ch 60 spinal cord injury

Question 1

most unstable type of spinal cord injury

Answer 1

flexion-rotation injury

Question 2

after how many hours does permanent spinal cord damage occur from edema

Answer 2

24+ hours

Question 3

vertebral level where there is the most damage to vertebral bones and ligaments

Answer 3

skeletal level of injury

Question 4

lowest segment of spinal cord with normal sensory and motor function on both sides of body

Answer 4

neurologic level of injury

Question 5

how many cervical vertebrae

Answer 5

8

Question 6

how many thoracic vertebrae

Answer 6

12

Question 7

how many lumbar vertebrae

Answer 7

5

Question 8

what level vertebrae fracture can kill someone

Answer 8

C1/C2

Question 9

3 types paralysis

Answer 9

tetraplegia (neck down)
paraplegia (waist down)
hemiplegia (one side body)

Question 10

biggest concern with cervical and upper thoracic injuries (3)

Answer 10

• impaired breathing
• impaired ability to regulate bp
• impaired heart function

Question 11

nursing considerations for pts with injury at or above C4 level

Answer 11

• need ventilator

- need cardiac support

Question 12

resp S+S for pts with injury below C4

Answer 12

-labored breathing and hypoventilation

Question 13

any cord injury above level T6 affects what body system

Answer 13

sympathetic nervous system

cardiovascular

Question 14

cardiovascular S+S with injuries above level T6

Answer 14

• bradycardia

- hypotension

Question 15

what meds should be given to pt with level T6 injury or above when they get to ER to help manage hypotension (3)

Answer 15

• domaine
• epinephrine
• atropine

Question 16

S+S autonomic dysreflexia (5)

Answer 16

• blurred vision
• throbbing headache
• marked diaphoresis above injury level
• bradycardia
• severe increase bp

Question 17

what are pts who have level T6 injury or higher at risk for

Answer 17

autonomic dysreflexia

Question 18

triggers of autonomic dysreflexia (4)

Answer 18

• full bladder/UTI
• restrictive clothing
• pressure areas
• fecal impaction

Question 19

Tx autonomic dysreflexia

Answer 19

• find underlying cause

- nifedipine

Question 20

bladder complication after spinal cord injury

Answer 20

-neurogenic bladder: difficulty urinating independently

Question 21

Tx neurogenic bladder

Answer 21

self intermittent catheterization

Question 22

med Tx neurogenic spasticity (3)

Answer 22

• anticholinergic (oxybutynin, tolterodine)
• alpha blocker (terazosin, doxazosin)
• antispasmodics (baclofen)

Question 23

SE anticholinergics (oxybutynin, tolterodine) (5)

Answer 23

• headache
• dizziness
• dry mouth
• constipation
• dry eyes

Question 24

contraindications anticholinergics (oxybutynin, tolterodine) (2)

Answer 24

• urinary retention

- uncontrolled narrow angle glaucoma

Question 25

GI issues after level T5 injury or above (5)

Answer 25

- hypomobility - paralytic ileus - gastric distention - peptic ulcers - neurogenic bowel

Question 26

meds for peptic ulcers (3)

Answer 26

- PPIs (-prazole) - high dose corticosteroids - H2 blockers (famotidine)

Question 27

inability to defecate independently

Answer 27

neurogenic bowel

Question 28

Tx neurogenic bowel (4)

Answer 28

- scheduled toileting - stool softener - suppository - high fiber diet and adequate fluid intake

Question 29

adjustment of body temp to room temp

Answer 29

poikilothermism

Question 30

how is thermal regulation impaired with spinal cord injury

Answer 30

-decreased ability to sweat and shiver

Question 31

admin/nursing considerations for antispasmodics (baclofen and dantrolene) (4)

Answer 31

- monitor for weakness - avoid driving - don't stop taking abruptly - do not take with alcohol or CNS depressants

Question 32

what imbalance can NG suctioning lead to

Answer 32

metabolic alkalosis

Question 33

nutritional considerations for spinal cord injury pts

Answer 33

- high calorie - high protein - high nitrogen - NG tube

Question 34

scale for classifying extent of impairment from spinal cord injury

Answer 34

ASIA scale | american spinal injury association

Question 35

Dx spinal cord injury

Answer 35

- x-rays | - CT

Question 36

immediate Tx spinal cord injury

Answer 36

- patent airway - good ventilation - adequate circulation (dopamine, epinephrine) - protect further cord damage - increase bp with meds

Question 37

after spinal cord injury: temporary neurologic syndrome, reversible

Answer 37

spinal shock

Question 38

S+S spinal shock (3)

Answer 38

- loss of reflexes - loss of sensation - flaccid paralysis below level of injury

Question 39

prophylactic Tx to prevent spinal shock

Answer 39

high dose corticosteroids

Question 40

after spinal cord injury: loss of vasomotor tone, generally associated with injury T6 or higher

Answer 40

neurogenic shock

Question 41

S+S neurogenic shock (3)

Answer 41

- hypoTN - bradycardia - decreased CO

Question 42

med Tx neurogenic shock (2)

Answer 42

- atropine (for bradycardia) | - dopamine/norephinephrine/vasopressin (for bp)

Question 43

nursing admin considerations for vasopressors (dopamine, norepinephrine, vasopressin) (3)

Answer 43

- monitor bp q15mins - watch IV site for extravasation - know target mean arterial pressure (ex: MAP>65)