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3.3- Spinal Cord Complications Flashcards

0
Q

_____-______ controls the diaphragm?

A

C3-C5

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1
Q

What complication occurs almost immediately after injury due to decreased innervation of muscles?

A

respiratory complications

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2
Q

What is the leading respiratory issue following a spinal cord injury? Why?

A

pneumonia- because lower or incomplete injuries may weaken the respiratory muscles

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3
Q

What may limit patients ability to exercise?

A

decreased respiratory

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4
Q

Early ________ to ________ is extremely important

A

acclamation to upright

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5
Q

What can be used to help respiration?

A
  1. abdominal binders/corsets
  2. assistive cough techniques
  3. spirometry
  4. diaphragmatic strengthening
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6
Q

What is at greatest risk the first 2 weeks due to immobility and medically fragile?

A

DVT

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7
Q

What percent can get a DVT?

A

up to 60%

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8
Q

Where does a DVT usually from and dislodge? What can happen?

A

usually in calf. Death

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9
Q

Why are DVT’s difficult to discover?

A

Because the patient lacks sensation, will need to look for swelling and redness

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10
Q

What can be used to prevent DVT’s?

A
  1. Coumandin/Heparin porphylatic

2. TET hose/pressure devices to promote venous return

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11
Q

Early return to ______ and transfer to W/C is important

A

upright

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12
Q

What causes orthostatic hypotension?

A

venous pooling causes blood to collect in LE’s-without good muscle pumping and LE vasoresponse the BP decreases during positional changes-pass out.

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13
Q

What BP level is a dangerous level-below can cause cardiac arrest?

A

70/40

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14
Q

T/F Orthostatic hypotension is the worst after the person is positioned upright.

A

FASLE-it is worse at first, but gets better as the person gets used to upright

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15
Q

What 2 things can we use to help with orthostatic hypotension?

A

abdominal binder and TET hose

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16
Q

What is also another common problem of spinal cord complications?

A

Pressure Ulcers

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17
Q

Name all 12 spinal cord complications

A
  1. Respiratory
  2. DVT
  3. Orthostatic hypotension
  4. Pressure ulcers
  5. Autonomic dysreflexia
  6. Heterotopic ossificans
  7. Pain
  8. Contractures
  9. Osteoporosis
  10. Bowel/Bladder
  11. Sexual dysfunction
  12. Spasticity
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18
Q

What can occur during spinal shock but gets worse during stastic stage?

A

pressure ulcers

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19
Q

What is caused by lack of blood flow, especially in the bony area?

A

pressure ulcers

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20
Q

Why are pressure ulcers difficult for spinal cord injuries?

A

Can no longer feel the discomfort we feel that would cause them to change positions.

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21
Q

Early on, pressure ulcers develop around the _______ from being in bed. When moved to WC they tend to develop around the _______________

A

coccyx, ishial tuberosity

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22
Q

Patient must be taught to do _______ of pressure relief for every ________ of sitting

A

1 minute for every 15-30 minutes of sitting

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23
Q

Who must be taught to do skin inspections?

A

family/patient

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24
Descending inhibitory input from the brain that usually modulates autonomic function is lost, works on a reflex basis.
Autonomic dysreflexia
25
What only occurs with injuries above T6 and can occur at any time but is usually the first 6 weeks?
autonomic dysreflexia
26
The autonomic response is set off by a noxious stimuli below the level of lesion and reflex continues until the stimuli is removed-dangerous and cas cause death.
automomic dysreflexia
27
What are the symptoms of autonomic dysreflexia? There are 7
1. severe headache 2. profuse sweating 3. vasoconstriction below level of lesion 4. vasodilation (flushing) above lesion 5. runny nose 6. pilierection 7. severe increases in BP (can cause seizure, stroke, detached retina)
28
What are some causes of autonomic dysreflexia?
1. full bladder/catheter kink 2. bowel distension 3. pressure sores 4. noxious stimulation 5. environmental temp change 6. passive hip stretch
29
What treatment can we do when we see a patient experiencing autonomic dysreflexia?
1. look for and eliminate source of stimulation 2. lower patient BP by raising the head (use orthostatic hypotension) 3. return patient to their hospital floor level and contact nurse/MD immediately
30
Bone formation in soft tissue below level of lesion around a large joint. Knees, hips, shoulders
heterotopic ossificans
31
Doesn't show well on early xrays and could be due to neurologic trauma-its not well understood.
heterotopic ossificans
32
What are the signs/symptoms of heterotopic ossificans?
1. decreased ROM 2. swelling 3. redness (looks like DVT)
33
heterotopic ossificans- some believe in aggressive ________, some feel it is contraindicated and may require ______
ROM, surgery
34
Is common despite loss of sensation. May be due to irriatation or damage to sensory pathways.
pain
35
Common-poorly localized mumbness, tingle, burning, shooting and aching pain is known as?
Phantom pain
36
What treatment can be used for pain?
1. meds-NSAIDS, antidepressants (may increase spasticity) 2. psych mamagement-pain clinics 3. acupuncture, biofeedback, TENS 4. narcotics (try to avoid) nerve blocks
37
What is caused by spasticity and decreased movement?
Contractures
38
Most common contracture is _______?
PF
39
___________ creates a problem for ambulation and keeping feet flat on pedals of chair.
PF contracture
40
_______ and ______ contractures are common from sitting
knee and hip
41
For contractures try to get ________ on a regular basis
prone
42
Why should you not stretch the back out too much?
spasticity helps to hold them up
43
What causes osteoporosis?
decreased WB causes demineralization of bones
44
What mineral collects in the kidneys and can cause kidney stones?
CA
45
What is the best treatment for osteoporosis?
weightbearing asap
46
What function is controlled by S2-S4?
bowel/bladder
47
Initially the bladder is ______ from _____________
flacid, spinal shock
48
What is reflexive neurogenic bladder?
when the bladder reflexively empties when pressure reaches a certain level
49
If the injury is above S2 what happens to the bladder?
reflexive neurogenic bladder
50
T/F Maunal pressure to the bladder can help empty it if the injury is above S2?
True
51
What is Non-Reflexive Bladder?
bladder is flaccid and needs a catheter to empty
52
If the injury is to the cauda equina or conus medullaris you will have ____________ bladder
non-reflexive bladder
53
What is generally not under volunatry control, but can be self managed on a regular schedule?
bowel
54
T/F can use fiber and stool softeners and lots of fluid and a stimulus either manual or suppository to aid in bowel movement
True
55
Sexual dysfunction, _______ motor neuron injury with sacral reflex arch intact. Can get an errection but no ________
upper, ejaculation
56
T/F With sexual dysfunction, there is a good chance of having kids without help
False- poor chance of having kids without help
57
With sexual dysfunction, women have ______ and can get _______ usually hospitalized last _______-______ week because they don't feel labor pain.
menstruation, pregnant 4-6 weeks
58
Is greater with cervical and incomplete injuries and exacerbated by noxious stimulation
spasticity
59
Spasticity can be helpful in what areas?
1. muscle pumps of venous system | 2. may help with functional activities (transfers, bed mobility)
60
When the spinal cord injury is accute what is the best treatment to start with?
Respiration-depends on level | *maximize anything available to increase diaphragm strength
61
What are ways to help with respiration strength and keeping mucous under control?
1. increase lateral expnsion, incentive spirometry, chest wall stretching 2. postural drainage, assistive cough techniques
62
Initially ______ may be limited by halo or back brace
ROM
63
When should you limit hip flexion to 90 degrees?
patient in a back brace | **don't pull against an ustable area
64
________ tight areas, but sometimes it is more ________ to leave tight
stretch, functional
65
What is a tenodesis grip?
keeping finger flexors tight, extending the wrist will cause the fingers to flex into a grasp
66
Tight _______ extensors help keep _____ back-helps with sitting balance and respiratory function.
cervical, head
67
Tight ______ _______ helps with rolling, transfers, and maintain sitting
low back
68
What flexibility should we work on for long sitting, hip flexors/extensors, hip rotators and ankle DF?
hamstring
69
Strength-start in ______ _______ and increase as possible (contraindicated in fx areas)
gravity neutral
70
Bilateral use of ______ is helpful for strength
UE's
71
Focus strength on anterior delts, shoulder extensors, and bicpes
quadraplegic
72
Strength focus on shoulder depressors, tricpes and lats
Paraplegic
73
Acclimation to upright, start by raising ______ of ______ | ***watch vitals
head of bed
74
Accclimation to upright can be progressed to ______ with elevating leg rests and tilt table
WC
75
What prevents osteoporosis, helps bladder/bowel and decreases abnormal tone
WB on LE's ASAP
76
Beyond accute phase we can start working on what 5 things?
1. bed mobility 2. pressure relief 3. WC propulsion 4. transfer training 5. gait training (para-using bracing)
77
Bed Mobility: give 4 things they can do to be mobile in bed
1. rolling (pressure relief) 2. transfer to prone (good hip stretch) 3. prone on elbows (good for head/nect control, GH stabilization) 4. supine on elbows (work on long sitting)
78
What bed mobility is good for pressure relief?
rolling
79
What bed mobility is good for hip stretch?
transfer to prone
80
What bed mobility is good to work on long sitting?
supine on elbows
81
What bed mobility is good for head/neck control, GH stabilization?
prone on elbows

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