Chapter 45 Problems of CNS: The Spinal Cord Flashcards
factors contributing to low back pain
changes in support structures: spinal stenosis, hypertrophy of intraspinal ligaments, osteoarthritis
changes in vertebral support and malalignment: scoliosis, lordosis
vascular changes: diminished blood supply to the spinal cord or cauda equina caused by arteriosclerosis, blood dyscrasias
intervertebral disk degeneration
Exercises for chronic or postoperative low back pain (6)
extension: stomach lying upper trunk extension prone pushup flexion: pelvic tilt semi sit ups knee to chest
Major Complications of Lumbar Spinal Surgery (first 4)
CSF leak: observe for clear fluid on or around dressing. report CSF leakage immediately to surgeon (pt is kept bedrest while tear heals)
Fluid Volume Deficit: monitor I&O, monitor drain output, should not be more than 250mL in 8hr during the first 24 hours. monitor for signs of hypotension and tachycardia.
Acute Urinary Retention: assist to bathroom or bsc asap postop. assist male pts to stand at bedside asap postop.
Paralytic Ileus: monitor for flatus or stool. assess for abd distention, nausea, vomiting
Major Complications of Lumbar Spinal Surgery (last 3)
Fat Embolism Syndrome (FES): more common in people with spinal fusion. observe and report chest pain, dyspnea, anxiety, mental status changes (particularly common in older adults). note petechiae around neck, upper chest, buccal membrane, conjunctiva. monitor ABGs for decreased PaO2.
Persistent or Progressive Lumbar Radiculopathy (nerve root pain): report pain not responsive to opioids. document location and nature of pain. administer prescribed analgesics as prescribed.
Infection: wound, diskitis, hematoma. monitor temp carefully (slight elevation is normal). increased temp elevation or spike after second postop day is possibly indicative of infection. report increased pain or swelling at wound site or in legs. give antibiotics as prescribed if infection is confirmed. use clean technique for dressing changes.
Care of Pt after Anterior Cervical Diskectomy and Fusion: Postop
assess ABCs (first priority!)
check for bleeding and drainage at incision site
monitor vital signs and neurologic status frequently
check for swallowing ability
monitor I&O
assess ability to void (may be a problem secondary to opiates)
manage pain adequately
assist with ambulation within a few hours after surgery if able.
Care of Pt after Anterior Cervical Diskectomy and Fusion: Discharge Teaching
be sure someone is with pt for first few days after surgery
review drug therapy
teach care of the incision
review activity restrictions (no lifting, no driving until physician permission, no strenuous activity)
walk every day
call the surgeon if symptoms of pain, numbness, and tingling worsen or if swallowing becomes difficult
wear brace or collar per surgeon’s prescription
Postop Complications of Cervical Diskectomy
hoarseness due to laryngeal injury; temporary or permanent
temporary dysphagia; may last a few days to several months; usually not severe
esophageal, tracheal, vertebral artery injury
wound infection
injury to spinal cord or nerve roots
dura mater tears with associated CSF leaks
pseudoarthrosis caused by nonunion of fusion
graft and screw loosening if a fusion was performed
Assessing motor function in the patient with a spinal cord injury
to assess C4-C5: apply downward pressure while the patient shrugs his or her shoulders upward
to assess C5-C6: apply resistance while the patient pulls up his or her arms
to assess C7: apply resistance while the patient straightens his or her flexed arms
to assess C8: make sure the patient is able to grasp an object and form a fist
to assess L2-4: apply resistance while the patient lifts his or her legs from the bed
to assess L5: apply resistance while the patient dorsiflexes his or her feet
to assess S1: apply resistance while the patient plantar flexes his or her feet
Pt with Spinal Cord Injury: Airway Management
position pt. to maximize ventilation potential
identify pt requiring actual/potential airway insertion
insert oral or nasopharyngeal airway as appropriate
perform chest physiotherapy as appropriate
remove secretions by encouraging coughing or by suctioning
encourage slow, deep breathing, turning and coughing
instruct how to cough effectively
assist with incentive spirometer, as appropriate
auscultate breath sounds, noting areas of decreased or absent ventilation and presence of adventitious sounds
perform endotracheal or nasotracheal suctioning
administer humidified oxygen as appropriate
regulate fluid intake
position to alleviate dyspnea
monitor respiratory and oxygenation status
Pt with Spinal Cord Injury: Positioning: Neurologic
immobilize or support the affected body part as appropriate
place in the designated therapeutic position
maintain proper body alignment
position with head and neck in alignment
turn using the log roll
apply orthosis collar
instruct on orthosis collar care prn
apply and maintain splinting or bracing device
monitor skin integrity under bracing device/orthosis collar
instruct on pin site care, prn
monitor traction pin insertion site
perform traction/orthosis device pin insertion site care
monitor traction device setup
Autonomic Dysreflexia (severe uncontrolled SNS output caused by a distended bladder or constipation r/t SCI above level of T6)
sudden onset of severe, throbbing headache severe, rapidly occurring hypertension bradycardia flushing above level of lesion (face and chest) pale extremities below level of lesion nasal stuffiness sweating nausea blurred vision piloerection feeling of apprehension
Emergency care of pt. experiencing autonomic dysreflexia: immediate interventions
place pt in sitting position (first priority!!!)
page/notify health care provider
loosen tight clothing on pt
assess for and treat the cause
check the urinary catheter tubing for kinks or obstruction
if not present, check bladder for distention and catheterize immediately if indicated
place anesthetic ointment on tip of catheter before insertion
check pt for fecal impaction if present, disimpact immediately using anesthetic ointment
check the room temp to ensure it is not too cool or drafty
monitor blood pressures every 10-15 minutes
give nitrates or hydralazine (Apresoline, Novo-Hylazin) as prescribed
What Pts need to know about aging with spinal cord injury
get flu shots annually, tetanus every 10 yrs, and pna vaccine as required
for women, have annual Pap smears and mammograms
take measures to prevent osteoporosis, increase calcium, exercise, and avoid caffeine and smoking
practice meticulous skin care, moisturize, drink plenty of water
prevent constipation: drink adequate fluids, eat healthy diet with fiber, exercise
modify activities if joint pain occurs: powered rather than manual wheelchair. ask health care provider about treatment options (more likely to develop arthritis due to wheelchair’s stress on upper extremities)
Spinal Cord Tumors: General
pain
sensory loss or impairment
motor loss or impairment
sphincter disturbance (bladder before bowel)
Spinal Cord Tumors: High Cervical
Respiratory distress diaphragm paralysis occipital headache quadriparesis stiff neck nystagmus cranial nerve dysfunction
