Week 7: Spinal Cord Trauma Flashcards Preview

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Flashcards in Week 7: Spinal Cord Trauma Deck (57):
1

How to know if pt is coroners case

-less than 24 hours
-pt who just came out of surgery

2

Ideal time frame for doing post mortem care

-1 hour

3

Spinal cord begins and ends?

Spinal cord begins at the foramen magnum in the cranium and ends at the L1-L2 vertebra level

4

Spinal nerves continue until?

continue to the last sacral vertebra

5

Grey matter

voluntary and autonomic motor neurons

6

white matter

ascending and descending motor fibers

7

Posterios column dorsal

touch, proprioception and vibration sense

8

lateral spinothalamic tract

pain, temp sensation

9

lateral pyramidal

voluntary movement

10

-originate in cerebral cortex
-project downward
-result in skeletal muscle movement
-injury: spastic paralysis

upper motor neurons

11

-originates at each vertebral level
-project to specific parts of the body
-results in movement/sensation
-injury=flaccid paralysis

lower motor neurons

12

-skin innervated by sensory spinal nerves

Dermatones

13

Reflex arc

involuntary response to a stimulus without direct input from the brain

14

myotome

muscle group innervated by motor neurons

15

sympathetic response

-fight or flight
-everything centralized into core system of the body
-tachycardia
-dilated bronchi and pupils
*middle portion of spinal column

16

parasympathetic

-constriction of the pupils
-constriction of lungs
-hr slows down
*both at the top and bottom (brainstem and s2-4)

17

etioloy of traumatic SCI

-MVA (motor vehicle accident)most common cause
-falls, violence, sport injury
-SCI typically occurs from indirect injury from vertebral bones compressing cord
-SCI frequently occur with head injuries
-Cord injury may be caused by direct trauma from knives, bullets, etc

18

primary & secondary spinal cord injury

-right when the injury happens, immediate injury to spinal cord
-secondary is physiological response to the trauma: ischemia, hypoxia, hemorrhaging, edema

19

*due to loss of vasomotor tone
-SNS loss results in arasympathetic dominance with vasomotor failure
-loss of SNS innervation causes peripheral pooling and decreased cardiac output
-hypotention and bradycardia
-orthostatic hypotension and poor temperature control (poikilothermic)

neurogenic shock

20

-decreased reflexes and loss of sensation below the level of injury
-motor loss: flaccid paralysis below level injury
-sensory loss: touch, pressure, temperature pain, and proprioception perception below injury
-lasts days to months

spinal shock

21

how do you know spinal shock resolving

Clonus: one of the first signs
-hyperflexia of foot
-test by flexing leg at knee and quickly dorsiflex the foot
-rhythmic oscillations of foot agains hand

22

classification of SCI

mechanism of injury
skeletal neurologic level
completeness (degree) of injury
Mechanism of injury: felxion, hyperextension, compression, felxion/rotation

23

flexion (hyperflexion)

-most common because of natural protection position
-generally cause neck to be unstable because of stretching of the ligaments

24

hyperextention

caused by chin hitting a surface area, such as dashboard or bathtub
-usually causes central cord syndrome symptoms

25

compression

-caused by force from above, as hit on head
-or from below as landing on butt
-usually affects the lumbar region

26

flexion/rotation

-most unstable
-results in tearing of ligamentous structures that normally stabilize the spine
-usually results in serious neurologic deficits

27

skeletal level vs neurologic level

skeletal level: vertebral level where the most damage to the bones

neurologic level: the lowest segment of the spinal cord with normal sensory and motor function on both sides of the body

28

after spinal shock:
-motor deficits:spastic paralysis below level of injury
-sensory: loss of all sensation perception
-autonomic deficits: vasomotor failure and spastic bladder

complete (transection) degree of SCI injury

29

-injury to the center of the cordd by edema and hemorrhage
-motor weakness and sensory loss in all extremities
-upper extremities affected more

incomplete degree of SCI, central cord syndrome

30

-hemisection of cord
-ipsilateral paralysis
-ipsilateral superficial sensation, vibration and proprioception loss
-contralateral loss of pain and temp perception

incomplete classification of SCI, brown-sequard syndrome

31

-injury to anterior cord
-loss of voluntary motor, pain, and temp perception below injury
-retains posterior column funtion (sensations of touch, position, vibration)

incomplete classification of SCI, anterior cord syndrome

32

-least frequent syndrome
-injury to the posterior (dorsal) columns
-loss of proprioception
-pain, temp, sensation, and motor function below the level of the lesion remain intact

incomplete SCI, posterior cord syndrome

33

-clonus medullaris: injury to the sacral cord (conus) and lumbar nerve roots
-cauda equina: injury to the lumbosacral nerve roots
-result: are flexic (flaccid) bladder and bowel, flaccid lower limbs

incomplete SCIs

34

upper motor deficits result in?

spastic paralysis

35

lower motor deficits result in?

flaccid paralysis and muscle atrophy

36

paresis

weakness

37

plegia

paralysis

38

c1-c3 are?

usually fatal
-ventilator dependent
-no bowel/bladder control
-electric wheelchair with chin/mouth

39

loss of phrenic innervation causes?

dependent on ventilator

40

C6 injury

weak grasp
-has shoulder/biceps to transfer/push wheelchair
-considered level of independence

41

T1-6

-full use of upper extremity
-transfer
-drive car with hand controls and do ADL's
-no bowel/bladder control

42

immediate care of spinal injury at scene

-transport with c-collar
-assess abc's
iv for life line
ng to suction
foley

43

solumedrol

-pt started within 4, treated for 24 hours of solumedrol
-within 8 hours, treated for 48 hours
-to decrease edema around spinal cord

44

medications for SCI

-vasopressors to maintain perfusion
-histamine H2 blockers to prevent stress ulcers
-anticoagulants
-stool softeners
-antispasmodics

45

gardner-wells tongs

on weights, versus halo which is put onto the patient with a brace

46

physical exam of spinal injury pt.

-LOC and pupils, may have indirect SCI from head injury
-respiratory status-phrenic nerve (diaphragm) and intercostals, lung sounds
-vital signs
-motor
-sensory
-bowel and bladder function

47

c6, t4, t10

c6: thumb
t4:nipple
t10: naval

48

Nursing problems/interventions

1.impaired mobility
2.impaired gas exchange
3. impaired skin integrity
4. constipation
5. impaired urinary elimination
6.risk for autonomic dysreflexia
7. ineffective coping

49

ROM is done?

every 2 hours

50

how to deal with constipation in SCI

-bowels rely on more bulk than nerve
-stimulate bowels at the same time each day. Best after a meal when normal peristalsis occurs
-individual may progress from Dulcolax suppository to glycerin then to gloved finger for digital stimulation
-assess bowel sounds prior to giving food for the first time-paralytic ileus!

51

goal for residual in bladder scan?

residual <100ml/20% of the bladder capacity

52

urecholine

stimulates bladder contraction

53

risk for autonomic dysreflexia description

-SCI above T6
-Results in loss of normal compensatory mechanisms when sympathetic nervous system is stimulated
-Life threatening-if goes unchecked BP an result in cerebral hemorrhage
-Vasodilation symptoms above SCI
-Vasoconstriction symptoms below SCI
-the cause of SNS stimulation

54

What one lab would you check with regards to skin integrity

-pre-albumin

55

autonomic dysreflexia nursing interventions

-elevate HOB-causes orthostatic hypotention
-indentify cause/alleviate if full bladder/cath, if skin/ remove pressure, if full bowel/ empty, etc
-remove support hose/abdominal binder
-monitor BP- can get >300 S
-Give PRN medication to lower BP
-If above not effective-call physician

56

What is the max amount of urine you can safely empty out the bladder at one time?

800mL

57

ineffective coping/sexuality nursing interventions

-assess readiness/knowledge/their ability
-use proper terminology
-suggestions: empty bladder before sex, withhold fluids and antispasmodics, certain positions may increase spasms, explore new erogenous zones, penile implants
-refer to specially trained counselor