Ch 16 Spinal Cord Injury Flashcards
What do spinal cord injuries involve
The loss of motor function, sensory function, reflexes, and control of elimination.
Injuries in the cervical region result in what
Quadriplegia
What is quadriplegia
Paralysis/ paresis of all 4 extremities and trunk.
What is SCI
Spinal cord injury
Injuries below T1 results in what
Paraplegia/ paresis of the lower extremities
Truncal instability also results if the injury SCI occurs where
If the injury is in the upper thoracic region
What dictates the level of SCI
The level of cord involved
Complete lesions ( injuries) results in what
The loss of all voluntary movement below the site of injury
Hyper flexion injuries are caused by what
Acceleration injuries that cause sharp forward flexion of the spine
Give example of hyper flexion injuries
Head on collision, fall, diving.
What are hyper extension injuries caused by
By a backward snap of the spine
Give examples of hyper extension injuries
Rear end collision, downward fall onto the chin.
What are objective physical assessment findings of a SCI
Inability to feel light touch by a cotton ball, inability to discriminate between sharp and dull pain, hot and cold.
Absent deep tendon reflexes, flaccidity of muscles,
Hypotension that is more severe when sitting in the upright position
Shallow respirations
Dependent edema
NEUROGENIC SHOCK, which accompanies spinal injury
Loss of temp regulation
When does neurogenic shock occur
After an SCI, and can cause total loss of voluntary and autonomic function for several days to weeks. Hypotension, dependent edema, and loss of temperature regulation are common symptoms, and paralytic ileus… It occurs due to the loss of autonomic function
When in an upright position, ppl in neurogenic shock experience what
Hypotension, transfer to a wheelchair should occur in stages, if the client reports dizziness, recline the back of the wheelchair
Clients who have upper motor neuron injuries ( above L1 and L2) will have what type of muscle tone
They will convert to a spastic muscle tone after neurogenic shock
Paraplegics who have lower motor neuron injuries ( below L1 and L2 ) will have what type of paralysis
They will convert to a flaccid type of paralysis
Will clients who have complete SCIs regain mobility
NO
Spastic neurogenic bladder
Clients who have upper motor neuron injuries will develop a spastic bladder after the neurogenic shock resolves.
What are bladder management options for males
Condom catheters and stimulation of the micturition reflex by tugging on the pubic hair
Flaccid neurogenic bladder
Client who have lower motor neuron injuries will develop a flaccid bladder
What is bladder treatment for a flaccid neurogenic bladder
Intermittent catherization for males and females.
Credes method
Downward pressure placed on the bladder to manually express the urine
What is nursing care for bowel regulation with neurogenic shock
It does not differ much between upper and lower motor neuron injuries… Daily use of stool softeners or bulk forming laxatives are recommended.
Why are glucocorticoids given after a SCI
Adrenocortical steroids such as methylprednisolone (solu-Medrol) aid in decreasing edema of the spinal cord, which can cause spinal cord compression and areas of ischemia
Why are vasopressors given during a SCI
Norepinephrine and dopamine are given to treat hypotension, particularly during neurogenic shock
Why would antimuscarinics be given during SCIs
Atropine sulfate may be given to treat bradycardia
Why would plasma expanded be given during a SCI
Dextran ( volume expander) may be given to treat hypotension secondary to spinal shock…..
OBSERVE CLIENT FOR SYMPTOMS OF FLUID OVERLOAD
Why would baclofen and dantrolene sodium be given during a SCI
They will be given to clients who have severe muscles spasticity. Muscle spasticity can be so severe that clients develop pressure ulcers, which can make sitting in a wheel chair very difficult
What should the nurse monitor for when administering baclofen and dantrolene sodium
Drowsiness
Muscle weakness
How may baclofen be administered to reduce sedative effects
Intrathecally
Why may cholinergics be administered following a SCI
Bethanechol ( Urecholine) decreases muscle spasticity of the bladder, allowing for easier bladder training and fewer accidents ……OBSERVE FOR URINARY RETENTION MEASURE RESIDUALS PERIODICALLY…
Why is the vasodilator hydralazine ( Apresoline) administered
It is used PRN to treat episodes of hypertension during autonomic dysreflexia
Clients who have cervical fracture may be placed in what type of immobilization device
Clients who have cervical fractures may be placed in a halo fixation device or cervical tongs.
What is the purpose of a halo fixation or cervical tong
To provide traction and or immobilize the spinal column
What are nursing actions for cervical tongs
Maintain body alignment and ensure the weights hang freely
What are surgical interventions for SCI
Spinal fusion is commonly done when a spinal fracture cera Es an area of instability of the spine.
How are spinal fusions of the cervical area performed
They are usually done using an anterior approach through the front of the neck.
How are spinal fusions in the thoracic or lumbar regions performed
Using a posterior approach and can be combined with a decompressive laminectomy
How are decompressive laminectomies performed
By removing a section of Latina, accessing the spinal canal, and removing bone fragments, foreign bodies, or hematomas that may be placing pressure on the spinal cord. Donor bone is often obtained from the iliac crest and be used to fuse together the vertebrae that are unstable. Application of paravertebral rods can be used to mechanically immobilize several vertebral levels.
What are complications of SCI
Orthostatic hypotension
Neurogenic shock
Autonomic dysreflexia
Why and when does autonomic dysreflexia occur following a SCI
It occurs secondary to the stimulation of the sympathetic nervous system and inadequate compensatory response by the parasympathetic nervous system.
Injuries below what level do not experience autonomic dysreflexia
Injuries below T6 do not experience autonomic dysreflexia because the parasympathetic nervous system is able to neutralize the sympathetic response.
What does stimulation of the sympathetic nervous system cause
Extreme hypertension, sudden severe headache, pallor below the level of the spinal cords lesion dermatome, blurred vision Diaphoresis Restlessness Nausea Piloerection(goosebumps)
What does stimulation of the parasympathetic nervous system cause
Bradycardia
Flushing above the corresponding dermatome to the spinal cord lesion ( flushed face and neck)
Nasal stiffness
A nurse is caring for a client who experienced a cervical spine injury 24 HR ago, what medications should the nurse expect to be administered
Glucocorticoids
Plasma expanders
H2 antagonists
What medication would a nurse question if a dr prescribes it for a person who suffered a cervical spine injury 24 HR ago
Muscle relaxants because the client will still be in spinal shock 24 HR following the injury the client will not experience muscle spasms until after the spinal shock has resolved, making muscle relaxants unnecessary at this time.
