T3 - Probs of CNS (Spinal Cord) (Josh) Flashcards Preview

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Flashcards in T3 - Probs of CNS (Spinal Cord) (Josh) Deck (88):
1

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

Pillow under knees

Meds (Acetaminopen and NSAIDs)

Heat

PT

Weight control

C and A Therapies (yoga, etc)

2

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

Percutaneous Lumbar Discectomy

Thermodiscectomy

Laser-assisted Laparoscopic Lumbar Discectomy

3

What are the conventional surgeries for Lumbrosacral Back Pain?

Discectomy

Laminectomy

Spinal Fusion

4

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

5

What are the 5 types of Spinal Cord Injuries?

Hyperflexion

Hyperextension

Axial Loading (Vertical Compression)

Excessive Head Rotation

Penetration

6

Which section of SC are Hyperflexion SC injuries typically seen?

C5 and C6

7

Whiplash is an example of a --- SC injury.

Hyperextension

8

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

Axial Loading (Vertical Compression)

9

What is a Complete SC injury?

total loss of sensory and motor function below level of injury

10

What are the two types of Complete SC injuries?

Tetraplegia (quad)

Paraplegia

11

With Tetraplegia, where is the injury at?

C1-C8 region

12

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

above C3

13

With ---, paralysis is of both legs.

paraplegia

14

Where is the injury with a Paraplegia SC injury?

Thoracolumbar Region (T2-L1)

15

What are Incomplete Spinal Cord Injuries?

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

16

What are the types of Incomplete SC injuries?

Brown-Sequard

Central Cord

Anterior

Posterior

17

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

18

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

19

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

Central Cord Injury

20

Which Incomplete SC Injury:

- Loss of motor function below site of injury

- Loss of pain, temp, and crude sensation

Anterior Injury

21

Anterior Incomplete SC Injuries are associated with which injuries?

Flexion injuries

Acute Herniation of an intervertebral disc

22

Posterior Incomplete SC injuries are associated with which injuries?

Cervical Hyperextension Injuries

23

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

24

What is Spinal Shock?

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

25

How long can Spinal Shock last before sensation returns?

48 hrs to several weeks

26

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

Anal Sphincter

27

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

28

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.

29

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

30

What is HR like with Neurogenic Shock?

low HR

31

What is temp like with Neurogenic Shock?

Poikilothermic

**take on temp of room

32

What is skin like with Neurogenic Shock?

warm and dry

33

Management of Neurogenic Shock

Fluid resuscitation

Vasopressors

Maintain normothermia

Position to avoid orthostasis
- NO trendelenberg
- HOB slowly raised

34

Management goals with SC Injuries?

Prevent UTIs

Scheduled bowel program

Increase fluid intake

Relieve spasms with warm baths, muscle relaxants, antispasmadics

Position changes

35

What beverages can help prevent UTIs?

Cranberry juice

Apple juice

Grape juice

36

What is Autonomic Dysreflexia?

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

37

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

38

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

39

Autonomic Dysreflexia:

Above the injury, the skin will be --

Below the injury, the skin will be --

flushed

pale

40

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

41

Autonomic Dysreflexia:

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

urinary system

42

Autonomic Dysreflexia:

If acute symptoms persist, what should we suspect?

fecal impaction

43

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

44

Risk factors for MS

Virus or Infections agents

Cold climate

Physical injury

Emotional stress

Pregnancy

Overexertion

Temp extremes

Hot shower/bath

45

S/S of MS

Fatigue

Pain or Parasthesia (tingling)

Diplopia

Tinnitus

Dysphagia

Muscle spasticity

Ataxia

Bladder dysfunction

46

Meds for MS

Immunosuppressive agents

Prednisone

Interferon Beta

Carbamazepine

47

What are the immunosuppressive agents for MS?

Azathioprine

Cyclosporine


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

48

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

eye

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

49

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

Lou Gehrig's Disease

50

With ALS, which pathways are affected?

motor pathway

***sensory pathway is NOT affected

51

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

motor

UMN

LMN

52

S/S of ALS

Muscle weakness, wasting, atrophy

Muscle spasticity and hyperreflexia

Fasciculations

Brainstem signs (dysarthria, dysphagia)

Dyspnea, resp paralysis

Fatigue

53

What is cure for ALS?

no known cure

54

Which medication can slow the progression of ALS?

Riluzole

***Hepatotoxic

55

Collaborative care of ALS

PT

Speech Therapy

Occupational Therapy

56

Which disease is marked by RELAPSES and REMISSIONS?

Multiple Sclerosis

57

--- 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.

MS

58

T/F: MS is more common in women.

True

***ages 20-40

59

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

60

Prednison is used for MS.

What are some adverse effects?

Infection

Hypervolemia

Hypokalemia

Hyperglycemia

GI bleeding

Personality changes

61

MS:

How does Interferon B work to treat MS?

prevents and treats relapses

62

With ALS, what is the prognosis?

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

63

ALS:

How well does Riluzole work?

adds 2-3 months to lifespan

64

ALS:

What to remember about Riluzole?

Hepatoxic (no ETOH)

Store away from bright light

Assess for dizziness, vertigo, and somnolence

65

ALS:

What are the Anitspasmadics that can be used for symptoms?

Baclofen

Dantrolene

Diazepam

66

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

67

SCI Urinary Symptoms:

--- --- for initial injury.

--- --- for long term care.

Foley Cath

Intermittent Cath

68

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

69

Autonomic Dysreflexia:

Where will Spinal Cord injury be?

above T5-T6

70

SCI:

When you see low BP, think --- ---

When you see high BP, think --- ---

Neurogenic Shock

Autonomic Dysreflexia

71

SCI:

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

Central Cord Syndrome

72

SCI:

Hematomas are associated with which Spinal Cord injury?

Central Cord

73

SCI:

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

Excessive Head Rotation

74

SCI:

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

Hyperflexion

75

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

76

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

Huntington's Disease

77

Huntington's Disease:

Which neurotransmitter decreases?

Which one increases?

GABA (inhibitor)

Glutamate (excitatory)

***why you have the jerky movements

78

T/F: Huntington's Disease is hereditary.

True

79

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

80

Alzheimers:

What type of diet is helpful?

Dark colored fruits/veggies

Folate

Vit B12, C, and E

81

Parkinsons:

What psychological factors are we assessing for?

depression

anxiety

insomnia

82

Parkinsons:

What type of diet is helpful?

high protien, high calorie

***Monitor for ability to eat

***monitor fluid/food intake

83

Parkinsons:

When should activities be scheduled?

later in day to give them time to get ready

***they are much slower than normal

84

Parkinsons:

What autonomic signs would we see in the physical assessment?

Othostatic hypotension

Flushing

85

Parkinsons:

What type of emotional condition are they likely in?

Labile

Depressed

Paranoid

86

Which type of seizure may experience an aura?

Simple Partial

87

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

cluster

88

3 R's of Migraines

Recognize symptoms

Respond and call health care provider

Relive pain and associated symptoms