Week 8 - Spinal Cord Injuries Flashcards
(48 cards)
Treatment for autonomic dysreflexia?
Treatment:
-Sitting pt upright
-Monitor VS
*Remove offensive stimuli
-Antihypertensive meds
Treatment: Lower BP (sit patient upright), most important thing we need to do is remove the offensive stimuli (empty bladder)
What do triggers for autonomic dysreflexia do/cause?
Triggers an exasperated vasoconstriction below the level of injury…. Shoots BP up due to vasoconstriction, Bradycardia due to brain telling the heart to slow down!
Complete Vs Incomplete SCI? (what kind of chance does each have for a functional recovery?)
What is a complete SCI?
Total loss of sensory and motor function below level of injury
Very low chance of functional recovery
What is an incomplete SCI?:
Partial preservation of sensory or motor function below level of injury
Potential for some functional recovery
What is a rotational SCI? what causes them/is their MOI?
Definition:
Twisting of the spine
Extreme lateral flexion or twisting of the head and neck
Mechanism of Injury?
T-Boned MVC’s
Blows to the head (boxing/assaults)
What is an incomplete SCI?
-What is the potential for preservation of sensory or motor function/is there a chance for it?
-What can there be?
Incomplete SCI: Partial preservation of sensory or motor function at and below the level of injury!
-There is potential for some functional recovery!
-There can/would be crossover when it comes to partial spinal cord injuries!!
In developing countries what are the main causes of death for SCIs?
Preventable complications are the main cause of death in developing countries
what kind of interventions is needed for Below an L2 – L3 – L4 ?
Below an L2 – L3 – L4 – need different walking aides
S+S for neurogenic shock? (6 main ones)
Signs and Symptoms:
-Loss of sympathetic response
-Peripheral vasodilation below the level of the injury (brain can’t communicate with nervous system below injury)
-Low blood pressure (hypotension)
-Impaired thermoregulation - poikilothermic
-Bradycardia
Skin is going to look bright red and flushed below the level of injury due to the blood pooling in that area
For our primary survey with SCIs what interventions/what do we do during our primary survey? (6 main/different things)
Primary survey:
- C-spine and back board - Don’t want to keep back board on for to long due them causing skin breakdown faster
-Jaw thrust (no head-tilt-chin-lift)
-Caution suctioning (can stimulate vagus nerve)
-High flow O2 (resp muscle impairment)
-Circulatory assessment
-Disability – reassure patient
What is an example of a minor hyperextension injury?
-Whiplash - minor
What medication can we give our patient to avoid hypotension to ensure injury site still gets adequate perfusion?
Atropine can be giving – don’t want patient to become hypotensive because we still need adequate perfusion to the injury site
S+S for spinal shock? (4 of them)
Signs and Symptoms:
Flaccid paralysis
Absence of cutaneous / proprioceptive sensation
Loss of autonomic function
Suppression of reflex activity below the site of injury
Complications for hyperextension injuries?
Complications:
-Stretch or tear of the anterior longitudinal ligaments
-Possible fracture to arch
-Subluxation of the vertebrae (a partial dislocation/a slight misalignment of the vertebrae)
-Rupture of the disks
During our secondary survey for SCIs what can we be doing/assessing? (4 main things)
Secondary survey:
1.) Log-roll patient
2.) Rectal tone
3.) Motor and sensory function (spinal tracts)
Noxious stimuli
4.) Reflex functions
What is autonomic dysreflexia? What system does it impact?
Definition:
-SCI T6 or above
-Uncontrolled, massive sympathetic reflex response to a pain/discomfort stimulus below the level of the lesion (often full bladder/bowel)
-It is considered a medical emergancy!!
-Impacts autonomic system
Treatment for neurogenic shock?
Treatment:
-Prevent cardiovascular instability
-Promote optimal tissue perfusion (treat bradycardia)
-SBP>90 and MAP from 85-90 for the first seven days
-Administer atropine to help restore patient BP
Primary treatment is to help maintain the patients BP so that adequate tissue perfusion of the spine can occur!
For spinal shock what are we as nurses doing?
Ongoing VS/Reflex monitoring
What do we need to understand with SCIs?
Understand that there still can be injuries that are occurring below the injury that the patient might not even be aware of due to their inability to feel below the injury site
Noxious Stimuli
What are soft tissue injuries? what do/can they cause?
Soft Tissue Injuries:
-Muscles, ligaments are stretched
They cause: Edema/microhemmorhages cause pain/spasms/headache
S+S of autonomic dysreflexia? (below and above injury)
Signs and Symptoms:
-Below injury – severe vasoconstriction
-HTN, Bradycardia
-Above injury – vasodilation
-Facial flushing, pounding headache, sweating, anxiety
What is spinal shock? what causes it?
Definition: Transient suppression of reflexes below spinal cord injury. Think “concussion” of spine.
-Transient = They improve over time!!!!! - Can take days, weeks, months and/or years for function to come back
-Only temporary
Cause by: Edema, inflammation, possible bleeding causing temporary ischemia
What kind of SCI is Neurogenic shock?
This is a primary injury due to the body being in shock!
What are 9 different ways we manage SCIs?
1.) Bone Stabilization
-We want to stabilize the bones/spinal cord so we can avoid further injury!
-We stabilize with surgical fixation, traction, and collars
2.) Respiratory Support
-Want to make sure our patients are still breathing and alive
-Do this with ventilators, oxygen, medications, positioning, physio, suction, binders
3.) Cardiovascular Support
-Monitor patients BP
-Have patient wear compression socks to avoid DVTs!
4.) Gastrointestinal Support
-Patient won’t be able to move so a G tube will be inserted to ensure patient
is getting nutrients!
-Administer medications like laxatives to ensure patient doesn’t get
constipated!
5.) Skin Integrity
-Patient will be in bed so ensure you monitor them for pressure sores +
reposition them!
6.) MSK Support
-Monitor patient for contractures and spasticity!
7.) Urinary Retention
-Monitor patient for UTI, foley will most likely be in
place!
8.) Other Medications
-Analgesics, steroids for swelling, etc.
9.) Coping
-This is a new and very scary time for the patient,
patients will require a lot of support with adjusting to
their new reality
What is a traumatic SCI/when does it occur? (definition)
Occurs when an external physical impact, such as that resulting from a motor vehicle collision, fall, or from violence, damages the spinal cord. Varying degrees of motor and/or sensory deficits, or paralysis, may be present.
