GF14: Neuro Spinal Cord Injury (SCI) Flashcards
What is an SCI?
- Spinal cord injury
- Spinal cord injuries happen when there is damage to or a break in the spinal cord.
What are two types of SCIs?
- Complete
- Partial
Define complete SCI
- Complete break in the spinal cord
- No motor or sensory function below the level of injury
Define partial SCI
- Spinal cord is only partially severed or damaged
- Some level of sensory or motor function below the level of injury (highly variable)
What is the patho of a SCI?
- Trauma occurs to the spine
- The level of injury determines severity and what systems are affected.
- Injury puts pressure on, cuts into or severs the spinal cord
- Injury inflammation and bruising will occur cutting nerve signals below site of injury
- Due to inflammation, initial s/s may be worse than where they will finally settle when the inflammation resolves
- As the injury heals, scar tissue will form and some s/m function may or may not return
- Pt will reach a new baseline of functioning
What are some common s/s of spinal cord injury?
- Tingling/Vibrating/Buzzing sensation
- Difficulty w/ balance and gait
- Incontinence or retention
- Loss of reflexes, motor or sensory functions
- SOB, difficult WOB
- HR/BP changes
- Pain or pressure
What are the emergency nursing interventions (immediately following SCI)?
- ABCS
- Airway, breathing, circulation, spine stability
- Maintain fluid balance to keep BP stable WITHOUT causing fluid overload
After ABCS are addressed, what are the assessments to be done?
- Mental status changes
- Changes in level of consciousness
- Blood perfusion
- Blood pressure and heart rate
- If they are intubated, assess their arterial blood gas (ABG) levels to make sure they are getting enough oxygen and aren’t retaining too much CO2.
How are we monitoring blood perfusion with a SCI pt?
Monitor the color and temperature of the patient’s skin and check capillary refill and peripheral pulses
What are we assessing for regarding BP/HR of SCI pt?
- Watch for hypotension and bradycardia, which can be signs that the patient is going into neurogenic shock, or
- hypertension and bradycardia which may indicate autonomic dysreflexia
What assessment function tests should be done for SCI pt?
- sensory and motor
- reflexes
How do we prevent further damage of the spinal cord immediately post SCI?
Keep their head and spine straight, log-roll them if they need to be repositioned, and use a C-collar, traction device, or backboard
Why should we put compression socks on a pt with SCI?
blood vessels might lose sympathetic tone, and blood might pool in the legs. Using compression socks or sequential compression devices (SCDs) may help prevent DVTs.
What is the relationship between SCIs and reflexes?
- Reflexes don’t work during shock period
- As inflammation subsides, shock ends and reflexes return to normal along w/ vitals
What are the s/s of upper motor neuron damage?
- Slight decrease in muscle mass (if LMN is still working)
- Decrease in power/strength
- Hypertonia/spasticity
- Hyperreflexia
- Babinski
What are the s/s of lower motor neuron damage?
- Significant decrease in muscle mass
- Significant decrease in power (paresis/paralysis)
- Hyporeflexia (dead reflexes)
- Hypotonia/flaccid
What is the collar that is standard to put on to protect cervical spine?
Philadelphia collar
How does a C5 injury affect movement?
Pt will experience quadriplegia
How does an injury to C3-5 affect respiratory function?
- The phrenic nerve controls contraction/relaxation of the diaphragm
- The phrenic nerve passes through C3-5
- If there is an injury to C3-5, signals will not be able to pass the point of injury
- Diaphragm function will be lost and the pt will no longer be able to breathe
- They will need to be intubated and put on a ventilator
What is the #1 priority for any C level injury?
Respiratory function
How does a T1-T10 injury affect movement?
- Pt will experience paraplegia
- Gi tract and bladder won’t work properly
True or False
A SCI to L1-L5 will render the patient a paraplegic.
False, it may or may not.
What are the location levels of T4, T10, L3?
- T4: nipple line
- T10: navel line
- L3: iliac crest
What does the rotabed permit?
Rotating and pitching the pt into any position desired
