Spinal Cord Injury

Question 1

Spinal Shock

Answer 1

Decreased reflexes

Loss of sensation and thermoregulation

flaccid paralysis below injury

Days to weeks

Question 2

Neurogenic shock

Answer 2

Characterized by:

• hypotension
• bradycardia

Loss of Sympathetic Nervous System innervation

• Mega peripheral vasodilation
• Venous pooling
• LOWER cardiac output

Assoc. with T6 or higher injury

Question 3

Flexion Spinal injury

Answer 3

ex. Car accident,
Bent over. upper vertebrae slide forward while lower stay still, ruptures the back of spine

Compressing spinal cord because it is no longer flush

Question 4

Hyperextension spinal injury

Answer 4

Opposite of flexion spinal injury- bend backwards, ruptures front

Question 5

compression fracture spinal injury

Answer 5

Compression crushes vertebrae and forces bony fragments into the spinal canal

Question 6

Flexion rotation spinal injury

Answer 6

Spine twisted, ligaments that hold it in place are ruptured and the cord is compressed.

TWISTY

Question 7

What spinal injury locations are most common?

Answer 7

Cervical and lumbar are the most common due to being popular twisting sites

Question 8

What location of spinal injury causes tetraplegia (quadraplegia)?

Answer 8

Cervical section of spinal cord!

The lower the level, the more function is retained in the arms

Question 9

What spinal damage sites result in paraplegia?

Answer 9

Thoracic, Lumbar, or Sacral

Question 10

What are the degrees of spinal injury

Answer 10

Complete:
-Total loss of sensory and motor function below injury level

Incomplete/partial:

• Mixed loss of voluntary motor and sensation
• Some tracts still intact

Degree of sensory and motor loss depends on level of injury

Question 11

incomplete SCI Central Cord Syndrome

Answer 11

Damage to central spinal cord

Cervical most common

Especially old people

Results in Motor weakness and sensory loss
Lower extremities not usually affected

Dysesthetic (abnormal sensation) burning in upper extremities

Question 12

Cauda Equina Syndrome

Answer 12

Results from damage to cauda equine (Lumbar and sacral nerve roots)

Asymmetrical distal weakness
Asymmetrical severe pain
Flaccid paralysis of lower extremities

Complete loss of sensation between legs and over butt, back of legs

Flaccid bladder and bowel

Question 13

Manifestations of C4 injury (around jaw level)

Answer 13

Tetraplegia, complete paralysis below neck

Question 14

Manifestations of C6 injury (around where trap meets neck)

Answer 14

Partial paralysis of hands, arms, and lower body

Question 15

Manifestations of T6 injury (kind of at mid shoulder blade level)

Answer 15

Paraplegia, paralysis below chest

Question 16

Manifestations of L1 injury (around belly button)

Answer 16

Paraplegia, paralysis below waist

Question 17

ASIA impairment scale

Answer 17

A: Complete, no sensory or motor function between s4 and s5

B: Sensory incomplete- Only sensory (not motor) preserved below neurologic level and includes S4 and 5

C: Motor Incomplete- Motor function at most caudal segments (voluntary anal contraction)

D: Motor incomplete- Everything involved with C, but with at least 1/2+ of muscle functions below the level of injury having a muscle grade 3+

E: Normal

Question 18

Respiratory system manifestations of SCI

Answer 18

Closely r/t level of injury

If above C4- total loss of respiratory function

Below C4: Diaphragmatic breathing leads to respiratory insufficiency

Question 19

Phrenic nerve relation to SCI

Answer 19

Allows for diaphragmatic breathing if below C4

Edema and hemorrhage can further affect phrenic functioning–> respiratory dysfunction

Question 20

Affects of SCI above T6

Answer 20

Leads to nervous system dysfunction, neurogenic shock

• Bradycardia
• Peripheral vasodilation
• Hypotension

Dilated veins can cause hypovolemia and reduce cardiac output

Question 21

What SCI location results in Bradycardia, peripheral vasodilation, and hypotension?

Answer 21

Above T6!

Question 22

Neurogenic bladder

Answer 22

Bladder dysfunction r/t abnormal innervation

Can be
Flacid
Spastic
Dyssynergic (lack coordination between detrusor contraction w/ urethral relaxation)

Can manifest as ugency, frequency, incontinence, inability to void, !!!high bladder pressures resulting urine backing up into kidneys

Question 23

Acute urinary manifestations (SCI)

Answer 23

CAN’T PISS OH NO
Urinary retention

Atonic bladder, overdistended and fails to emtpy
-Need indwelling catheter

Question 24

Postacute phase urinary manifestations (SCI)

Answer 24

Bladder can become hyperirritable
Loss of bladder inhibition from brain

Reflex emptying—>ALWAYS PISSIN AYEE

Question 25

SCI effects on GI

Answer 25

Decreased motor activity-->distention Paralytic ileus--> need NG tube Delayed gastric emptying Excess HCL---> Ulcers Might not be able to relay pain or sensation r/t intraabdominal bleeding--> look for lab values and BP

Question 26

SCI effects on Integumentary

Answer 26

Skin breakdown Poikilothermism (Body becoming equal to room temp due to SNS temp sensations being interrupted) Can't shiver or sweat below level of injury More common with high cervical injury

Question 27

Metabolic Needs SCI

Answer 27

NG suctioning can cause metabolic alkalosis (monitor Na/K) Increased nutritional needs to prevent breakdown and catabolism

Question 28

Preferred method of diagnostic to dx injury (SCI)

Answer 28

CT scan is preferred When CT not available Cervical x rays MRI used for soft tissue injury Cervical injuries +AMS might need CT angiogram to see vertebral artery damage

Question 29

When is spinal immobilization not recommended?

Answer 29

With penetrating trauma--> higher mortality rates`

Question 30

Emergency considerations of SCI

Answer 30

IMMOBILIZE SPINE -Neck brace/collar w/ supportive blocks on backboard KEEP SBP over 90!!! SHOCK SaO2 over 90%

Question 31

Nonoperative stabilization of SCI

Answer 31

Decompression via traction or realignment--> prevents secondary edema Early realignment by closed reduction via craniocervical traction is effective

Question 32

Surgery for SCI

Answer 32

within 24h assoc. w/ improved outcome Fusion (attaching metal pieces to spine to keep aligned) when two or more vertebrae injured.

Question 33

SCI drug therapy

Answer 33

Lovenox to prevent VTE (don't use if bleeding, low kidney function or recent surgery) Vasopressors (Neo-Synephrine, Levophed) maintain MAP over 85-90mmHg Anticholinergic (atropine) if bradycardia symptomatic Be aware of altered drug metabolism--> higher chance for interaction

Question 34

SCI C1--3 respiratory

Answer 34

Apnea | Can't cough

Question 35

SCI C5-T6 respiratory

Answer 35

Decreased respiratory reserved

Question 36

SCI neurologic effects below C8 (complete)

Answer 36

Pos. babinski after spinal shock resolution Hyperactive DTR

Question 37

Halo Ring SCI considerations

Answer 37

Can be attached to vest after pt begins to mobilize again Watch for infection around halo ring insertion sites (cleanse w/ half strength peroxide and NS bid, antibiotic ointment) DON'T USE IF LIGAMENT INSTABILITY--- need surgery

Question 38

Respiratory dysfunction extra points SCI (arterial blood oxygen'/CO2 concentrations, counting)

Answer 38

If they can't count to 10 NEED IMMEDIATE ATTENTION PaO2 over 60mmHg and PaCO2 under 45mmHg are acceptable ranges if uncomplicated tetraplegia Assisted cough: place hands just below xiphoid process and exert pressure timed with pt cough.

Question 39

Combating SCI r/t constipation

Answer 39

Daily rectal stimulant- enema or suppository Inc. fiber Good fluid intake Activity when possible Valsalva maneuver if under T12 Gastrocolic reflex 30mins-1hr helps poop

Question 40

Meds to treat neuropathic pain in SCI

Answer 40

Neurontin or Lyrica

Question 41

How often to reposition patient SCI

Answer 41

every 2 hours in bed Every 15-20 mins in chair

Question 42

Autonomic dysreflexia aka hyperreflexia (SCI)

Answer 42

Huge cardiovascular reaction uncompensated - Reflex arteriolar vasoconstriction--->BP inc. - Parasympathetic cant vasodilate due to injury - Heart senses HTN and slows HR--> bradycardia - T6 or higher ``` Can lead to status epilepticus, stroke, MI,death Manifestations: HTN (SBP up to 300!) Bradycardia (30-40bpm) Diaphoresis above injury Throbbing headache Piloerections (hairs standing up, goosebumps) Blurerd spots in visual field Congestion Anxiety Nausea ```

Question 43

Most common precipitating cause of Autonomic Dysreflexia (SCI)

Answer 43

Distended bladder or rectum

Question 44

Autonomic dysreflexia nursing interventions (SCI)

Answer 44

``` Elevate head Notify HC provider Immediate catheterization Remove stool impaction if there Remove constrictive clothing Monitor BP frequently ```

Question 45

Drugs for Neurogenic bladder (SCI)

Answer 45

Anticholinergic drugs: Ditropan, Detrol Alpha adrenergic blockers: Hytrin, Cardura Antispasmodic drugs: Lioresal