Advanced spinal surgical nursing Flashcards
List the nine conditions that can be seen in the spinal patient
degenerative developmental anomalous (cysts) neoplastic nutritional inflammatory (discospondylitis/empyema) trauma fractures/luxations vascular
List the four types of degenerative spinal disease and what the characteristics of each
Disc extrusion
Small breeds, annulus tears and degenerative nucleus squirts out
Disc protrusion
Large breeds, annulus bulges compressing the cord
Cervical spondylomyelotpathy
canal stenosis, facet hypertrophy, disc protrusion, flaval ligament hypertrophy-compress the cord (rotties)
Lumbosacral disease
disc protrusion, facet hyperplasia, soft tissue proliferation possible subluxation
impinge on cauda equine/nerve roots directly affecting the blood supply (labs GSD)
List the types of neoplasia that can occur in the spine
Primary (from neurological tissues)
Secondary (from surrounding neurological tissues )
Tertiary metastasised
What are anomalous cysts?
Sub arachnoid diverticula
an abnormal adhesion between layers of meninges which causes a collection of csf that compresses the cord or inflammation/odema in the cord
What is disconsponylitis?
Infection of the intervertebral discs and the end plates of the surrounding vertebra
compresses cord lead to instability with a compressive /dynamic disease component
What pathological actions can cause spinal cord damage?
laceration compression contusion ischaemia inflammation
How do i medically manage the laceration compression contusion ischeamia infiltration and dysfunction
Laceration not solvable but preventable, immobilise area, maintain blood supply Compression no medical management contusion not solvable ischaemia (BP, HR, SV, CO, hypoxaemia) Infiltraion/ dysfunction treated with drugs or radiation
How do you immobilise a laceration spinal patient?
Spinal board
bandaging materials
spinal brace
When a primary spinal patient presents what do i need to control?
Ischaemia
ensure ventilating
appropriate blood supply
ensure CO is sufficient (arrythmias, shock)
Ensure blood volume and blood pressure is appropriate
what clinical parameters should be monitored in a spinal patient?
Resp rate and effort HR, PQ Pulse oximeter blood gas blood pressure fluid volume status
What is a dorsal laminectomy?
Removal of the laminae of the dorsal vertebral arch +/- the spinous process (access to dorsal spinal column)
CSM, lumbar sacral disease, SAD, disc diseases
What is a facectectomy?
Removal of the articular facet
lumbar sacral disease CSM
What is a Foraminotomy?
Enlargement of an intervertebral foramen to relive pressure on a nerve root
Lumbosacral disease
What is a hemilaminectomy?
Removal of one half of the lateral vertebral arch ( includes pedical and facets)
allows access to lateral and partial access to the ventral or dorsal spinal column
Tumours SAD
What is a corpecomty?
Lateral approach with removal of part of the vertebral body and endplates either side of the IVD
Allows for removal of compression from the ventral cord in thoracic and lumbar cord without going through the thorax or abdomen
dangerous in the cervical cord do not use at the lumbosacral junction
What is a ventral slot?
Slot like opening from a ventral approach in endplates of the vertebral body and removal of part of the disc in the cervical spine
access to ventral aspect of the spinal column
What is stabilisation of the spine and what is it used for?
removing the motion between adjacent vertebrae using implants and boe grafts
consider distraction-fusion for CSM and LS
List the retractors that are useful in spinal surgery
Gelpis and odd legs
mckee retrators
List the equipment useful for bone and soft tissue removal in the spinal surgery
Spinal burr Kerrisons rongeurs Bone punch forceps Friedman microrongeurs compound action spinal rongeurs
List the equipment useful in tissue, periosteal or tissue retraction
freer periosteal elevatro dandy nerve hook sheas curette Rosen mobiliser younger scaler jaquette scaler Adsons nerve hook
List the equipment useful for haemostasis in spinal surgery
Bone wax srugicell spongistan surgisnow PVA Duragen Codman surgical patties
Areas to implement nursing specific to the spinal patient
Manage urinary incontinence
prevent pressure sores
detect and control pain support and monitor the resp rate
promote motor recovery
What is important in physical therapy of the spinal patient?
Prevent pressure sores maintain motor fuction reduces pain supports the respiratory tract improves bond
Why is it important to carry out physical therapy?
plasticity of cells changing the way that they work
Nervous system re-learning movements only possibly whilst generating the movement
START EARLY
What does physical therapy do?
improves lymph and venous drainage promotes motor function improves bond relaxes patient Pain relief
What does physical therapy do for the motor system?
Maintains joint health
limits muscle wastage
prevents limb muscles spasticity/contracture/ flaccidity
Retrains gait patterns
What does physical therapy do for the sensory system?
improve core stability
retrain gait patterns
stimulates proprioception
What actions do we perform for physical therapy?
Massage Passive range of motion Active assisted exercises Active exercises proprioceptive exercises
What is massage important for?
Lymph and venous return minimises pain limits muscle spaciticy Dermal stimulation Warms up muscles
What is passive range of motion important for?
joint health
flexibility/elasticity
gait patterning
What are active assisted exercises?
assistance during muscular contraction assisted walking walking with a sling physio-rolls water treadmill
what are active exercises?
Unassisted movement of a joint static exercises (standing on one leg) walking (straight line,figure of 8) specific exercises (sit to stand)
What are proprioceptive exercises?
Body recognition of limb position standing wobble board uneven surfaces walking over poles weaving through cones
What other modalities can be use in physical thearpy?
Cold therapy
Hot therapy
Neuromuscular electrical stimulation
laser therapy
What do you need to consider when making a physical therapy plan?
Previous activity environment temperament client expectations client involvement physical examination neuro exam disease process concurrent orthopaedic conditions
What physical therapy should be included in the firs 48-72 hours post-surgery?
Massage
full body light massage
cold compress
What physical therapy should be included when the dog is able to support weight with no limb movements?
Massage limb muscles Light full body massage Passive range of motion (15 cycles of each joint) Standing exercises Weight shifting exercies
What physical therapy should be included when the dog has initial limb movement?
Passive range of motion standing exercise weight shifting assisted walking hydrotherapy
What physical therapy should be included when the dog has good limb movements?
Sit to stand circles and figures of 8 wobble board walking over poles hydrotherapy
Why is skin and wound management important?
infection
pain
poor quality of life
Why does skin disease occur?
Boredom sensory dysfunction (neuropathic pain) recumbencey bladder/faecal dysfunction
How do pressure sores develop?
Lack of movement lead to mechanical load in one area ischaemia reduced pulsatile blood flow reduced venous return reperfusion tissue injury blood pressure abnormalities Deep tissue first then skin
What are the pressure points where pressure sores are most likely to form?
Ischial tuberosities
lateral condyles of the humerus
perianal
What are the risk factors of pressure sores?
Dogs with long fur diarrhoea weather age concurrent ortho condition heating of the floor
How are pressure sores prevented?
Turn every 2 to 4 hours Appropriate bedding sling bed porous bedding non-slippery floor absorbent pads use of lower cages Physical therapy to promote circulation Skin inspection once a day Drying the skin (waterproof barrier cream) Manage bladder Avoid unnecessary dressing care with tape on skin
How do you treat pressure sores?
Clean
debride
antibiotics
bandaging
If a spinal patient is unable to urinate what can this lead to?
UTI
Bladder distension (lead to atony)
Distension of the ureters
predisposition to skin sores
How can you manage the bladder in the spinal patient?
Manual expression (3x daily)
Intermittent catheterisation
Indwelling catheter
drug therapy
What can lack of pain management lead to?
Self mutilation
reduced rate of rehab
What are the types of pain?
Inflammatory-tissue damage
Neuropathic- dysfuction in transmission of noiciception
Acute- sudden onset localised
chronic- intense and unrelenting and persists
Why should the respiratory tract be managed in spinal patients?
prone to hypoventilation atelectasis pneumonia Monitor respiratory parameters Turn regularly Physical therapy propping into sternal appropriate drug and o2 therapy
