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Nursing 2016 > Chapter 43 Spinal > Flashcards

Chapter 43 Spinal Flashcards

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1
Q

Describe acute pain.

A

due to trauma or injury. Muscle strain or spasm, ligament sprain or disc degeneration/herniation - less than 3 months

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2
Q

What is a herniated disc?

A

nerve pressure ( usually sciatic nerve- burning, stabbing, radiating pain)

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3
Q

What is a spinal stenosis>

A

narrowing of the spinal cord or nerve root

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4
Q

What is spondyloisthesis?

A

Defect in one of the vertebrae

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5
Q

What is Spondylolisthesis

A

vertebrae slips onto the one below itself

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6
Q

What is spondylosis?

A

degenerative changes in the spine

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7
Q

How do you assess for lower back pain?

A

pain, mobility, paresthsia (tingling), urinary and bowel incontinence

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8
Q

Describe interventions for acute lower back pain.

A

Position (Williams); Frequent position changes
Medications: NSAIDs acetaminophen, opioid/non opioid, analgesics, steroids
Epidural-corticosteroid/anesthetic

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9
Q

Describe interventions for chronic lower back pain.

A

Antidepressants
Heat/cold application
PT
Weight restrictions

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10
Q

What is phonophresis?

A

topical drug and 10 minutes of ultrasound (provided by PT)

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11
Q

What is lontophoresis?

A

toical drug and electrical current (provided by PT)

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12
Q

Describe surgical management for lower back pain

A

Minimally invasive
Patients will go home the same day
Conventional open- discectomy, laminectomy, fusion (p. 889)

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13
Q

What are some post-op considerations for lower back pain?

A

Conventional surgery- first 24-48 hours are the most critical
VS (fever& hypotension may indicate bleeding and pain)
Neurologic assessment
Ability to void
Pain ( PCA/ Oral medication)
Drains/ drainage (clear drainage usually indicates meningeal tear. Patients with meningeal tear and CSF leak are placed in a supine position and strictly on bed rest. Notify physician immediately if you suspect a CSF leak.)
Moving/mobility
VTE prevention

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14
Q

Explain failed back surgery syndrome (FBSS)

A

Usually due to the combination of organic, psychological and socioeconomic factors
Nerve blocks/ spinal cord stimulators
Repeated surgery
Intrathecal (spinal) injections with Ziconotide (Prialt)- N-type calcium channel blocker.

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15
Q

Describe cervical neck pain.

A

Often due to bulging or herniated disc. (nerve compression)
Radiating pain
Contributing factors: aging, poor posture, lifting, tumors, rheumatoid arthritis, osteoarthritis, infection

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16
Q

Describe nonsurgical pain management for cervical neck.

A

Position
Medication
PT

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17
Q

Describe surgical management (anterior and posterior approach) for cervical neck pain management.

A

Postoperative management : airway, breathing, circulation
VS; bleeding/drainage; swallowing; I&O
Ability to void
Pain
Mobility

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18
Q

What are some cervical neck pain surgical complications?

A 
Hoarseness
Dysphagia
Esophageal, tracheal or vertebral artery injury
Wound infection
CSF leak
Hardware problems
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19
Q

What is a complete spinal cord injury?

A

there is no innervation below the injury

20
Q

What is an incomplete spinal cord injury?

A

some function or movement belove thw injury is present

21
Q

List the primary injuries

A 
hyperflexion
hyperextension
axial loading
rotation injuries
penetrating injuries
22
Q

What is hyperflexion mechanism of injury

A

extreme flexion of the neck; car accidents; injury to thorax and lumbar spine if due to fall on buttocks.-primary

23
Q

What is hyperextension mechanism of injury

A

rapture of longitudinal ligament- primary

24
Q

What is axial loading mechanism of injury?

A

vertical compression (vertebrae shatters) primary

25
Q

What are the secondary mechanisms of injury?

A 
Hemorrhage
Ischemia
Hypovolemia
Impaired tissue perfusion
Local edema
26
Q

Describe an assessment for spinal cord injury.

A

History
Airway; Breathing; Circulation (Cardiovascular and respiratory assessment)
Airway may be compromised; C3-5 controls breathing; pulse, BP, bleeding
Level of Consciousness (Glasgow coma scale)
Spinal shock
Sensory assessment
GI & GU assessment

27
Q

What are some interventions for SCI?

A 
Airway and breathing
Intubation
Coughing, pulmonary hygiene and suctioning
Neurogenic shock 
Maintain hydration
Monitor blood pressure (VS)
Preventing secondary injuries
Immobilization
Body alignment 
Motor function & pain
28
Q

What are some interventions for SCI?

A 
Pressure ulcers
Frequent position change
Surgery
To stabilize the spine
Urinary and bowel elimination
Foley catheter
Intermittent emptying 
Stool softeners
Increased fluid intake
29
Q

What are some drug therapy for SCI?

A 
Dextran- plasma expander
Atropine sulfate – bradycardia tx
Dopmine – hypertension
Tizanidine- skeletal muscle relaxant
Celebrex- heterotopic ossification
Calcium & phosphate- prevent osteoporosis
30
Q

Autonomic Dysreflexia

A

know :) It is the idea that you could be sitting on a tac and a paralyzed patient may not recognize it but the body will and will respond by a shooting blood pressure. Caused by bladder, bowel, skin irritation

31
Q

What is a extramedullary spinal cord tumor?

A

within the spinal dura but not in the spinal cord

32
Q

What is the assessment for a spinal cord tumor?

A

Pain- Radicular
Mobility –weakness, clumsiness, hyperactive reflexes
Sensory perception
Bladder and bowel weakness

33
Q

What is an intramedulliary spinal cord tumor?

A

within the spinal cord central gray matter

34
Q

What are some interventions for spinal cord tumors?

A

Surgery to relieve pressure and control symptoms
Postoperatively: monitor VS, neurologic function, CSF leak
Radiation- spinal cord can not tolerate high doses of radiation
Overexposure manifestations even 6-12 mts post therapy
Chemotherapy – limited options

35
Q

Describe multiple sclerosis.

A

Inflammation which causes demyelination and axonal injury
Demyelination – slow or stopped impulses
Characterized by periods of remission and exacerbation

36
Q

What are the 4 major types of MS?

A

Relapsing- Remitting type
Primary Progressive
Secondary Progressive
Progressive Relasping

37
Q

What is relapsing remitting type of MS?

A

classic type. Symptoms develop and resolve with in few weeks or months

38
Q

What is primary progressive MS?

A

Progressive neurologic deterioration without remission

39
Q

What is a secondary progressive MS?

A

starts as relapsing/remitting but it gets progressively worst

40
Q

What is progressive relapsing MS?

A

frequent relapses with partial recovery

41
Q

What is the assessment for MS?

A 
Presents as neurologic disease.
Patients are often stiff and fatigued. Fatigue is very specific and disabling (sensitivity to temperature)
Flexor spasm
Hyporective reflexes
Positive Babinski(toes curled outward)
Unsteady gait
Intention tremor (tremor with activity)
Dysmetria
Vertigo
Speech problems
42
Q

What are some diagnostic tests for MS?

A

No specific test
MRI
CSF- increased protein & WBC
CSF- IgG presence

43
Q

What are some interventions for MS?

A 
Interventions:
Mainly pharmacological (p 908)
PT
Promote mobility 
Psychotherapy
44
Q

Describe Amyotrophic Lateral Sclerosis- Lou Gehrig’s Disease.

A

Adult onset
Upper and lower motor neuron disease
Progressive weakness and muscle wasting
Leads to paralysis
Affects the ability to talk, swallow, breathe
Unknown cure
Negative prognosis (death occurs with in 3 years of diagnosis)
Unknown cause
May be due to the combination of genetic, viral and environmental factors

45
Q

What is the assessment for Lou Gehrig’s Disease?

A

Fatigue
Muscle atrophy & Weakness
Motor & Cognitive changes

46
Q

What are the interventions for Lou Gehrig’s disease?

A

PT & OT
Palliative Care
Speech therapy
Riluzole (Rilutek)

Nursing 2016 (20 decks)

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