Mobility: Spinal cord injuries & guillain Barre syndrome Flashcards
- Abnormal response to pain
- Extension or arms look like “E’s”
- Indicates problems with midbran or pons
Decerebrate posturing
Types of spinal cord damage
- Contusion
- Laceration
- Transetion
- Vascular injury
What type of Spinal cord injury is this?
- Some function preserved below primary injury
- Central cord syndrome
- Anterior cord syndrome
- Posterior cord syndrome
- Brown-sequard syndrome
Incomplete spinal cord injury
Means same side of injury
Ipsilateral
Head excessively turned, may tear ligaments, fracture articular surfaces, and cause compression fractures
Mechaism of injury for the spinal cord
Excessive rotaion
Components of reflexes &sensory exam
- Gag, cough, and swallow
- Blink, corneal
- Assess DTR
- Stereognosis
- 2-point discrimination
- Paresthesia
- Response to pain
- Proprioception
The ability to identify objects with eyes closed and sense of touch only
Stereognosis
Surgical management for spinal cord injuries
- Decompression laminectomies
- Spinal fusion
- Hyper response to stimulus that occurs after spinal shock has resolved, in T6 or higher SCI
- Stimulus could be pain, full bladder or bowel, broken bone, rapid temp. change, infection, DVT, pressure injury
- S/S: HTN, severe HA, nasal congestion, bradycardia, diaphoresis, nausea, impending doom, flushed warm skin above injury, pale/dry skin below injury, chills
Autonomic Dysreflexia
Surgery used to treat a spinal cord injury that utilizes bone graft or insert rods
Spinal fusion
Spinal cord injury that is a bruise
contusion
- Autoimmune attack on peripheral nerve myelin
- Often triggered by a recent infection (2/3): Campylobacter jejuni, cytomegalovirus, Haemophilus influenzae, Zika virus, etc.
- S/S: Motor weakness, numbness, tingling, decresed/absend DTR, ascending or flaccid paralysis from lower extremities over several days
Guillain-Barre Syndrome (GBS)
If Autonomic dysreflexia is not identified and treated what could it lead to?
- HTN stroke
- pulmonary edema
- MI
- cerebral hemorrhage
- death
Treatment of neurogenic & spinal shock
- Maintain airway and immobilization
- Fluid replacement to increase BP
- Vasopressors to constrict blood volume to increase BP and HR
- Control of the environmental temperature to keep them warm
- Atropine may be used to increase HR
- Inotropic agents
- Hemisection of spinal cord from penetrating injury or primary ischemia, infection, or hemorrhagic event
Clinical Manifestations: - Ipsilateral (same side of injury) loss of motor function, proprioception, and vibration
- Contralateral (opposite side of injury) loss of pain and temperature
Brown-Sequard syndrome
- Cervical immobilization for cervical fractures
- Utilizes cranial pins and a device that encircles the head
Halo traction
Interventions for Autonomic Dysreflexia
- Monitor BP close
- Elevate HOB
- Remove restrictive clothing
- Check bladder and bowel
- Check for skin breakdown
- Admin antihypertensive
S/S of Guillain-Barre Syndrome
- Motor weakness
- Numbness
- Tingling
- Decreased/absent DTR or Areflexia
- Ascending flaccid paralysis from lower extremities over several days
Surgical treatment for a spinal cord injury that removes laminae to allow for cord swelling
Decompression laminectomies
Neurogenic shock is the only type of shock with ____________.
Bradycardia
Ways to test responses to pain
- Sternal rub
- Nailbed pressure
- Most common from hyperextension with central swelling
- Functional motor loss greater in arms than legs
- Bladder dysfunction
- Variable loss of sensation
Central cord syndrome
GCS score that indicates a poor prognosis
< 8
The following are S/S of what?
- Motor weakness
- Numbness
- Tingling
- Decreased/absent DTR or Areflexia
- Ascending flaccid paralysis from lower extremities over several days
Guillain-Barre Syndrome
Normal GCS
15
Pertinant social hx for a neuro exam
- Alcohol
- meds
- Illicit drugs
Complications to monitor for in a spinal cord injury patient
- PNA
- Chronic pain
- Spasticity
- Muscle loss
- Skin breakdown
- Paralytic ileus
- Sexual dysfunction
- Mental health issues - depression & anxiety
Injury that cuts through cord
transection
The sense of self-movement, force, and body position
Proprioception
Components of a neuro exam
- Health history
- Social history
- GCS
- Test cranial nerves
- Motor testing-strength, movement
- Reflexes
- Sensory testing (Tactile and painful responses)
- VS
U-shaped for spinal traction with pressure controlled pins on opposite ends of skull
Gardner-wells tongs
Who is most at risk for a spinal cord injury?
Men age 16-18
Spine immobilized with cervical collar and backboard to prevent further damage
Spinal cord injury that is a partial cut
laceration
An injury at C8-T12 is considered what type of spinal cord injury
Thoracic injury
An injury at S1-S5 Is considered what type of injury?
Sacral injury
An injury at C1-C7 is considered what type of injury?
Cervical spine injury
Means opposite side of injury
Contralateral
PmHx that is pertinant for a neuro exam
- Pain
- Headache
- Seizures
- Dizziness
- Visual issues
- weakness
- abnormal sensation
Fusions result in decreased what?
ROM in the affected area
Mechanisms of injury for the spinal cord
- Hyperflexion
- Hyperextension
- Whiplash
- Axial loading
- Excessive rotation
Caused by chin hitting a surface area, such as dashboard/bathtub, usually causes central cord syndrome S&S
Mechanism of injury for the spinal cord
Hyperextension
Quadriplegia and Tetraplegia is causedby what type of spinal injury
Cervical spine injury
Paraplegia is caused by what type of spainal cord injury
Thoracic or lumbar injury
What type of spinal cord injury is this?
- Irrerersible
- Loss of sensory, motor, and autonomic funtion below the level of injury
Complete spinal cord injury
Diagnostic tests expected for someone with a suspected cervical spine injury
- Neuro exam
- X-ray
- CT scan
- MRI
- UA
- H&H/CBC
- ABG
*
Nursing interventions for spinal cord injury
- Maintain suction equipment at bedside
- Teach coughing and deep breathing
- Maintain spinal immobilization and stabilization
- Passive ROM to prevent contractures, loss of muscle tone, and DVT
- Repositioning q2h
- Performing routine pin site care
- Teaching S&S of respiratory distress and autonomic dysreflexia
- Teaching proper skin care and repositioning when using wheelchair
most common natural protective position, can cause neck to be unstable because stretching of ligaments
Mechanism of injury for the spinal cord
Hyperflexion
Spinal cord injury that causes altered perfusion to the cord
Vascular injury
- Abnormal response to pain
- Flexion response to pain or arms move inwards like “C’s”
- Indicates problems with spinal tract or cerebral hemisphere
Decorticate posturing
“Think arms move towards the cord”
- Anterior compression from bony fragments or acute disk herniation
- Loss of function, pain, temparature, crude touch & pressure below injury
- Preserved proprioception, fine touch/pressure, and vibration
Anterior cord syndrome
The following are S/S of what?
- HTN
- Severe headache
- Nasal congestion
- bradycardia
- Nausea
- Impending doom
- Flushed warm skin above injury
- pale dry skin below injury
- Chills
Autonomic Dysreflexia
An injury at L1-L5 is considered what type of injury?
Lumbar injury
Medications used to treat spinal cord injuries
- Lovenox/Enoxaparin/heparin for DVT prevention
- Gabapentin for neuropathic pain
- Opioids, non-opioids, and NSAIDs for pain
- Baclofen to reduce spasticity
- Atropine for bradycardia
- Vasopressors
S/S of autonomic dysreflexia
- HTN
- Severe headache
- Nasal congestion
- bradycardia
- Nausea
- Impending doom
- Flushed warm skin above injury
- pale dry skin below injury
- Chills
C3-C4 spinal cord injury can cause a patient to be what? Why?
Ventilator dependednt d/t loss of intercation of the diaphragm
Lumbar and sacral injuries cause what?
Decreased control of legs, bpwel, bladder, and sexual dysfuntion
2-point discrimination test
Identifying between dull and sharp objects
Tests that will help idenify any internal bleeding for a patient with a spine injury
- UA
- CBC/H&H
- ABG
- Acute compression
- Loss of perception, fine touch/pressure, and vibration
- Intact pain, temp, and crude touch and pressure
Posterior cord Syndrome
What are the three stages of GBS
- Acute
- Plateau
- Recovery
What stage of GBS is this?
Onset of clinical manifestations, edema, and inflammation, lasting 4 weeks
Acute stage
What stage of GBS is this?
When demyelination ceases, lasts few days to weeks
Plateau stage
What stage of GBS is this?
Remyelination and axonal regeneration begin and gradual improvement in S&S
Recovery stage
How to dx GBS
- PmHx
- Thorough exam
- Lumbar puncture
- Electromyography (EMG)
If someone has GBS what would a electromyography (EMG) show?
Slowed nerve conduction
If someone has GBS what would a lumbar puncture show?
elevated protein and normal cell count
Treatment for GBS
- Plasmaphersis & IVIG
- Monitor respiratory function and tida volume compacity
- Can require mechanical ventilation
- Nutritional support and enternal feedings
If GBS progresses to diaphragm paralysis what will be needed?
Mechanical ventilation
If someone with GBS is experiencing dysphagia or if the cranial nerves are affected what will be required?
Nutritional support and enternal feedings
What can be given to GBS patients to decrease antibodies?
Plasmapheresis and IVIG
Complications of GBS
- Respiratory arrest
- Complications of imobility (DVT, Pressure injuries
Nursing care for patient with GBS
- Respiratory assessment with vital capacity
- Cranial nerve assessment (facial expression, speech, gag, swallow)
- Motor and sensory assessment
- Pain assessment
- Frequent turning and ROM
- VTE prevention (heparin, SCDs)
- Establish method of communication (Ex: soft call bell)
- Teach patient and family about each stage of GBS
The client with a C6 spinal cord injury is admitted to the ED complaining of a severe, pounding headache and has a BP of 180/110. Which intervention should the nurse implement?
A. Keep the client flat in bed.
B. Administer a narcotic analgesic.
C. Assess for bladder distention.
D. Monitor vital signs.
The nurse provides care for a client placed in a halo brace in the last 24 hours because of a spinal cord injury. Which of the following is the first priority of the nurse?
A. Loosen the connections on the vest to assess the skin.
B. Assess the pin sites.
C. Evaluate if the client is able to reposition self in bed.
D. Encourage active ROM exercises to lower extremities.
Which clinical manifestation would the nurse assess for a client with a T12 spinal cord injury who is experiencing spinal shock?
A. Flaccid paralysis below the waist.
B. Inability to move upper extremities.
C. Complaints of a pounding headache.
D. Hypotension and tachycardia.
