Exam 3 - SCI Flashcards
what are the 4 components to the spinal cord
cervical (C1-8)
thoracic (T1-12)
lumbar (L1-5)
sacral (S1-5)
SCI above __ causes paralysis of respiratory muscles AND all 4 extremities (quadriplegia)
C4
primary SCI is caused by cord compression d/t
bone displacement
interruption of blood supply
traction from pulling on cord
what is secondary SCI
ongoing, progressive damage that occurs after initial injury
secondary SCI: permanent damage may occur within __ hours d/t ___
24 hours; edema
extent of SCI damage and prognosis is not determined until __ hours or more after injury
72 hours
greatest improvement of SCI occurs in the first __ to __ months after injury
3-6 months
3 measures to classify SCI
mechanism of injury
level of injury
degree of injury
what are the 5 major mechanisms of SCI
flexion
hyperextension
flexion-rotation
extension-rotation
compression
tetraplegia is aka ___ and occurs d/t injury in which area
quadraplegia; cervical
paraplegia occurs d/t injury in which areas
thoracic
lumbar
complete vs. incomplete (partial) injuries
c: total loss of sensory and motor function below level of injury
i/p: mixed loss; some tracts intact
what is central cord syndrome
damage to central spinal cord, commonly cervical
older adults
motor weakness
sensory loss - low extremities not affected
dysesthetic
what is dysesthetic
burning pain in upper extremities
what is anterior cord syndrome
damage to anterior spinal artery (compromised blood flow)
resulted from flexion injury
motor paralysis, loss of pain + temp sensation below level of injury
what is brown-sequard syndrome
damage to 1/2 of cord
resulted from penetrating injury
what is conus medullaris syndrome
damage to conus medullaris (lowest portion of spinal cord)
leg: preserved, weak or flaccid
decrease, loss of sensation in perianal
areflexic (flaccid) bladder, bowel
impotence
what is cauda equina syndrome
damage to cauda equine (lumbar, sacral nerve roots)
flaccid paralysis of lower extremities
complete loss of sensation in saddle area
areflexic bladder, bowel
severe, radicular, asymmetric pain
injuries above __ lead to dysfunction of sympathetic nervous system
T6
neurogenic shock
bradycardia
peripheral vasodilation
hypotension
acute phase: urinary system function
retention
bladder atonic, over distended, fails to empty
indwelling catheter
postacute phase: urinary system function
bladder can become hyperirritable
loss of inhibition from brain
reflex emptying, failure to store urine
GI s/sx
gastric distention
paralytic ileus
delayed gastric emptying
stress ulcers
dysphagia
integumentary s/sx
skin breakdown potential
piokilothermia
NG suctioning puts the pt at risk for which acid-base imbalance
metabolic alkalosis
what is of concern the first 3 months after a SCI
DVT, PE
nociceptive pain
musculoskeletal: dull, ache; worse with movement
visceral: thorax, abdomen, pelvis
neuropathic pain location
at or below level of injury
hot, burning, tingling, pins + needles, cold, shooting
when is spinal immobilization not recommended
penetrating trauma
you want to maintain SBP > __ mmHg
90
surgery within __ hours is associated with improved neurological outcome
24 hours
why are vasopressors given
maintain MAP > 85-90 mmHg
S/E of vasopressor agents
tachycardia
VT, afib
elevated troponin
metabolic acidosis
C1-3 will have ___ and inability to ___
apnea; inability to cough
C4 will have a poor ___ and ___
poor cough; hypoventilation
C5-6 will have a ___ ___ reserve
decrease respiratory
what to auscultate with a T5 injury
bowel sounds
overall goal of SCI
optimal level of neurologic functioning
pin site care
cleanse with 1/2 strength peroxide and NS BID
apply abx ointment
what is kinetic therapy
continual side-to-side rotation
prevent pulmonary complications
prevent pressure ulcers
nutrition should be started within __ hours. it should be what
72 hours
high protein, high calorie
what occurs during intermittent catheterization program
4-6 times daily
monitor for s/sx of UTI
increase fluid intake
what is daily rectal stimulation
suppository or small-volume enema
dulcolax, colace
when does stress ulcers commonly occur after injury
6-14 days
what are some meds that can be given to help with neuropathic pain
gabapentin
lyrica
cymbalta
amitriptyline
return of ___ may complicate rehab
reflexes
hyperactive
exaggerated responses
penile erection
spasms
what are some antispasmodic meds that can be given
baclofen
dantrium
xeniflex
botox injections
