Chapter 20 Acute Spinal Cord Injury Flashcards
2) A patient is diagnosed with a fracture of anterior and posterior columns of three cervical vertebrae. How would the nurse describe this injury?
1. As life threatening
2. As stable
3. As minor
4. As unstable
Answer: 4
Explanation: 1. In itself, this injury is not life threatening. If secondary damage occurs, it could become life threatening.
2. This injury is significant and would not be considered stable.
3. Damage to two columns of three vertebrae is not a minor injury.
4. The spine is conceptualized as having three columns: an anterior column that includes the anterior part of the vertebral body, a middle column that houses the posterior wall of the vertebral body, and a posterior column that includes the vertebral arch. If two or more of these columns are damaged, the injury is considered to be unstable. The patient has an unstable spinal cord injury.
1) A patient is admitted for a lumbar laminectomy. The nurse reinforces teaching that which portion of the vertebra will be removed?
1. Roof of the arch
2. Cartilage inside the vertebra
3. Pedicles that attach the arch to the body
4. Spinous process
Answer: 1
Explanation: 1. Each vertebra consists of a body that is anterior and an arch that is posterior. The arch section is composed of two pedicles that attach the arch to the body and two laminae that form the roof of the arch.
2. Cartilage is not a part of the vertebra.
3. The pedicles attach the arch to the body of the vertebra. This is not the site of a laminectomy.
4. The spinous process is located at the rear of the vertebrae. This is not the site of the laminae.
3) A patient is diagnosed with damage to the spinothalamic tract of the spinal cord. Which assessment finding would the nurse attribute to this damage?
1. The patient reports an unusual amount of pain.
2. Muscle spasms are occurring in the patient’s right leg.
3. The patient has ataxia.
4. The patient is complaining of vertigo.
Answer: 1
Explanation: 1. The spinothalamic tract originates in the spinal cord, crosses over with segments of entry, and ascends to the thalamus in the brain. It transmits pain and temperature. The patient with damage to the spinothalamic tract of the spinal cord will manifest an unusual amount of pain.
2. The corticospinal tract originates in the brain and crosses over in the brainstem to innervate the opposite side of the body. It transmits motor activity, which would be the cause for the muscle spasms in the patient.
3. The posterior horn contains axons from the peripheral sensory neurons and is responsible for position sense. Damage to this portion of the cord could manifest as ataxia.
4. The posterior horn contains axons from the peripheral sensory neurons and is responsible for position sense. Damage to this portion of the cord could manifest as vertigo in the patient.
4) The nurse is caring for a patient with a fractured sacrum. The nurse would assess for which changes as a result of this fracture?
1. Altered sympathetic responses
2. Alteration in pain responses
3. Alteration in position sense
4. Altered parasympathetic responses
Answer: 4
Explanation: 1. The sympathetic nervous system is in the gray matter of the first thoracic through the second lumbar section of the cord. The patient does not have an injury to this region.
2. Alteration in pain responses would be seen with damage to the spinothalamic tracts.
3. Alteration in position sense would be seen with damage to the posterior column tracts.
4. The parasympathetic nervous system originates in a group of neurons located in the brainstem and in a group located between the second and fourth sacral segments of the cord. The patient with a fractured sacrum could experience alterations in the parasympathetic responses.
5) A patient is diagnosed with central cord syndrome. Which assessment finding would the nurse anticipate from this injury?
1. Complete paralysis of lower extremities
2. Loss of bladder and bowel function
3. Motor function intact in upper extremities
4. Variable motor function in lower extremities
Answer: 4
Explanation: 1. Complete paralysis of lower extremities does not result from central cord syndrome.
2. Patients with central cord injury typically retain some bladder and bowel function.
3. The upper extremities will demonstrate spastic paralysis and not an intact upper extremity motor status.
4. In central cord syndrome, the patient will demonstrate variable motor function of the lower extremities.
6) A patient comes into the emergency department after being injured in an automobile crash in which a semi-truck hit her car from behind. The nurse will assess this patient for findings associated with which type of injury?
1. Ankylosing spondylitis
2. Axial loading
3. Hyperflexion
4. Hyperextension
Answer: 4
Explanation: 1. Ankylosing spondylitis can cause a nontraumatic hyperextension injury.
2. Axial loading injury, or compression fracture, is caused by a vertical force along the spinal cord and is seen after diving into shallow water or jumping from tall heights and landing on the feet or buttocks.
3. Hyperflexion injury is most often caused by a sudden deceleration of the motion of the head or a head-on collision.
4. Hyperextension injuries are caused by a forward and backward motion of the head as seen in rear-end collisions. With this injury, the anterior ligaments are torn and the spinal cord is stretched. A mild form of hyperextension injury is the whiplash injury.
7) A patient was admitted this morning after sustaining an acute spinal cord injury. This afternoon his neurological assessment shows some deterioration of function. How would the nurse explain this to the patient’s family?
1. “Injured cells release potassium that causes destruction of the covering of nerves in the area injured.”
2. “Decreased blood flow increases the size of the affected area.”
3. “The body’s inflammatory response has caused blood vessels in the area to dilate.”
4. “Injury to nerves impairs the body’s healing responses.”
Answer: 2
Explanation: 1. Calcium is released in a spinal cord injury and is responsible for demyelization.
2. Blood flow to the spinal cord decreases immediately on injury as a result of hypotension and vasospasm-induced thrombosis. Thrombi in the microcirculation impede blood flow. The zone of ischemia can spread if perfusion to the cord is not restored.
3. Dilation of vessels would improve blood flow to the region and would not result in deterioration of neurological condition.
4. This statement is not true.
8) A patient suffered an acute T6 spinal cord injury. Family has been told that the patient will likely be paraplegic. However, this morning the patient has limited use of her arms. How should the nurse explain this change?
1. “There must be a second area of fracture higher in the spine.”
2. “The spinal cord is probably swollen above the area of original injury.”
3. “These changes are due to the low blood pressure she had before she got to the hospital.”
4. “This is a sign that she is dehydrated and will go away as we give her more IV fluids.”
Answer: 2
Explanation: 1. It would be premature to suggest that a second area of injury exists.
2. In a spinal cord injury, as the cord swells within the bony vertebrae, edema moves up and down the cord. A patient may exhibit symptoms as a result of the edema and not the initial injury. Because edema can extend the level of injury for several cord segments above and below the affected level, the extent of injury may not be determined for several days, until after the cord edema has resolved.
3. There is no evidence that this change in neurological status is associated with prehospital hypotension.
4. This change is not likely due to hypovolemia.
9) A patient is admitted with a fractured mandible and several fractured ribs. Which priority intervention would the nurse anticipate?
1. Providing pain medication
2. Determining lung function by chest x-ray
3. Maintaining spinal cord injury precautions
4. Stabilizing the rib fractures
Answer: 3
Explanation: 1. Provision of pain medication is indicated for this patient, but it is not the highest priority.
2. It is important to determine the status of this patient’s lung function but this is not the intervention of highest priority.
3. Since a spinal cord injury should be suspected in a patient with maxillofacial injury and clavicle or upper rib fractures, the patient should be maintained on spinal cord injury precautions until the injury has been ruled out.
4. It is important to stabilize rib fractures, but this is not the intervention of highest priority
10) It is suspected that a patient admitted with spinal cord injury has severe cord injury. The nurse would prepare the patient for which diagnostic test to determine the extent of this edema?
1. Angiography
2. Somatosensory-evoked potentials
3. CT scan
4. MRI
Answer: 4
Explanation: 1. Angiography is useful for patients with complex cervical spine fractures involving subluxation, extension into the foramen transversarium, or upper C1 to C3 fractures.
2. Somatosensory-evoked potentials are used to establish a functional prognosis after resolution of spinal cord edema.
3. CT scans are not the most sensitive tests for determination of cord edema.
4. The MRI has greater sensitivity than a CT scan for diagnosing contusions, hematomas, and edema. The diagnostic test that would be the most helpful for this patient would be the MRI.
