of injury, hot burning, sensitive to stimuli and pain from light touch

now onto back of the video recording flashcards, just remember the other flashcards were things we still need to know but gives a great overview on each system and how a spinal cord injury can affect the body

what is the most common cause of spinal cord injuries?

trauma ( 38% cars and 30.5% falls)

there are two types of injuries when it comes to talking about spinal cord injury. what is primary mean? what is secondary mean ?

the direct cause swelling, symptoms, complications leading to spinal cord injury

direct physical trauma to the spinal cord can be what ?

blunt, penetrating

spinal cord compression can be by what 3 things ?

bone displacement interruption of blood supply traction from pulling on cord

its important to note that with spinal cord injury, it can cause progressive damage, which we as nurses will try to do what to prevent it?

stabilize the spine, neck and head

what are 3 examples of secondary injury ?

edema ishecmia inflammation

how does edema cause a secondary injury to the spine ?

within 24 hours the edema will increase and put pressure on the spine and cause permanent damage

how does ischemia cause a secondary injury to the spine ?

lack of blood supply can lead to vasospasm in the spine causing damage

how does inflammation cause a secondary injury to the spine ?

leads to glial scar formation which restricts regeneration of the cord leading to permanent nerve and neural deficit damage

when it comes to spinal cord we are going to talk about two important types of shock, which are ?

spinal shock neurogenic shock

when does spinal shock occur?

shortly after injury and last days to weeks

what is spinal shock characterized by ? (3)

loss of deep tendon reflexes loss of sensation flaccid paralysis below the level of injury(no tone)

how does spinal shock occur?

spinal cord is responding to the injury and it stops working because of the edema, damage, inflammation, ischemia

is spinal shock a protective mechanism ? why is it and what is it protecting us from? can this be resolved, if yes, how?

yes protect nervous system from further injury it can be with recovery

Remember, spinal shock happens directly after the injury and our body shuts down. no deep tendon reflexes, loss of sensation, flaccid paralysis ( no muscle tone ) as a protective mechanism for us. and usually this will end up going away with recovery, however what is the issue behind this ?

right off the bat, we can not tell what neuro deficts they have because of the spinal shock so we have to wait for it resolve before we know exactly what's going on

where does neurogenic shock occur in? (cervical number) how long can it last?

in cervical or high thoracic (at or above t6) injury 1-3 weeks

neurogenic shock is characterized by what 3 things?

hypotension (less than 90) bradycardia temperature dysregulation

neurogenic shock is a loss of sis innervation causing what? that answer meaning^

unopposed paraysmpathic response - venous pooling - decreased cardiac output - peripheral vasodilation

t6 or above we can see what type of shock? t12 or lumbar injury are they are going have neurogenic shock?

neurogenic shock we are not going to see that there

since patients with neurogenic shock can not regulate their temperature, what temperature do you think they will end up being at?

room temp

how do we classify a spinal cord injury ? (3)

mechanism of injury (how) level of injury (where) degree of injury ( how bad )

what are some examples of mechanisms of injury patients can do to get an injury ?

flexion ( strong forward crash ) hyperextension ( banging head on table) compression fracture ( diving into shallow pool ) flexion rotation - most unstable due to ligament tearing like falling from a horse

when talking about the level of injury, we talk about two things, which are?

skeletal level neurologic level

what is skeletal level? what is neurologic level?

which vertebra is around the spinal cord is injured (physical damage occur) ( broken ) these are the neurologic symptoms they exhibit ( nerve damage occurred )

C1-T1 is called what? below t2 is what?

tetraplegia ( quadriplegia ) ( all 4 extremities ) paraplegia ( can't use legs )

she said to look at the picture in the powerpoint, this is the skeletal picture talking about the levels of paralysis a patient with a spinal cord injury will exhibit, so your job is to talk about what is happening at each level. c4 injury c6 injury t6 injury l1 injury

tetraplegia, complete paralysis below the neck results in partial paralysis of the hands and arms and lower body paraplegia, results in paralysis below the chest paraplegia, results in paralysis below the waist

when we are talking about the degree of injury we are talking about 2 things which are?

complete incomplete ( partial )

what is a complete degree of injury ?

total loss of sensory and motor function below level of injury

what is incomplete (partial) degree of injury ?

mixed loss of voluntary motor activity and sensation

what is the scale we use to assess the clinical manifestation for a patient with spinal cord injury ? which helps us to?

American spinal injury association impairment scale (ASIA) - classifies severity of impairment - combines assessment of motor and sensory function to determine neurologic level and completeness of injury

clinical manifestations are a direct results of trauma that causes what 4 things ?

cord compression ischemia edama possible cord transection

what is a dermatome? provide example

sensory region of skin corresponding to each spinal cord segment spinal cord injury, move fingers thumb issues - higher c6 injury

what are some diagnostic studies for spinal cord injuries?

cervical x-rays ct scan mri ct angiogram

what is the emergency management for patients with spinal cord injuries ?

patent airway, adequate respiration adminiser oxygen maintain systolic blood pressure iv access - 2 bore ivs monitor for neurogenic shock stablize cervcial spine assess for other injuries control external bleeding obtain appropriate imaging secure airways keep warm obtain brief history

we are going to need to roll the patient, how are we going to move them ?

log roll them

when you are concern with a patient for motor function, make sure you are doing what?

bilateral !!! not one arm first then the other arm, do it both!

how are we going to assess for sensory for patients with spinal cord injuries?

pinprick position sense and vibration

inter professional care acute care notes brain injury and vertebral artery injury - history of unconsciousness - signs of concussion musculoskeletal injuries trauma to internal organs - hemorrhage : decreased blood pressure, increased pulse - hematuria move the patient in alignment as a unit (logroll) monitor respiratory, cardiac, urinary, gi functions prepare for transfer to surgery or icu

Stabilization of injured spinal segment and decompression - Traction or realignment - Eliminates damaging motion - Prevent secondary damage Early realignment of unstable fracture-dislocation - Closed reduction through craniocervical traction Used following acute SCI to manage instability and decompress the spinal cord - Reduces secondary injury and improves outcomes Surgery within 24 hours of injury is recommended for central cord syndrome and adults with any SCI

we use to treat patients with high dose of what _____but we dont use it anymore

corticosteroids examples like methylprednisolone

remember patients with spinal cord injuries can not move their legs, so they are at risk for? and we need to treat with what ?

VTE, DVT, blood clot heparin

remember what type of motion are we going to do for patients with spinal cord injuries? and why?

passive range of motion because remember they are paralysis!!

why night we need to use vasopressors agents to maintain the mean arterial pressure 85-90?

neurogenic shock - they are hypotensive ! we may need to give vasopressor

what are some examples of vasopressors ?

phenylephrine, norepinephrine

nursing assessment notes Subjective data Health history, functional health patterns, coping Objective data - Poikilothermism - Warm, dry skin below level of injury intially (neurogenic shock) - Respiratory-Consider level of injury, Bradycardia, hypotension Decreased or absent bowel sounds Abdominal distention Constipation, incontinence, impaction

Urinary retention, flaccid, spasticity Priapism, altered sexual function Neurologic Complete: areflexic, paralysis, hyperactive deep tendon reflexes, positive Babinski Incomplete: mixed loss of motor and sensory functions Muscle atony, contractures Pain Possible diagnostic findings

nursing diagnoses notes - Impaired breathing - Impaired nutritional status -Ineffective tissue perfusion - Impaired tissue integrity - Impaired urinary system function - Constipation - Difficulty coping

nursing planning notes Overall goals - Maintain optimal level of neurologic functioning - Have minimal to no complications of immobility - Learn new skills, gain new knowledge, and acquire new behaviors to care for self or direct others to do so - Return to home at optimum level of functioning

nursing implementation health promotion notes Identify high-risk populations and provide teaching Support legislation to: - Prohibit texting while driving - Mandate use of seat belts in cars - Mandate helmets for motorcyclists/ bicyclists - Mandate child safety seats - Promote programs for older adults to prevent accidental death and injury - Recommend tougher penalties for impaired driving

Health promoting behaviors after SCI impact general health and well-being - Teaching and counseling - Referring to programs - Performing routine physical exams - Facilitate wheelchair-accessible exam rooms, adjustable height tables, and extra time for appointments

the higher you have a spinal cord injury, the more severe complications are going to be for patients. so we always want to maintain a neutral neck position - keep the body in correct alignment - logroll to prevent movement of spine closed reduction with skeletal traction for realignemt - maintain traction at all times surgical : cervical fusion or other stabilization procedure

typically when patients have a high spinal cord injury we are going to put them in this what ?

halo vest

what is the function of the halo vest? main concern with

stabilize the neck pins in the skull it attaches to infection

how do we take care of the pins ?

clean with cholrhexidine twice a day apply antibiotic ointment

if a patient has a lower spinal injury, we can put them in braces as well, only down side of this compared to the vest is that movement, like flexion, extension and rotation is very limited. there are beds, that can move you to help prevent pressure injuries and aid with circulation , fluid mobilize so we can prevent respiratory issues

remember when a patient is having spinal shock, they are going to have no reflexes, however after the resolution of spinal shock, what will they have?

hyper active, exaggerated responses with no control - muscle spams (men will have penile erections)

its very sad to think and tell a patent, after your spinal shock reflexes, having none, has gone away and now your spinal shock has resolved, to where you have so much movement, you think youre doing better, you have to tell them what?

it does not mean mobility is returning back

how can we help a patient with hyper-reflexes? like what drug and injection ? (2)

antispasmodic drugs botuslim toxin injection

autonomic dysreflexia is a what?

life threatening situation in where your t6 or below has a hyper stimulation of your nervous system

what is the biggest cause of autonomic dysreflexia ? (4)

restrictive clothing full bladder/urinary tract infection pressure areas fecal impaction

what are clinical manifestations of autonomic dysreflexia ?(6) vasodilation above the level of injury

high blood pressure flushed face headache distended neck veins decrease heart rate increase sweating

what are clinical manifestations of vasoconstriction below level of injury for patient with autonomic dysreflexia? (3)

pale Cool no sweating

if autonomic dysreflexia is not resolved, it can lead to what?

status epilepticus stroke myocardial infarction death

what is the first thing we are going to do if we suspect a patient to be having autonomic dysreflexia?

elevate the head of the bed 45, sit them up!!

after we sit them up, what are we going to assess or how are we going remove the cause for autonomic dysreflexia? (3) think of the causes of autonomic dysreflexia In the first place

immediate catheriation - for the full blader remove stool impaction remove constrictive clothing/tight shoes

after someone is discharged from the hospital, we are can send them home or rehab. Complex rehabilitation Physical and psychological care and intensive and specialized rehabilitation lead to function at highest level of wellness Interprofessional team effort Problems from acute injury become chronic and last throughout life Rehabilitation focuses on retraining physiologic processes and management of changes Organized around patient’s goals and needs

Patient expected to be involved in therapies and learn self-care Progress can be slow Can be very stressful Nurses provide frequent encouragement, specialized care, patient and caregiver education; and help coordinate efforts of team

respiratory rehabilitation notes Patients with mechanical ventilation need: Round-the-clock caregiver Respiratory hygiene Tracheostomy care Education (include caregiver) Improved function possible with nerve stimulator If removed from the ventilator, tracheostomy downsizing will take place in rehab Teach: - Assisted coughing, Incentive spirometry - Breathing exercises, Limit exposure to sick people - Swallowing precautions ad diet recommendations to reduce aspiration

notes neurogenic bladder Comprehensive program needed to manage bladder function Goal is to improve quality of life and safety by: - Preserving renal function - Minimizing UTIs and bladder stones - Developing a plan for incontinence Management Patient and caregiver teaching for successful self-management - Where to obtain supplies for selected management technique - When to seek health care - Bladder retraining - Fluid schedule - Indwelling urinary catheter-needs 3-4 L of fluid daily Factors to consider - Patient preference, upper extremity function, and caregiver availability

what are some drainage methods for neurogenic bladder?

bladder reflex retraining catherters urinary diversion surgery

what type of diet for bowel moment for spinal cord injuries ?

high fiber to help with constipation

Voluntary control may be lost Patient and Caregiver Teaching High-fiber diet Adequate fluid intake Timing, position, activity Drug treatment Suppositories Small-volume enemas Digital stimulation Valsalva maneuver International Spinal Cord Injury Bowel Function Data Set

spasticity can be both beneficial and undesirable Aids with mobility Improves circulation Difficult positioning and mobility from spasms Treatment ROM exercises Antispasmodic drugs Botulinum toxin injections

skin care notes Prevention of PI essential for life-long treatment plan Patient and caregiver teaching Comprehensive daily exam to monitor skin condition Teach to reposition At least every 2 hours while in bed Every 15 to 20 minutes when in a chair Pressure-relieving cushion, mattress, pillows Adequate nutrition Standard wound care procedures

pain management notes Acute pain - Initial injury pain persists for few weeks of rehabilitation Chronic pain -May be result of overuse of muscles -Sleep may be disrupted Assess, evaluate, and treat routinely Analgesics Massage and repositioning Refer to pain management specialist

sexuality notes Important issue regardless of patient’s age or gender Nurse or rehabilitation specialist must: Provide support for patient and partner Discuss alternatives for sexual satisfaction

grief and depression Depression common and disabling Overwhelming sense of loss Loss of control Grief Response Shock and denial Anger Depression Adjustment and acceptance Provide Support Allow mourning while encouraging hope Goal of recovery: adjustment more than acceptance Sympathy not helpful Encourage patient participation Consistency of care Psychiatric consult if needed Drugs and therapy Caregiver and family counseling Support group

Expected outcomes Adequate ventilation with no signs of respiratory distress Adequate circulation and BP Intact skin Adequate nutrition Bowel management Bladder management No autonomic dysreflexia

gerontologic considerations Increased incidence Falls are leading cause of SCI at age 65 and older Increased complications Hospitalized linger Increased mortality rates Health promotion and screening Rehabilitation lengthened

Spinal cord injury Flashcards

(107 cards)