class 15 spinal cord injury Flashcards
what is a spinal cord injury
insult to cord changing motor/sesnory function
-most common in ages 16-30 males
most common causes of spinal cord injury
-motor vehicle crashes
-unintentional falls
-recreational activites
types of spinal cord damage
-transient concussion
-contusion
-laceration
-compression
-complete transecion
most common vertebra damaged
C5
C6
C7
T12
L1
priority with suspected spinal cord injury
-#1 ABC’s
-neuro assessment, immobilize complete
-assess V/S for hypovolemic shock
-X-ray
-MRI
(cannot know the extend of damage without imaging unless cord is completely severed)
what is tetraplegia
-cervical region affected
-all 4 extremities
what is paraplegia
-thoracic
-lumbar
-sacral regions
-lower extremities
what is complete spinal cord injury
-loss of motor and sensory function below injury
what is incomplete spinal cord injury
-partial or complete sensory/motor fibres perserved
if someone has a C3 injury or higher:
require mechanical ventilation
acute phase management of spinal cord management
-immobilization, body alignment, skin integrity
-respiratory and CV support
-high dose IV corticosteroids (not used in Canada)
-skeletal fracture reduction and traction
what is a primary spinal cord injury
as a result from an injury
what is secondary spinal cord injury
caused by edema, inflammation, surrounding primary injury
acute complications of spinal cord injury
spinal shock
neurogenic shock
what is spinal shock
-decreased reflex activity below injury (bowel & bladder loss of control)
-loss of sensation
-flaccid paralysis
-hypotension
-bradycardia
what is neurogenic shock
may last up to 4 months post injury
-loss of autonomic nervous vasomotor tone
-hypotension
-bradycardia
-peripheral vasodilation
-venous pooling
-decreased cardiac output
-loss of sweating
management of spinal and neurogenic shock
-vasopressors (dopamine, atropine)
-NG decompression (dec bowel distension)
-bladder and bowel management (foley + bowel program)
-temperature monitoring
manifestations of thromboembolism
-chest pain
-anxiety
-SOB
-increased PaCO2
-decreased PaO2
management of venous thromboembolism
-low dose
-anti-embolism stockings/sequential pneumatic compression device
-calf and thigh measurement
-indwelling filter invena cava
what is autonomic dysreflexia
-life threatening emergency
-abnormal overeaction of the autonomic nervous system after a spinal cord injury (usually occurs in rehab phase)
manifestations of autonomic dysreflexia
-hypertension
-severe H/A
-diaphoresis
-bradycardia
-piloerection
-flushing of skin
-nasal congestion
-nausea
management of autonomic dysreflexia
-sit pt upright
-remove stimuli
-palpate/empty bladder
-digital rectal exam, removal of stool
-check skin for pressure/irritation
-monitor BP closely (may need antihypertensive)
-educate pt
home care to prevent disuse syndrome
-ROM exercises QID
-frequent repositioning
-botox injections, baclofen pumps, tendon severing
home care to promote skin integrity
-BID visual and tactile exam
-monitor ischia, trochanters, heelsm sacrum
-reposition Q2H
-pressure relieving cushions/mattresses
-high protein, calorie, vitamin, fluid diet
-shift weight every (15-30 min)
home care bladder management
-identify appropriate drainage method
-surgical options
-anticholinergic drugs, adrenergic blockers, antispasmotic drugs
home care bowel management
-high fiber/fluid diet
-suppositories or enemas with digital stimulation
-stool softeners
-valsalva and manual stimulation (for lower motor neuron lesions)
-time BM for 30-60 minutes after breakfast
-upright position with feet flat on floor or stool
-exercise
home care sexuality
-can have reflex sexual fucntion if upper motor neuron lesion
-may be capable of psychogenic erection if lower motor neuron lesion
-medications/penile prosthesis
-open communication
-pregnancy is not contraindicated
home care coping mechanisms
-promote self care
-counseling for patient, caregiver and family
