T3 - Probs of CNS (Spinal Cord) (Josh) Flashcards by Josh Miller

What are some non-surgical methods of relieving Lumbrosacral Back Pain?

Pillow under knees

Meds (Acetaminopen and NSAIDs)

Heat

Weight control

C and A Therapies (yoga, etc)

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What are the Minimally Invasive Surg options of Lumbrosacral Back Pain?

Percutaneous Lumbar Discectomy

Thermodiscectomy

Laser-assisted Laparoscopic Lumbar Discectomy

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What are the conventional surgeries for Lumbrosacral Back Pain?

Discectomy

Laminectomy

Spinal Fusion

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Post-surgical care for Lumbrosacral Back Pain surgery?

Neuro assessments and vitals

Patient’s ability to void

Pain control

Wound care

CSF check

Positioning/Mobility

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What are the 5 types of Spinal Cord Injuries?

Hyperflexion

Hyperextension

Axial Loading (Vertical Compression)

Excessive Head Rotation

Penetration

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Which section of SC are Hyperflexion SC injuries typically seen?

C5 and C6

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Whiplash is an example of a — SC injury.

Hyperextension

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Jumping head first into shallow water is an example of which SC injury?

Axial Loading (Vertical Compression)

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What is a Complete SC injury?

total loss of sensory and motor function below level of injury

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What are the two types of Complete SC injuries?

Tetraplegia (quad)

Paraplegia

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With Tetraplegia, where is the injury at?

C1-C8 region

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Which section of Spinal Cord will result in paralysis of diaphragm if injured (Christopher Reeve)?

above C3

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With —, paralysis is of both legs.

paraplegia

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Where is the injury with a Paraplegia SC injury?

Thoracolumbar Region (T2-L1)

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What are Incomplete Spinal Cord Injuries?

mixed loss of voluntary motor activity and sensation below level of injury

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What are the types of Incomplete SC injuries?

Brown-Sequard

Central Cord

Posterior

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Which type of Incomplete SC Injury:

Transection/Damage of one side of SC below injury site
Loss of voluntary motor function on SAME SIDE as injury
Loss of pain, temp, and sensation on OPPOSITE SIDE of injury

Brown-Sequard

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Which type of Incomplete SC Injury:

Hematoma formation in central or cervical cord
motor weakenss (more in upper extremities)
Sensor function varies
Varying degrees of bowel and bladder dysfunction

Central Cord Injury

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Which Incomplete SC Injury is associated with Cervical Flexion and Cervical Extension injuries?

Central Cord Injury

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Which Incomplete SC Injury:

Loss of motor function below site of injury
Loss of pain, temp, and crude sensation

Anterior Injury

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Anterior Incomplete SC Injuries are associated with which injuries?

Flexion injuries

Acute Herniation of an intervertebral disc

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Posterior Incomplete SC injuries are associated with which injuries?

Cervical Hyperextension Injuries

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Which Incomplete SC Injury:

Loss of position sense, vibration, and pressure
May lose ability to walk due to loss of position sense
Motor function, pain and temp sensation are INTACT

Posterior

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What is Spinal Shock?

Complication of SCI where you lose complete sensation for a while before it gradually returns

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How long can Spinal Shock last before sensation returns?

48 hrs to several weeks

What is the first reflex to typically return with Spinal Shock?

Anal Sphincter

What is med management for Spinal Shock?

Corticosteroids ***high dose of methylprednisolone IV within 8 hrs used to be done but is controversial b/c of immunosuppression

What is Neurogenic Shock?

complication of SCI Neurogenic shock is a distributive type of shock resulting in low blood pressure, occasionally with a slowed heart rate, that is attributed to the disruption of the autonomic pathways within the spinal cord.

With Neurogenic Shock, what are the blood vessels unable to do? What do you do to treat?

unable to constrict, which leads to decreased SVR, decreased preload, and decreased CO IV fluids

What is HR like with Neurogenic Shock?

low HR

What is temp like with Neurogenic Shock?

Poikilothermic **take on temp of room

What is skin like with Neurogenic Shock?

warm and dry

Management of Neurogenic Shock

Fluid resuscitation Vasopressors Maintain normothermia Position to avoid orthostasis - NO trendelenberg - HOB slowly raised

Management goals with SC Injuries?

Prevent UTIs Scheduled bowel program Increase fluid intake Relieve spasms with warm baths, muscle relaxants, antispasmadics Position changes

What beverages can help prevent UTIs?

Cranberry juice Apple juice Grape juice

What is Autonomic Dysreflexia?

BP in perso with SCI above T5-T6 becomes excesssively high due to overactivity of the Autonomic Nervous System

What causes Autonomic Dysreflexia?

a painful stimulus occurs below the level of spinal cord injury. The stimulus is then mediated through the CNS and PNCS

S/S of Autonomic Dysreflexia

Severe HTN (SBP may be 300) Bradycardia Severe HA with blurred vision Nausea / Restlessness Skin flushed above injury and pale below Distended bladder, bowel

Autonomic Dysreflexia: Above the injury, the skin will be -- Below the injury, the skin will be --

flushed pale

Management for Autonomic Dysreflexia

If supine, immediately site patient up Frequent VS (q 5 mins) Look for instigating causes Loosen clothing and constrictive devices Catheter (check for kinks if one already is in) AntiHTN meds

Autonomic Dysreflexia: When looking for instigating causes, what should we inspect first?

urinary system

Autonomic Dysreflexia: If acute symptoms persist, what should we suspect?

fecal impaction

Patho of MS.

Chronic disease with no known cure that progresses over time marked by relapses and remissions that may or may not return client to their previous baseline level of function

Risk factors for MS

Virus or Infections agents Cold climate Physical injury Emotional stress Pregnancy Overexertion Temp extremes Hot shower/bath

S/S of MS

Fatigue Pain or Parasthesia (tingling) Diplopia Tinnitus Dysphagia Muscle spasticity Ataxia Bladder dysfunction

Meds for MS

Immunosuppressive agents Prednisone Interferon Beta Carbamazepine

What are the immunosuppressive agents for MS?

Azathioprine Cyclosporine ***with both, assess for HTN and Kidney Dysfunction

With MS, we have lots of --- probs.

eye - diplopia - nystagmus - changes in peripheral vision - loss of visual accuity

ALS is aka --- --- ---

Lou Gehrig's Disease

With ALS, which pathways are affected?

motor pathway ***sensory pathway is NOT affected

ALS is a progressive --- neuron disease that affects --- and ---

motor UMN LMN

S/S of ALS

Muscle weakness, wasting, atrophy Muscle spasticity and hyperreflexia Fasciculations Brainstem signs (dysarthria, dysphagia) Dyspnea, resp paralysis Fatigue

What is cure for ALS?

no known cure

Which medication can slow the progression of ALS?

Riluzole ***Hepatotoxic

Collaborative care of ALS

PT Speech Therapy Occupational Therapy

Which disease is marked by RELAPSES and REMISSIONS?

Multiple Sclerosis

--- is an autoimmune disorder characterized by development of plague in white matter of the CNS. This plaque damages the myelin sheath, interfering with impulse transmission b/t the CNS and the body.

T/F: MS is more common in women.

True ***ages 20-40

MS: What should we remember about Azathriprine and Cyclosporine?

Monitor for long-term effects Be alert for infection Assess for HTN Assess for kidney dysfunction

Prednison is used for MS. What are some adverse effects?

Infection Hypervolemia Hypokalemia Hyperglycemia GI bleeding Personality changes

MS: How does Interferon B work to treat MS?

prevents and treats relapses

With ALS, what is the prognosis?

death usually occurs within 3-5 yrs due to respiratory failure

ALS: How well does Riluzole work?

adds 2-3 months to lifespan

ALS: What to remember about Riluzole?

Hepatoxic (no ETOH) Store away from bright light Assess for dizziness, vertigo, and somnolence

ALS: What are the Anitspasmadics that can be used for symptoms?

Baclofen Dantrolene Diazepam

SCI: Why are urinary problems so bad?

they retain urine due to loss of autonomic and reflex bladder control results in overextended bladder (UTI) that can reflux into kidneys

SCI Urinary Symptoms: --- --- for initial injury. --- --- for long term care.

Foley Cath Intermittent Cath

SCI: How can we help with bowel problems?

Scheduled bowel program High fiber food Increase fluids Suppositories and Stool softeners Digital Stimulation for UMN injuries Enemas

Autonomic Dysreflexia: Where will Spinal Cord injury be?

above T5-T6

SCI: When you see low BP, think --- --- When you see high BP, think --- ---

Neurogenic Shock Autonomic Dysreflexia

SCI: When you see that they are weaker in upper extremities than lower extremities, assume it is what type of injury?

Central Cord Syndrome

SCI: Hematomas are associated with which Spinal Cord injury?

Central Cord

SCI: Which type of injury displaces spinal column and may disrupt ligaments, vessels, tissue, bone, and related organs?

Excessive Head Rotation

SCI: Which type of injury results in compression of cord from fractures and rupture/tearing of muscles/ligaments?

Hyperflexion

Lumbrosacral Back Pain: With an Anterior Cervical Discectomy, what is our main concern?

it comes from the front side, so our main concern is MAKING SURE AIRWAY IS NOT COMPROMISED

When you see brisk, jerky (choreoform) movements, think --- ---

Huntington's Disease

Huntington's Disease: Which neurotransmitter decreases? Which one increases?

GABA (inhibitor) Glutamate (excitatory) ***why you have the jerky movements

T/F: Huntington's Disease is hereditary.

True

Definitions: --- is the inability to find words. --- is the inability to use words/objects correctly. --- is the inability to speak/understand --- is the loss of sensory comprehension.

Anomia Apraxia Aphasia Agnosia

Alzheimers: What type of diet is helpful?

Dark colored fruits/veggies Folate Vit B12, C, and E

Parkinsons: What psychological factors are we assessing for?

depression anxiety insomnia

Parkinsons: What type of diet is helpful?

high protien, high calorie ***Monitor for ability to eat ***monitor fluid/food intake

Parkinsons: When should activities be scheduled?

later in day to give them time to get ready ***they are much slower than normal

Parkinsons: What autonomic signs would we see in the physical assessment?

Othostatic hypotension Flushing

Parkinsons: What type of emotional condition are they likely in?

Labile Depressed Paranoid

Which type of seizure may experience an aura?

Simple Partial

Miosis (pinpoint constriction of pupil) is a s/s of --- headaches.

cluster

3 R's of Migraines

Recognize symptoms Respond and call health care provider Relive pain and associated symptoms