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Med Surg > Ch 16 Spinal Cord Injury > Flashcards

Ch 16 Spinal Cord Injury Flashcards

1
Q

What do spinal cord injuries involve

A

The loss of motor function, sensory function, reflexes, and control of elimination.

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2
Q

Injuries in the cervical region result in what

A

Quadriplegia

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3
Q

What is quadriplegia

A

Paralysis/ paresis of all 4 extremities and trunk.

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4
Q

What is SCI

A

Spinal cord injury

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5
Q

Injuries below T1 results in what

A

Paraplegia/ paresis of the lower extremities

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6
Q

Truncal instability also results if the injury SCI occurs where

A

If the injury is in the upper thoracic region

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7
Q

What dictates the level of SCI

A

The level of cord involved

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8
Q

Complete lesions ( injuries) results in what

A

The loss of all voluntary movement below the site of injury

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9
Q

Hyper flexion injuries are caused by what

A

Acceleration injuries that cause sharp forward flexion of the spine

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10
Q

Give example of hyper flexion injuries

A

Head on collision, fall, diving.

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11
Q

What are hyper extension injuries caused by

A

By a backward snap of the spine

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12
Q

Give examples of hyper extension injuries

A

Rear end collision, downward fall onto the chin.

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13
Q

What are objective physical assessment findings of a SCI

A

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

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14
Q

When does neurogenic shock occur

A

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

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15
Q

When in an upright position, ppl in neurogenic shock experience what

A

Hypotension, transfer to a wheelchair should occur in stages, if the client reports dizziness, recline the back of the wheelchair

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16
Q

Clients who have upper motor neuron injuries ( above L1 and L2) will have what type of muscle tone

A

They will convert to a spastic muscle tone after neurogenic shock

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17
Q

Paraplegics who have lower motor neuron injuries ( below L1 and L2 ) will have what type of paralysis

A

They will convert to a flaccid type of paralysis

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18
Q

Will clients who have complete SCIs regain mobility

A

NO

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19
Q

Spastic neurogenic bladder

A

Clients who have upper motor neuron injuries will develop a spastic bladder after the neurogenic shock resolves.

20
Q

What are bladder management options for males

A

Condom catheters and stimulation of the micturition reflex by tugging on the pubic hair

21
Q

Flaccid neurogenic bladder

A

Client who have lower motor neuron injuries will develop a flaccid bladder

22
Q

What is bladder treatment for a flaccid neurogenic bladder

A

Intermittent catherization for males and females.

23
Q

Credes method

A

Downward pressure placed on the bladder to manually express the urine

24
Q

What is nursing care for bowel regulation with neurogenic shock

A

It does not differ much between upper and lower motor neuron injuries… Daily use of stool softeners or bulk forming laxatives are recommended.

25
Q

Why are glucocorticoids given after a SCI

A

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

26
Q

Why are vasopressors given during a SCI

A

Norepinephrine and dopamine are given to treat hypotension, particularly during neurogenic shock

27
Q

Why would antimuscarinics be given during SCIs

A

Atropine sulfate may be given to treat bradycardia

28
Q

Why would plasma expanded be given during a SCI

A

Dextran ( volume expander) may be given to treat hypotension secondary to spinal shock…..
OBSERVE CLIENT FOR SYMPTOMS OF FLUID OVERLOAD

29
Q

Why would baclofen and dantrolene sodium be given during a SCI

A

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

30
Q

What should the nurse monitor for when administering baclofen and dantrolene sodium

A

Drowsiness

Muscle weakness

31
Q

How may baclofen be administered to reduce sedative effects

A

Intrathecally

32
Q

Why may cholinergics be administered following a SCI

A

Bethanechol ( Urecholine) decreases muscle spasticity of the bladder, allowing for easier bladder training and fewer accidents ……OBSERVE FOR URINARY RETENTION MEASURE RESIDUALS PERIODICALLY…

33
Q

Why is the vasodilator hydralazine ( Apresoline) administered

A

It is used PRN to treat episodes of hypertension during autonomic dysreflexia

34
Q

Clients who have cervical fracture may be placed in what type of immobilization device

A

Clients who have cervical fractures may be placed in a halo fixation device or cervical tongs.

35
Q

What is the purpose of a halo fixation or cervical tong

A

To provide traction and or immobilize the spinal column

36
Q

What are nursing actions for cervical tongs

A

Maintain body alignment and ensure the weights hang freely

37
Q

What are surgical interventions for SCI

A

Spinal fusion is commonly done when a spinal fracture cera Es an area of instability of the spine.

38
Q

How are spinal fusions of the cervical area performed

A

They are usually done using an anterior approach through the front of the neck.

39
Q

How are spinal fusions in the thoracic or lumbar regions performed

A

Using a posterior approach and can be combined with a decompressive laminectomy

40
Q

How are decompressive laminectomies performed

A

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.

41
Q

What are complications of SCI

A

Orthostatic hypotension
Neurogenic shock
Autonomic dysreflexia

42
Q

Why and when does autonomic dysreflexia occur following a SCI

A

It occurs secondary to the stimulation of the sympathetic nervous system and inadequate compensatory response by the parasympathetic nervous system.

43
Q

Injuries below what level do not experience autonomic dysreflexia

A

Injuries below T6 do not experience autonomic dysreflexia because the parasympathetic nervous system is able to neutralize the sympathetic response.

44
Q

What does stimulation of the sympathetic nervous system cause

A 
Extreme hypertension,
sudden severe headache, 
pallor below the level of the spinal cords lesion dermatome, 
blurred vision
Diaphoresis
Restlessness
Nausea
Piloerection(goosebumps)
45
Q

What does stimulation of the parasympathetic nervous system cause

A

Bradycardia
Flushing above the corresponding dermatome to the spinal cord lesion ( flushed face and neck)
Nasal stiffness

46
Q

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

A

Glucocorticoids
Plasma expanders
H2 antagonists

47
Q

What medication would a nurse question if a dr prescribes it for a person who suffered a cervical spine injury 24 HR ago

A

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.

Med Surg (19 decks)

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