3.3- Spinal Cord Complications Flashcards
_____-______ controls the diaphragm?
C3-C5
What complication occurs almost immediately after injury due to decreased innervation of muscles?
respiratory complications
What is the leading respiratory issue following a spinal cord injury? Why?
pneumonia- because lower or incomplete injuries may weaken the respiratory muscles
What may limit patients ability to exercise?
decreased respiratory
Early ________ to ________ is extremely important
acclamation to upright
What can be used to help respiration?
- abdominal binders/corsets
- assistive cough techniques
- spirometry
- diaphragmatic strengthening
What is at greatest risk the first 2 weeks due to immobility and medically fragile?
DVT
What percent can get a DVT?
up to 60%
Where does a DVT usually from and dislodge? What can happen?
usually in calf. Death
Why are DVT’s difficult to discover?
Because the patient lacks sensation, will need to look for swelling and redness
What can be used to prevent DVT’s?
- Coumandin/Heparin porphylatic
2. TET hose/pressure devices to promote venous return
Early return to ______ and transfer to W/C is important
upright
What causes orthostatic hypotension?
venous pooling causes blood to collect in LE’s-without good muscle pumping and LE vasoresponse the BP decreases during positional changes-pass out.
What BP level is a dangerous level-below can cause cardiac arrest?
70/40
T/F Orthostatic hypotension is the worst after the person is positioned upright.
FASLE-it is worse at first, but gets better as the person gets used to upright
What 2 things can we use to help with orthostatic hypotension?
abdominal binder and TET hose
What is also another common problem of spinal cord complications?
Pressure Ulcers
Name all 12 spinal cord complications
- Respiratory
- DVT
- Orthostatic hypotension
- Pressure ulcers
- Autonomic dysreflexia
- Heterotopic ossificans
- Pain
- Contractures
- Osteoporosis
- Bowel/Bladder
- Sexual dysfunction
- Spasticity
What can occur during spinal shock but gets worse during stastic stage?
pressure ulcers
What is caused by lack of blood flow, especially in the bony area?
pressure ulcers
Why are pressure ulcers difficult for spinal cord injuries?
Can no longer feel the discomfort we feel that would cause them to change positions.
Early on, pressure ulcers develop around the _______ from being in bed. When moved to WC they tend to develop around the _______________
coccyx, ishial tuberosity
Patient must be taught to do _______ of pressure relief for every ________ of sitting
1 minute for every 15-30 minutes of sitting
Who must be taught to do skin inspections?
family/patient
Descending inhibitory input from the brain that usually modulates autonomic function is lost, works on a reflex basis.
Autonomic dysreflexia
What only occurs with injuries above T6 and can occur at any time but is usually the first 6 weeks?
autonomic dysreflexia
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
What are the symptoms of autonomic dysreflexia? There are 7
- severe headache
- profuse sweating
- vasoconstriction below level of lesion
- vasodilation (flushing) above lesion
- runny nose
- pilierection
- severe increases in BP (can cause seizure, stroke, detached retina)
What are some causes of autonomic dysreflexia?
- full bladder/catheter kink
- bowel distension
- pressure sores
- noxious stimulation
- environmental temp change
- passive hip stretch
What treatment can we do when we see a patient experiencing autonomic dysreflexia?
- look for and eliminate source of stimulation
- lower patient BP by raising the head (use orthostatic hypotension)
- return patient to their hospital floor level and contact nurse/MD immediately
Bone formation in soft tissue below level of lesion around a large joint. Knees, hips, shoulders
heterotopic ossificans
Doesn’t show well on early xrays and could be due to neurologic trauma-its not well understood.
heterotopic ossificans
What are the signs/symptoms of heterotopic ossificans?
- decreased ROM
- swelling
- redness (looks like DVT)
heterotopic ossificans- some believe in aggressive ________, some feel it is contraindicated and may require ______
ROM, surgery
Is common despite loss of sensation. May be due to irriatation or damage to sensory pathways.
pain
Common-poorly localized mumbness, tingle, burning, shooting and aching pain is known as?
Phantom pain
What treatment can be used for pain?
- meds-NSAIDS, antidepressants (may increase spasticity)
- psych mamagement-pain clinics
- acupuncture, biofeedback, TENS
- narcotics (try to avoid) nerve blocks
What is caused by spasticity and decreased movement?
Contractures
Most common contracture is _______?
PF
___________ creates a problem for ambulation and keeping feet flat on pedals of chair.
PF contracture
_______ and ______ contractures are common from sitting
knee and hip
For contractures try to get ________ on a regular basis
prone
Why should you not stretch the back out too much?
spasticity helps to hold them up
What causes osteoporosis?
decreased WB causes demineralization of bones
What mineral collects in the kidneys and can cause kidney stones?
CA
What is the best treatment for osteoporosis?
weightbearing asap
What function is controlled by S2-S4?
bowel/bladder
Initially the bladder is ______ from _____________
flacid, spinal shock
What is reflexive neurogenic bladder?
when the bladder reflexively empties when pressure reaches a certain level
If the injury is above S2 what happens to the bladder?
reflexive neurogenic bladder
T/F Maunal pressure to the bladder can help empty it if the injury is above S2?
True
What is Non-Reflexive Bladder?
bladder is flaccid and needs a catheter to empty
If the injury is to the cauda equina or conus medullaris you will have ____________ bladder
non-reflexive bladder
What is generally not under volunatry control, but can be self managed on a regular schedule?
bowel
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
Sexual dysfunction, _______ motor neuron injury with sacral reflex arch intact. Can get an errection but no ________
upper, ejaculation
T/F With sexual dysfunction, there is a good chance of having kids without help
False- poor chance of having kids without help
With sexual dysfunction, women have ______ and can get _______ usually hospitalized last _______-______ week because they don’t feel labor pain.
menstruation, pregnant 4-6 weeks
Is greater with cervical and incomplete injuries and exacerbated by noxious stimulation
spasticity
Spasticity can be helpful in what areas?
- muscle pumps of venous system
2. may help with functional activities (transfers, bed mobility)
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
What are ways to help with respiration strength and keeping mucous under control?
- increase lateral expnsion, incentive spirometry, chest wall stretching
- postural drainage, assistive cough techniques
Initially ______ may be limited by halo or back brace
ROM
When should you limit hip flexion to 90 degrees?
patient in a back brace
**don’t pull against an ustable area
________ tight areas, but sometimes it is more ________ to leave tight
stretch, functional
What is a tenodesis grip?
keeping finger flexors tight, extending the wrist will cause the fingers to flex into a grasp
Tight _______ extensors help keep _____ back-helps with sitting balance and respiratory function.
cervical, head
Tight ______ _______ helps with rolling, transfers, and maintain sitting
low back
What flexibility should we work on for long sitting, hip flexors/extensors, hip rotators and ankle DF?
hamstring
Strength-start in ______ _______ and increase as possible (contraindicated in fx areas)
gravity neutral
Bilateral use of ______ is helpful for strength
UE’s
Focus strength on anterior delts, shoulder extensors, and bicpes
quadraplegic
Strength focus on shoulder depressors, tricpes and lats
Paraplegic
Acclimation to upright, start by raising ______ of ______
***watch vitals
head of bed
Accclimation to upright can be progressed to ______ with elevating leg rests and tilt table
WC
What prevents osteoporosis, helps bladder/bowel and decreases abnormal tone
WB on LE’s ASAP
Beyond accute phase we can start working on what 5 things?
- bed mobility
- pressure relief
- WC propulsion
- transfer training
- gait training (para-using bracing)
Bed Mobility: give 4 things they can do to be mobile in bed
- rolling (pressure relief)
- transfer to prone (good hip stretch)
- prone on elbows (good for head/nect control, GH stabilization)
- supine on elbows (work on long sitting)
What bed mobility is good for pressure relief?
rolling
What bed mobility is good for hip stretch?
transfer to prone
What bed mobility is good to work on long sitting?
supine on elbows
What bed mobility is good for head/neck control, GH stabilization?
prone on elbows
