2.8 Musculoskeletal Flashcards
Anesthesia
Anesthesia:
Absence of sensation, loss of pain and reflex
Paresthesia
Paresthesia:
Altered sensation, prickling, burning, tingling
Hyperesthesia
Hyperesthesia:
Increased sensitivity to stimulation
Ipsilateral
Ipsilateral:
Same side of body
Contralateral
Contralateral:
Opposite side of body
-plegia
-plegia:
Complete paralysis
-paresis
-paresis:
Partial paralysis, weakening
Tetra-
Tetra-:
Four limbs, quadriplegia
Hemi-
Hemi-:
One side of body
Para-
Para-:
Two limbs, paraplegia
Upper and lower motor neuron deficits comparison
Upper motor deficits:
Responsible for voluntary movement
Disruption leads to spastic paralysis and hyperreflexia
May have trouble carrying out skilled movement
May have a +Babinski reflex
Spastic bladder possible
May require bowel training
Lower motor deficits:
Responsible for skeletal muscle innervation and contraction
Muscles may be flaccid leading to atrophy
Loss of both voluntary and involuntary movement
Atonic (no sensation of voiding needs) bladder and bowel
Spinal cord injuries
CONCUSSION
Momentary disruption in the brain function due to immediate and brief LOC
Temporary axonal disturbance with amnesia common
Other symptoms may include HA, drowsy, confusion, visual disturbances, N/V
Spinal cord injuries
CONTUSION
A bruise on the surface of the brain or spinal cord (often due to the striking onto a bony prominence)
Coup-contrecoup (hyperflexion and hyperextension) is common
May result in edema and ICP
Spinal cord injuries
COMPRESSION
Squeezing of the spinal cord due to pressure from an external force
May be caused by tumor or trauma
Hyperflexion, axial loading, and excessive rotation may cause spinal cord compression (ex. diving into shallow water, landing on feet)
Spinal cord injuries
TRANSECTION: COMPLETE VS INCOMPLETE
A cut through the spinal cord
COMPLETE cut all the way through the cord (rare) with total loss of sensory and motor function below the level of injury
INCOMPLETE cut partially through the cord with mixed loss of voluntary motor activity, sensation or reflex
Neuro assessment and nursing interventions used for spinal cord injuries
ACUTE PHASE
STABLE PHASE
Acute phase:
Stable phase:
Compare and contrast, assessment findings, nursing interventions
SPINAL SHOCK
NEUROGENIC SHOCK
SPINAL shock:
The response of the spinal cord to an injury
Temporary loss of reflex function below level of injury, cervical or upper thoracic
Begins immediately after injury, may last 4-6 weeks, may mask post injury neurologic function
Sympathetic (“fight or flight”) function is lost; parasympathetic (“rest and digest”) function takes over
Characteristics:
Flaccid paralysis and loss of deep tendon reflexes
Loss of sensation below level of injury
Loss of bladder tone, intestinal peristalsis and vasomotor tone
Loss of perspiration and temperature control
Decreased BP and HR (autonomic dysfunction)
Resolves:
Gradual recovery of spinal shock begins; improved bladder tone, hyperreflexia, sacral reflexes
NEUROGENIC shock:
Cardiovascular compromise as a result of cervical or upper thoracic
Sympathetic nervous system is impaired and there is massive vasodilation below level of injury
Characteristics: Decreased BP and HR due to vasodilation Warm skin Respiratory dysfunction Paralytic ileus Urinary retention Poikilothermic (inability to regulate body temp) Critical care support May occur quickly, w/in 30 min of a T5 or higher SCI
Autonomic dysreflexia
Autonomic Dysreflexia:
Medica emergency
Specific to spinal cord injuries involving T6 and above
How it occurs:
Irritation below the level of SCI
Constriction of blood vessels
Causing high blood pressure
Signals to brain
Slow pulse and dilation of blood vessels above the injury level as an attempt to compensate for the rise in BP causing symptoms
Attempted compensation message cannot pass through the spinal cord and blood pressure continues to rise
S/S: BP 20-30mmHg above norm Sweating Pounding HA Flushed Tight chest Stuffy nose Blurred vision
Causes:
Bladder; distention, UTI, stones
Bowel; constipation, hemorrhoids, fissure, having bowel care preformed
Skin; pressure ulcers, tight clothing, ingrown toenail, blister/burn
Other; scrotal compression, sexual stimulation, labor during child birth, menstruations, or anything that causes ab pain
Emergency TX: Call for assistance Sit pt upright, lower legs Loosen tight clothing/leg straps Monitor BP
Treat first:
Bladder distention and constipation
If symptoms persist and cause unknown:
Admin prescribed medication
Nifedipine 10mg capsule “bite and swallow” method
Sacral sparing and it’s effect on sexuality
Sacral Sparing: Is proven by: Perianal sensation Rectal motor function Flexor activity of great toe
Bladder training is possible
Highest level of sexual function is possible
If sacral function is preserved this may the only way to differentiate between COMPLETE and INCOMPLETE cord injury
If pt has no signs or sacral sparing and is paralyzed, they are considered to have a COMPLETE SCI
Modifications in the administration of intramuscular drugs to cored injured patients
IM injections:
Give above the level of injury due to reduced blood flow to unused muscles
Impaired drug absorption
Increased risk for irritation and bleeding
May cause ulcerations of tissue
Important elements taught to patients with musculoskeletal injuries
Preventative: helmets, seatbelts, no diving, safety devices
Rehabilitation and self care
Support independence and use of assistive devices
Bowel, bladder and skin care
S/S of autonomic dysreflexia
Medications
Nutrition: fiber, fluids, protein
Nursing interventions and medications
NI:
Immobilize/stabilize the head/neck, maintain c-spine and longboard until cleared
Maintain airway patency and support breathing- suction/clear airway, give O2, assist with intubation
Monitor cardiovascular status- assess VS, tele, invasive monitor, risk for spinal and neurogenic shock
TX:
Administer IV fluids/medications
Volume support but monitor for fluid overload
Corticosteroids use is NOT supported as it was previously, control edema- may increase complications
Vasopressors (dopamine or dobutamine) for hypotension and atropine for bradycardia- if neurogenic shock
Antispasmodics (baclofen)
Antiemetics for N/V
Analgesics and narcotics for pain control
Proton pump inhibitors to prevent gastric ulcers related to stress
Anticoagulants to prevent DVT/PE
Stool softeners
Nursing interventions
Assessment, monitoring, labs
Strict I/O
Foley if indicated
Prevent constipation, bowel training
Protect skin
Prevent infection- skin, urine, pneumonia/sepsis (greatest risk for death)
Administer dietary nutrition as tolerated (high fiber, adequate fluids)
Labs and testing: ABG's Electrolytes Trauma panel CT Xray MRI Somatosensory- evoked potential studies, stimulates peripheral nerves to determine level of SCI by monitoring response time Post void residual, bladder scan
Nursing interventions
SUPPORT DEVICES ETC
Support stabilization and immobilization with traction devices and surgical procedures
Surgery: stabilization of the spine with metal rods, spinal fusion, decompression laminectomy
Traction/stabilization device: stabilization of the the cervical spine to prevent further damage
- Gardner-Wells tongs; not used much anymore
- Halo device; external fixation device, screwed into skull
Assist with thermoregulation
