ch 60 spinal cord injury Flashcards
most unstable type of spinal cord injury
flexion-rotation injury
after how many hours does permanent spinal cord damage occur from edema
24+ hours
vertebral level where there is the most damage to vertebral bones and ligaments
skeletal level of injury
lowest segment of spinal cord with normal sensory and motor function on both sides of body
neurologic level of injury
how many cervical vertebrae
8
how many thoracic vertebrae
12
how many lumbar vertebrae
5
what level vertebrae fracture can kill someone
C1/C2
3 types paralysis
tetraplegia (neck down)
paraplegia (waist down)
hemiplegia (one side body)
biggest concern with cervical and upper thoracic injuries (3)
- impaired breathing
- impaired ability to regulate bp
- impaired heart function
nursing considerations for pts with injury at or above C4 level
- need ventilator
- need cardiac support
resp S+S for pts with injury below C4
-labored breathing and hypoventilation
any cord injury above level T6 affects what body system
sympathetic nervous system
cardiovascular
cardiovascular S+S with injuries above level T6
- bradycardia
- hypotension
what meds should be given to pt with level T6 injury or above when they get to ER to help manage hypotension (3)
- domaine
- epinephrine
- atropine
S+S autonomic dysreflexia (5)
- blurred vision
- throbbing headache
- marked diaphoresis above injury level
- bradycardia
- severe increase bp
what are pts who have level T6 injury or higher at risk for
autonomic dysreflexia
triggers of autonomic dysreflexia (4)
- full bladder/UTI
- restrictive clothing
- pressure areas
- fecal impaction
Tx autonomic dysreflexia
- find underlying cause
- nifedipine
bladder complication after spinal cord injury
-neurogenic bladder: difficulty urinating independently
Tx neurogenic bladder
self intermittent catheterization
med Tx neurogenic spasticity (3)
- anticholinergic (oxybutynin, tolterodine)
- alpha blocker (terazosin, doxazosin)
- antispasmodics (baclofen)
SE anticholinergics (oxybutynin, tolterodine) (5)
- headache
- dizziness
- dry mouth
- constipation
- dry eyes
contraindications anticholinergics (oxybutynin, tolterodine) (2)
- urinary retention
- uncontrolled narrow angle glaucoma
GI issues after level T5 injury or above (5)
- hypomobility
- paralytic ileus
- gastric distention
- peptic ulcers
- neurogenic bowel
meds for peptic ulcers (3)
- PPIs (-prazole)
- high dose corticosteroids
- H2 blockers (famotidine)
inability to defecate independently
neurogenic bowel
Tx neurogenic bowel (4)
- scheduled toileting
- stool softener
- suppository
- high fiber diet and adequate fluid intake
adjustment of body temp to room temp
poikilothermism
how is thermal regulation impaired with spinal cord injury
-decreased ability to sweat and shiver
admin/nursing considerations for antispasmodics (baclofen and dantrolene) (4)
- monitor for weakness
- avoid driving
- don’t stop taking abruptly
- do not take with alcohol or CNS depressants
what imbalance can NG suctioning lead to
metabolic alkalosis
nutritional considerations for spinal cord injury pts
- high calorie
- high protein
- high nitrogen
- NG tube
scale for classifying extent of impairment from spinal cord injury
ASIA scale
american spinal injury association
Dx spinal cord injury
- x-rays
- CT
immediate Tx spinal cord injury
- patent airway
- good ventilation
- adequate circulation (dopamine, epinephrine)
- protect further cord damage
- increase bp with meds
after spinal cord injury: temporary neurologic syndrome, reversible
spinal shock
S+S spinal shock (3)
- loss of reflexes
- loss of sensation
- flaccid paralysis below level of injury
prophylactic Tx to prevent spinal shock
high dose corticosteroids
after spinal cord injury: loss of vasomotor tone, generally associated with injury T6 or higher
neurogenic shock
S+S neurogenic shock (3)
- hypoTN
- bradycardia
- decreased CO
med Tx neurogenic shock (2)
- atropine (for bradycardia)
- dopamine/norephinephrine/vasopressin (for bp)
nursing admin considerations for vasopressors (dopamine, norepinephrine, vasopressin) (3)
- monitor bp q15mins
- watch IV site for extravasation
- know target mean arterial pressure (ex: MAP>65)
