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N361: Pathophysiology II > Module 11 - Spinal Cord Injury > Flashcards

Module 11 - Spinal Cord Injury Flashcards

1
Q

How does the Peripheral NS break up?

A

Peripheral NS –> Motor (Efferent) Neurons –> Autonomic and Somatic (voluntary)

ANS –> SNS and PNS

Peripheral NS –> Sensory (Afferent) Neurons

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2
Q

Efferent

A

goes from the brain to the periphery

efferent

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3
Q

Afferent

A

goes from the periphery to the brain

sensory

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4
Q

How many vertebrae are there

A

32 to 33

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5
Q

What is the order of the vertebrae types and their amounts

A

7 Cervical

12 Thoracic

5 Lumbar

5 Fused Sacral

3-4 Fused Coccygeal

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6
Q

The First spinal Nerves exit … and this pattern goes until…

A

exit ABOVE C1 and this goes through C7

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7
Q

Where does the C7 spinal nerve exit

A

above the C7 vertebrae

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8
Q

Where does the C8 spinal nerve exit

A

C8 exits below C7 vertebrae and above T1. From there T1 spinal exits below T1, and so on for the rest

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9
Q

Intervertebral Discs

A

spongy disks between the spinal column giving flexibility and allows us to not have bone grinding on bone

also allows load bearing

made up of the nucleus pulposus and the annulus fibrosis

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10
Q

Nucleus Pulposus

A

area of the intervertebral discs that is the pulpy part more medial/inside

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11
Q

Annulus Fibrosis

A

the thick fibrotic ring that is more firm on the outside of the intervertebral disk

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12
Q

What gives our spinal cord and vertebrae support?

A

Longitudinal Ligaments - they give longitudinal support

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13
Q

Ligaments connect __ to ___

A

bone to bone

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14
Q

tendons connect __ to __

A

muscle to bone

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15
Q

What do longitudinal ligaments do?

A

they keep vertebrae aligned properly to stay straight

very functional in keeping vertebrae slipping side to side as well

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16
Q

What is the problem with a longitudinal ligament though?

A

they are stronger on the front side than back side so a disk herniation is more likely to go backward

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17
Q

Types of Longitudinal Ligaments

A

Anterior Longitudinal

posterior longitudinal

supraspinal

interspinal

ligamentum flavum

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18
Q

What is an additional stabilizer for the back?

A

Back muscles which help us stand erect

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19
Q

Efferent goes ___ Afferent comes ___

A

away ; toward

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20
Q

The sensory cortex and motor cortex and their afferent/efferent connections are mostly made of what

A

white matter

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21
Q

Where are the cell bodies (Grey Matter) in the brain and spinal cord?

A

it is outside the brain and inside the spinal cord

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22
Q

Where are the axons (white matter) in the brain and spinal cord?

A

inside of the brain and outside of the spinal cord

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23
Q

How do motor neurons move down the body?

A

they initiate at the motor cortex and travel down where they cross at the medulla oblongata and go down the opposite side where they then exit at the ventral root of the spinal cord

so the left arm is controlled by right motor nerves at the medulla oblongata level

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24
Q

How do sensory neurons move up the body?

A

Some will go up on the same side (ipsilaterally) while others go up the other side (contralateral)

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25
Q

What is an example of an ipsilateral sensation?

A

tickle

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26
Q

What is an example of a contralateral sensation?

A

pain

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27
Q

Why are men 4x more likely to have spinal cord injuries

A

males are more likely to engage in risk taking behaviors as young men

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28
Q

What age group tends to see more spinal injuries

A

younger adults to adults

average age is 33.4 with a median of 26 and a modal of 19

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29
Q

Causes for Serious Spinal Injury

A

motor vehicle accidents

falls

gunshot or stab wounds

sports injuries (diving 66%)

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30
Q

Causes for Less Serious Spinal Injury

A

lifting heavy objects

minor falls

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31
Q

The most common cause of spinal injury is …

A

motor vehicle accidents

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32
Q

-plegia

A

Paralysis

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33
Q

Monoplegia

A

paralysis in one limb

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34
Q

Hemiplegia

A

paralysis in both limbs on one side

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35
Q

Paraplegia

A

paralysis in both upper OR both lower limgs

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36
Q

Quadriplegia/Tetraplegia

A

Paralysis in all four limbs

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37
Q

-paresis

A

weakness

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38
Q

Ipsilateral

A

same side

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39
Q

Contralateral

A

opposite side

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40
Q

Hypotonia

A

less than normal muscle tone

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41
Q

Flaccidity

A

absent muscle tone

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42
Q

Hypertonia

A

excessive muscle tone

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43
Q

Spasticity

A

stiff awkward movement

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44
Q

Rigidity

A

immovable stiffness

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45
Q

Tetany

A

intermittent tonic spasms - paroxysmal

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46
Q

Vertebral Fracture

A

fragmentation of vertebral bone

can be the pedicle, lamina, or processes

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47
Q

What are the thin parts of a vertebrae

A

the pedicle and lamina

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48
Q

Laminectomy

A

surgical removal of part of the vertebral bone allowing for a disk to have some room if it is enlarged and swollen so it does not pinch any nerves

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49
Q

Vertebral Dislocation

A

displacement of the vertebral body

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50
Q

Vertebral Subluxation

A

partial dislocation of the vertebral bone

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51
Q

Types of Vertebral column Injuries

A

Flexion

Extension

Compression

Axial Rotation

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52
Q

Flexion Injury

A

flex the spine forward and cause an injury anteriorly

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53
Q

Extension Injury

A

extend the spine back and cause compression injuries in the back of the spinal cord

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54
Q

Compression Injury

A

When one vertebrae jams into another one

very dangerous

can occur in diving if landing on your head

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55
Q

Axial rotation injury

A

Twisting of the neck that kills someone

also though of with shaken baby syndrome

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56
Q

Extent of spinal injury depends on ___ and ___

A

location and severity

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57
Q

The higher the injury of the spinal cord…

A

the greater the chance of autonomic injury

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58
Q

Spinal cord injuries commonly involve…

A

both sensory and motor function

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59
Q

Spinal cord injury is…

A

mechanical disruption of neurons

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60
Q

Spinal cord injury can lead to…

A

injury related ischemia and hypoxia contributing to local infarction

development of micro hemorrhages or edema that causes interruption of neuronal function

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61
Q

You can have ___ without ischemia, but cannot have ischemia without ___

A

hypoxemia; hypoxemia

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62
Q

The two step pathophysiology of spinal cord injuries

A
  1. primary –> initial injury –> small hemorrhages in grey matter –> edematous changes in white matter –> necrosis of neural tissue –> IRREVERSIBLE DAMAGE
  2. secondary –> progressive neurologic damage leading to vascular damage, neuronal injury, and release of vasoactive agents and cellular enzyme
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63
Q

Secondary vascular damage in spinal cord injuries can lead to

A

ischemia

increased vascular permeability

edema

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64
Q

Secondary Neuronal injury in spinal cord injuries can lead to

A

loss of reflexes below the level of injury

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65
Q

Secondary release of vasoactive agents and cellular enzymes in spinal cord injuries can lead to

A

delayed swelling

demyelination

necrosis

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66
Q

Secondary progressive neurologic damage can become…

A

a cycle that repeats

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67
Q

Spinal Shock

A

where the spinal cord stops working below the level of a spinal cord injury

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68
Q

As swelling goes down some function can return but…

A

only if this is secondary damage, as primary is irreversible and never returns

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69
Q

Types of Spinal Cord Injury

A

Incomplete transection

Complete transection

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70
Q

Incomplete Transection

A

partial preservation of sensory and motor function as only part of spinal cord is damaged through

Central cord syndrome, anterior cord syndrome, brown-sequard syndrome, conus medullaris syndrome

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71
Q

Complete Transection

A

absence of sensory and motor function due to the spinal cord basically being severed

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72
Q

If complete transection is above T1 what occurs

A

Quadriplegia

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73
Q

If complete transection is below T1 what occurs

A

Paraplegia

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74
Q

Ventral Root

A

the anterior part in the spine

corticospinal tracts (motor) go to the ventral area at the anterior horn

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75
Q

Dorsal/Posterior Horn

A

sensory tracts ipsilateral or contralateral are at the dorsal column or dorsal root of the spinal nerve

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76
Q

Possible effects if spinal cord injury is at or above C5

A

respiratory paralysis - inability to respirate

quadriplegia

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77
Q

Possible effects of spinal cord injury between C5 and C6

A

paralysis of legs, wrists, hands

weakness of shoulder abduction and elbow flexion

loss of brachioradialis reflex

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78
Q

Possible effects of spinal cord injury between C6 and C7

A

paralysis of legs wrists and hands

Should and elbow movement and flexion still possible

loss of bicep jerk reflex

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79
Q

Possible effects of spinal cord injury between C7 and C8

A

paralysis of the legs and hands

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80
Q

Possible effects of spinal cord injury at C8 to T1

A

Horner’s syndrome (constricted pupil, ptosis, facial anhidrosis)

paralysis of legs

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81
Q

Possible effects of spinal cord injury between T11 and T12

A

paralysis of leg muscles above and below the knee

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82
Q

Possible effects of spinal cord injury at T12 to L1

A

paralysis below the knee

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83
Q

Possible effects of spinal cord injury at the Cauda Equina

A

hyporeflex or areflexic paresis of the lower extremities

usually pain and hyperesthesia in the distribution of the nerve roots

usually loss of bowel and bladder control

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84
Q

Possible effects of spinal cord injury at S3 to S5 or at the conus medullaris at L1

A

complete loss of bowel and bladder control

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85
Q

The most life threatening spinal cord injuries are…

A

are at the highest points in the cervical vertebrae

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86
Q

The higher the spinal cord injury the more likely…

A

you will need ventilator support for life and become quadriplegic

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87
Q

Hyperesthesia

A

abnormal increase in sensitivity to stimulation - particularly touch

also higher pain

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88
Q

Central Cord Syndrome - Nature of Injury

A

Damage to central gray or white matter of cord (central means the grey matter is most effected in the spine)

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89
Q

Central Cord Syndrome - Areas MOST affected

A

Motor function of upper extremities - paresis, paralysis of extremities, or loss of fine motor function

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90
Q

Central Cord Syndrome - Areas less or not affected

A

Motor function of lower extremities

Bowel, bladder, sexual function

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91
Q

Central Cord Syndrome - Recovery

A

Often recover to the point of being ambulatory and controlling bowel and bladder, but often are not able to perform detailed or intricate work with their hands

People seem to recover well

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92
Q

Who often has Central Cord Syndrome

A

elders with osteoporosis or vertebrae degeneration

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93
Q

Anterior Cord Syndrome - Nature of Injury

A

Infarction of anterior spinal artery resulting in damage to the anterior 2/3 of cord

This impacts the front of the spinal cord - facing our front

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94
Q

Anterior Cord Syndrome - Areas MOST affected

A

Loss of motor function by corticospinal (motor) tracts

Loss of pain and temperature sensation from damage to lateral spinothalamic tracts

Reduction in or loss of local reflexes & localized LMNs (lower motor neurons) of the anterior horn

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95
Q

Anterior Cord Syndrome - Areas less or not affected

A

Posterior 1/3 of cord

Dorsal column axons conveying position, vibration, and touch sensation

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96
Q

Anterior Cord Syndrome - Recovery

A

Tend to do poorly

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97
Q

Brown-Sequard Syndrome - Nature of Injury

A

Damage to a hemi-section (half) of the anterior and posterior cord

This is a rare syndrome and impacts half the body - vertically split, half the body does not work

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98
Q

Brown-Sequard Syndrome - Areas MOST Affected

A

Loss of voluntary motor function from the corticospinal tract

Proprioreception loss from the ipsilateral side of the body

Contralateral loss of pain and temperature sensation from the lateral spinothalamic tracts for all levels below the lesion

Lose one arm and one leg movement

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99
Q

Brown-Sequard Syndrome - Recovery

A

Many patients can improve at least enough to ambulate and to control bowel and bladder function

They must relearn to walk and control bladder and bowel though

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100
Q

Anterior Cord Syndrome cause

A

Lesions disproportionately affecting the anterior spinal cord, commonly due to infarction (e.g., caused by occlusion of the anterior spinal artery)

101
Q

Brown Sequard Syndrome cause

A

Unilateral spinal cord lesions, typically due to penetrating trauma

102
Q

Anterior Cord Syndrome S/S

A

All tracts malfunction except the posterior columns, thus sparing position and vibratory sensation

103
Q

Brown Sequard Syndrome S/S

A

Ipsilateral paresis

Ipsilateral loss of touch, position, and vibratory sensation

Contralateral loss of pain and temperature sensation*

104
Q

Central Cord Syndrome cause

A

Lesions affecting the center of the spinal cord, mainly central gray matter (including spinothalamic tracts, which cross), commonly due to trauma, syrinx, or tumors in the central spinal cord

105
Q

Conus Medullaris Syndrome cause

A

Lesions around L1

106
Q

central cord Syndrome S/S

A

Paresis tending to be more severe in the upper than in the lower extremities and sacral regions

Tendency to lose pain and temperature sensation in a capelike distribution over the upper neck, shoulders, and upper trunk, with light touch, position, and vibratory sensation relatively preserved (dissociated sensory loss)

107
Q

Conus Medullaris Syndrome S/S

A

Distal leg paresis

Perianal and perineal loss of sensation (saddle anesthesia)

Erectile dysfunction

Urinary retention, frequency, or incontinence

Fecal incontinence

Hypotonic anal sphincter

Abnormal bulbocavernosus and anal wink reflexes

108
Q

Conus Medullaris

A

end of the major spinal cord that becomes the spray of nerves not encased in the spinal cord at the tail

talks about low spinal cord activity

109
Q

Cauda Equina

A

The very end of the spinal cord looking like a horses tail with the nerves spread out

110
Q

Conus Medullaris Syndrome - Nature of Injury

A

Damage to the conus medullaris or the sacral cord and lumbar nerve roots within the neural canal

111
Q

Conus Medullaris Syndrome - Areas MOST affected

A

Flaccid bowel, bladder, and sexual function
Motor function in the legs and feet

112
Q

Conus Medullaris Syndrome - Areas less or not affected

A

Preserved reflexes if only conus is involved
May not have significant sensory impairment

113
Q

Cauda Equina Syndrome - Nature of Injury

A

Damage to the lumbosacral nerve roots within the canal

this is the nerve roots getting hurt

114
Q

Cauda Equina Syndrome - Areas MOST affected

A

Various patterns of asymmetric flaccid paralysis, sensory impairment, and pain

115
Q

Damage to the conus medullaris or cauda equina often result in …

A

bowel, bladder, and sexual dysfunction

116
Q

What to do for a neurologic examination

A

mental status and speech check

cranial nerve check

Central and peripheral sensory function check

motor function check

cranial and peripheral reflex assessment

cerebellar function and gait

117
Q

A lot of the neurological examination can be done…

A

just in non formal ways through conversation and watching via indirect discussion

118
Q

Spinal X Ray can…

A

provide details of the bone structures in the spine

can rule out instability, tumors, and fractures

119
Q

Spinal X rays are not good at…

A

capturing disc and nerve root structures

not good at soft tissue findings

120
Q

Spinal X rays cannot diagnose…

A

lumbar disc herniation or other causes of nerve pinching

121
Q

Computed Tomography (CT)

A

fancy x ray that can take cross section images of the body

will image large disc herniations but can miss smaller ones

122
Q

CT with Myelogram

A

radiopaque dyes injected into the sac around the nerve roots which lights up the nerve roots

provides substantial information on nerve roots

very sensitive test for nerve impingement and can pick up even very subtle lesions

123
Q

MRI

A

the gold standard of spinal cord injury diagnosis - but its very expensive

single most useful imaging study available for spine surgery

aids in the assessment of certain conditions by providing detail of the disc and nerve roots

provides highly refined detail of the spine’s anatomy

may not be first ordered

124
Q

Electromyography (EMG)

A

assesses the electrical activity of a nerve root

useful to distinguish nerve degeneration (neuropathy) from nerve root compression (radiculopathy)

Its like an EKG for nerve roots in the spine - can tell us if nerve roots are working

125
Q

Somatosensory Evoked Potentials (SSEP)

A

assesses speed of electrical conduction across the spinal cord

if spinal cord is significantly pinched, the electric signals will travel slower than usual

Also used to monitor spinal cord function during surgical procedures

126
Q

Why is EMG and SSEP seen less often?

A

Because MRI is used more

127
Q

The goal of spinal injury management is…

A

reduce neurological deficits and prevent additional ones

128
Q

Ways to Manage Spinal Cord Injuries

A

Immobilization with neck collars and back boards to limit movement, stabilize spinal column, and prevent further damage

Log-roll and secure head with straps or tape

Cervical: Cervical traction

Thoracic & lumbar: Bedrest & logrolling

High dose methylprednisolone w/in 8 hours- Stabilizes cell membranes, enhances impulse generation, improves blood flow, inhibits free radical formation

CURRENT RESEARCH: neuron regeneration with stem cells

Prevention, early detection, prompt intervention, rehabilitation

129
Q

What is the time frame to give methyl prednisone or steroids to stabilize cell membranes, improve blood flow, inhibit free radical formation, and enhance impulse generation in the spine? But keep in mind…

A

8 hours

but keep in mind that it can have impacts on the immune system and make people ill as a SE or increase GI bleeding

130
Q

Alterations in Functional Abilities as a Result of Spinal injury

A

Alterations in spinal reflexes

alterations in ventilation and communication dysfunctions

ANS system dysfunction - vasovagal response, autonomic dysreflexia, postural hypotension

Alteration in temperature regulation

circulatory system dysfunction

sensorimotor dysfunction

alterations in skin, pain, bladder function, bowel elimination, and sexual function

131
Q

Alterations in Spinal reflexes due to Upper Motor neuron lesions occur in what region and result in what?

A

affected by any injury T12 and above

Results in SPASTIC PARALYSIS of affected skeletal muscle groups, and muscles that control bowel, bladder, and sexual function - injury can still have reflex arc so muscles become painful and spastic but are less likely to do so

132
Q

Alterations in Spinal reflexes due to Lower Motor neuron lesions occur in what region and result in what?

A

affected by any injuries below T12

Results from damage to the peripheral nerves that exit each segment of the spinal cord

Causes FLACCID PARALYSIS of involved skeletal muscle groups and muscles that control bowel, bladder, and sexual function - no reflex arc d/t no innervations

133
Q

So, Spastic paralysis indicates __ damage and flaccid paralysis indicates __ damage

A

upper; lower

134
Q

Spinal or Neurogenic Shock

A

state of areflexia that occurs post spinal injury - they are the first complication of symptoms after an injury

involves the loss of all or most of the spinal reflexes below the level of the injury and also involves motor pathways

135
Q

Manifestations of Spinal Shock

A

flaccid paralysis

lack of tendon reflexes

and lack of autonomic function

A “waiting game” to see

136
Q

How long does Spinal Shock last

A

may last minutes, hours, days, or weeks, but is usually self limiting (inflammation goes down and the body regains some function)

137
Q

Areflexia

A

no reflex arcs below level of injury

138
Q

The diaphragm is innervated by __ to __ via __ nerves

A

by C3 to C5 by phrenic nerves

139
Q

Intercostal Muscles are innervated by __ to __

A

T1 to T7

140
Q

Major Muscles of Expiration are innervated by __ to __

A

T6 to T12

141
Q

Injury to C1 to C3 area leads to what Ventilation Dysfunctions

A

lack of respiratory effort

requires assisted ventilation dependence

there is respiratory paralysis

142
Q

injury to C3 to C5 leads to what Ventilation Dysfunctions

A

allows partial or full diaphragmatic function, but ventilation is diminished

143
Q

Injury below C5 leads to what Ventilation dysfunctions

A

ability to take a deep breath and cough less impaired - so the function is there

144
Q

Any damage to the __ region can impact ventilation dunction

A

chest

145
Q

Ways to meet communication needs for spinal injuries that are Verbal

A

Fenestrated tracheostomy tubes
Provide airflow for vibration of the vocal cords

Talking tracheostomy tubes

Diaphragmatic pacing

Electrolarynx-type devices

Mechanical ventilation with an air leak

146
Q

Ways to meet communication needs for spinal injuries that are Non-verbal

A

communication via boards or cards

computerized scanning programs

Mouth stick control devices

147
Q

How is afferent and efferent flow above the level of injury?

A

unaffected so there is normal function

148
Q

What occurs to ascending and descending transmissions below the injury?

A

They are blocked –> this causes uncontrolled spinal and autonomic reflexes (ANS dysfunction)

149
Q

What are the most severe ANS dysfunctions of spinal cord injury?

A

Autonomic regulation of circulatory function and thermoregulation are the most severe problems

150
Q

The higher the level the injury, the more profound the ANS dysfunction effect, especially above __

A

T6 (d/t diminished innervation of the carotid, diaphragm, and intercostal baroreceptors)

151
Q

A normal body without injury can have vasovagal responses from what nerve working through the PNS?

A

Nerve X (Vagus)

152
Q

Those with spinal injuries tend to have what more often

A

vasovagal responses

153
Q

The vagus nerve has what effect on heart rate?

A

a continuous inhibitory effect

154
Q

Vagal Stimulation in a Spinal injury region –> Vasovagal Response –> ?

A

Bradycardia or Asystole (in spinal injuries, normally it is just slowing heartrate)

normally the heart slowing down will have the SNS fix the response but the SNS response cannot get through the damaged area in this case

155
Q

We need to be careful doing what with spinal injury patients?

A

doing things that can cause a vasovagal response

156
Q

What are some things that can cause a vasovagal response?

A

Deep tracheal Suctioning - must hyperoxygenation with O2 to help

Rapid position changes - avoid d/t postural hypotension

157
Q

What can be done if a person begins to have a vasovagal response with a spinal cord injury

A

you can give anticholinergic drugs to work against the PNS via the cholinergic system

158
Q

Autonomic Dysreflexia

A

Acute episode of exaggerated sympathetic reflex responses that is a classic complication of spinal injury

“Autonomic Hyper Dysreflexia”

159
Q

What may cause Autonomic Dysreflexia

A

visceral (organ) stimuli that normally cause pain or discomfort in the abdominopelvic region

160
Q

Why does it take time before autonomic dysreflexia can occur after an injury?

A

It cannot occur until spinal shock is resolved and autonomic reflexes return - within 6 months of injury

161
Q

Autonomic Dysreflexia is __ in the first year and can occur___

A

unpredictable; lifelong

162
Q

Autonomic Dysreflexia occurs in spinal injuries that happen at what region and higher?

A

T6 and higher

163
Q

___ lesions can still have reflex arcs, but a ___ lesion means there is no reflex arc and no innervation for the reflex

A

UMN; LMN

164
Q

What is the Triad of characteristics for Autonomic Dysreflexia

A

HTN (signal to slow HR and lower pressure cannot get down to the area causing this)

Bradycardia (attempt to lower HTN)

Headache (vasodilation in the head causes a person to be red above the injury level and pale below the injury level from vasoconstriction)

165
Q

Autonomic Dysreflexia: Unregulated SNS activity –> Vasospasms, HTN, Skin pallor, Piloerection –> ?

A

baro-reflex mediated vagal bradycardia, vasodilation, flushed skin, profuse sweating above the level of injury, nasal congestion

166
Q

Causes for Autonomic Dysreflexia

A
  1. Visceral Distention (full bladder or rectum)
  2. Pain - pressure ulcers, ingrown toenails, dressing changes, diagnostic or operative procedures (cannot feel it but signals still sent)
  3. Visceral contractions - ejaculations, bladder spasms, uterine contractions
167
Q

The causes of Autonomic Dysreflexia can lead to what ultimate complications?

A

Convulsions, decreased LOC, and Death

168
Q

Interventions for Autonomic Dysreflexia

A

monitor BP every 5 minutes

remove stimulus and correct cause

position them upright

Remove AE hose (allows venous pooling to drop blood pressure)

IV peripheral vasodilators like apresoline and hyperstat

169
Q

A straight catheter may cause a vasovagal response while trying to intervene on autonomic dysreflexia, is that ok?

A

yes, it is a trade off

We would rather have that than AD

170
Q

What is unique to Autonomic Dysreflexia interventions?

A

Removal of AE hose is wanted to allow venous pooling

171
Q

What do IV vasodilators do in autonomic dysreflexia?

A

They lower BP to prevent a potential stroke

172
Q

What spinal injuries cause Postural Hypotension

A

occurs in persons with injuries at T4 to T6 and above

173
Q

Postural Hypotension

A

cannot maintain BP when changing position

related to interruption of descending control of sympathetic outflow to blood vessels in the extremities and abdomen (cannot vasoconstrict when position changing to keep BP up)

results in pooling of blood which decreases cardiac output

174
Q

Signs of Postural Hypotension

A

Dizziness

pallor

excessive sweating above the level of the lesion

blurred vision

fainting

175
Q

Prevention of Postural Hypotension

A

slow changes in position

measures to promote venous return (like putting on AE hose before getting them up

176
Q

Spinal injuries of any kind often cause what?

A

Alterations in temperature regulation

this is because of an SNS malfunction in regulation of body temperature, not infection

177
Q

Central mechanisms for temperature regulation are located…

A

in the hypothalamus

178
Q

When cold what signals does the hypothalamus cause

A

vasoconstriction and shivering –> conservation and production of heat

179
Q

When hot what signals does the hypothalamus cause

A

vasodilation and sweating –> dissipative and evaporative heat loss

180
Q

What happens to temperature regulation in spinal cord injury

A

sympathetic effector responses below the level of the injury are disrupted

this means a lack of ability to conserve and dissipate heat and sweat

181
Q

Higher levels of spinal injury cause…

A

greater disturbances in temperature regulation

182
Q

Poikilothermy

A

when someone assumes the external temperature for their body temperature below the level of a spinal injury

183
Q

Education for temperature regulation in spinal injury patients

A

clothing and awareness of environment

they can still get frostbite and heat stroke but they wont feel it

184
Q

What are common circulatory system dysfunctions with spinal cord injury

A

edema and DVT

185
Q

Decreased PVR, areflexia or hypotonia, and immobility in spinal injury –> ??

A

increased venous pressure and pooling of blood in the abdomen, lower limbs and extremities

186
Q

Orthostatic or dependent edema in spinal injury should have what intervention occur

A

elevation and compression via AE hose`

187
Q

DVT should have what interventions occur

A

low dose heparin

ROM

compression devices

assessment

188
Q

Sensorimotor dysfunction occurs in what way after spinal injury?

A

After spinal shock, isolated reflex activity + muscle tone not under control of higher centers returns

Results in hypertonia or involuntary spasticity of skeletal muscles below the level of injury

May be tonic (sustained tone) or clonic (intermittent)

189
Q

What are the benefits of Tonic (sustained tone) in a spinal injury

A

sustained tone

prevention of atrophy (shrinkage)

helps with venous return

190
Q

What are the downfalls of Tonic (sustained tone) in a spinal injury

A

contractures

skin breakdown

greater injury risk than clonic

191
Q

Spasticity occurs in injuries of what areas?

A

Injuries above T12

192
Q

Why do injuries below T12 not cause spasticity

A

Below T12 controls reflex responses and with that damaged it leads to flaccidity not spasticity

193
Q

What are some stimuli that could cause spasms in sensorimotor dysfunction and muscle tone?

A

muscle stretching

bladder infections

bowel distension or impaction

pressure areas

infections

194
Q

Interventions for Spasticity in Muscel Tone

A

PROM

avoid stimuli

antispasmodics on hand

195
Q

What innervates skin

A

cranial and spinal nerves in dermatomes

afferent/sensory info –> brain –> efferent/motor control and reflex activity at each dermatome

196
Q

What is one of the most preventable complication of spinal cord injury

A

skin dysfunction

197
Q

Normal SNS control of Skin does what?

A

controls vasomotor and sweat glands providing adequate circulation, excretions’ of body fluids and temp regulation

198
Q

What occurs with SNS control and skin with spinal injury

A

major risk for altered skin integrity from sweatiness uncontrolled or pressure or shearing forces when turning, trauma, and infection

199
Q

Factors that cause Skin Dysfunction and altered integrity

A

pressure

shearing forces

trauma

irritation

200
Q

Interventions for the Skin in a spinal cord injury patient

A

relieve pressure

encourage circulation

inspect for breakdown

201
Q

How can pain differ in a spinal cord injury

A

It can be one of many diverse and unpredictable pain syndromes such as mechanical/fracture pain, radicular or spinal nerve root pain, visceral pain, or central pain

basically they may not feel much or feel excessive pain

202
Q

Mechanical or Fracture Pain

A

dull, aching pain occurring at level of spinal injury from soft tissue damage

203
Q

Radicular or Spinal nerve Root pain

A

aching or shooting pain radiating along distribution of nerves

204
Q

Visceral pain

A

poorly localized pain

burning abdominal/pelvic discomfort related to bladder distension or UTI

205
Q

Central Pain

A

diffuse burning sensation below level of injury

aggravated by touch, movement, and visceral distension

206
Q

Interventions for Pain in spinal injuries

A

TENS units - help with nerve pain

TCAs (tricyclic antidepressants and antiepileptics)

NSAIDS

PT

207
Q

Normal bladder sensation comes what …

A

sensory signals from bladder stretch receptors S2 to S4 –> go to a reflex voiding center –> go to motor neurons S2 to S4 allowing voiding

208
Q

SNS and Bladder function

A

detrusor relaxation - bladder filling

209
Q

PNS and bladder function

A

detrusor contraction - voiding

210
Q

UMN Injury and Bladder Function

A

SPASTIC bladder dysfunction

lack awareness of bladder filling and voluntary control of voiding –> leads to incontinence

211
Q

LMN injury and Bladder function

A

FLACCID bladder dysfunction

lack awareness of bladder filling and lack of bladder tone –> unable to void –> retention and overflow –. potential for UTI

212
Q

Interventions for Bladder function in Spinal injury patients

A

continuous or intermittent drainage via catheter

external collection

manual techniques

teach them about catheters

213
Q

SNS and Bowel Elimination

A

T6 to L3 –> decrease intestinal motility and increase internal sphincter tone

214
Q

PNS and Bowel Elimination

A

S2 to S4 –> Increase intestinal motility and decrease internal sphincter tone

215
Q

How is bowel elimination affected in spinal injuries at S2 to S4

A

flaccid functioning of the defecation reflex and loss of voluntary control of the external anal sphincter

causes constipation from loss of control or bowel incontinence - can be either thing

216
Q

How is bowel elimination affected in spinal injuries above S2 to S4

A

spastic functioning of the defecation reflex and loss of anal sphincter tone –> intrinsic contractile responses intact but no defecation reflex

Has no defecation reflex leading to constipation

217
Q

Interventions for spinal cord injury bowel elimination

A

high fluids

high fiber diet

mobility

consistent pattern

privacy

positioning

laxatives

digital stimulation (questionable - can cause vasovagal response)

218
Q

What areas of the spine control mental stimuli or psychogenic sexual response

A

T11 to L2

219
Q

What areas of the spine controls sexual touch or reflexogenic sexual response

A

S2 to S4

220
Q

With sexual function, spinal cord injury at any level…

A

disrupts neural pathways (S2 to S4) between genitals and higher centers

221
Q

Where would a UMN lesion be and what would it cause for sexual dysfunction

A

T10 or higher

reflex sexual response to touch can occur, but there is no response to mental stimuli - a spinal lesion is blocking the pathway

222
Q

Where would a LMN lesion be and what would it cause for sexual dysfunction

A

T12 or below

sexual reflex center may be damaged –> no response to touch; below T12 sexual arousal by mental stimuli; L1 to L2 may have sexual responses to mental or touch stimuli

223
Q

Interventions for Spinal injury sexual function

A

erectile aids

lubricants

224
Q

Despite Sexual dysfunction, what may not be lost with spinal injury

A

fertility

for this reason pregnancy, labor, and birth control requires caution

225
Q

Does Viagra work for someone with a spinal cord issue?

A

No d/t circulation impairment

226
Q

Herniated Disk

A

disk exploding beyond where it should be

can push on nerves and hurt

can come from trauma or aging from drying of disk, but any time the nucleus is pushed out of place its very painful

nurses have a high rate of this

227
Q

What are some reasons for disk herniation

A

50% of the time is from trauma

aging

degenerative disorders

228
Q

The most common direction of disk herniation

A

posterior and oblique toward the intervertebral foramen and contained spinal nerve root, and dorsal root ganglion

So it heads backward and up at an angle into the space where the nerves are

229
Q

The most common kind of disk herniation

A

Lumbar Disk herniation - 90 to 95%

This tends to only effect one leg usually tho

230
Q

Where do lumbar disk herniations mostly occur

A

L4 to L5

OR

L5 to S1

231
Q

What can L5 nerve impingement from disk herniation cause

A

weakness in extension of the big toe and potentially in the ankle (foot drop)

numbness and pain can be felt on top of the foot, and the pain may also radiate into the buttocks

232
Q

What can S1 nerve impingement from disk herniation cause

A

loss of the ankle reflex and/or weakness in ankle push

numbness and pain can radiate down to the sole or outside of the foot

233
Q

Cervical Disk Herniation - Most common regions

A

C6 to C7

AND

C5 to C6

234
Q

What can C5 nerve impingement from disk herniation cause

A

shoulder pain

deltoid weakness

possible a small area of numbness in the shoulder

on physical exam, patient biceps reflex may be diminished

235
Q

What can C6 nerve impingement from disk herniation cause

A

weakness in the biceps and wrist extensors

pain and numbness that runs down the arm to the thumb

on physical exam, the brachioradialis reflex (mid forearm) may be diminished

236
Q

What can C7 nerve impingement from disk herniation cause

A

pain and numbness that runs down the arm to the middle finger

on physical exam, triceps reflex may be diminished

237
Q

What can C8 nerve impingement from disk herniation cause

A

hand dysfunction (this nerve supplies innervation to the small muscles of the hand)

pain and numbness that can run to the outside of the hand (little finger) and impair its reflex

238
Q

The key to cervical disk herniation…

A

the further the herniation is away from the top, the less severe it is

As the herniation goes down the cervical disk herniation though, the worse the hand is considered though

239
Q

Manifestations of (all) Disk herniations

A

1 PAIN - intensified by coughing sneezing, straining, stooping, standing, jarring

The pain is radiating

slight motor weakness

paresthesia and numbness

decreased reflexes

240
Q

Diagnosis of Disk herniation involves

A

A good H&P

Neurological Assessment

Diagnostic Testing

241
Q

What sort of things are included in the neurologic assessment for disk herniation

A

mental status and speech check

cranial nerve check

central and peripheral sensory function check

motor function check

cranial and peripheral reflex check

cerebellar function and gait

straight leg raise (SLR)

242
Q

If there is a disk herniation, what will occur during a straight leg raise

A

there will be sciatic pain from the leg to the calf

243
Q

What are some Diagnostic tests for Herniated Disks

A

X ray

CT

CT With myelogram

MRI

EMG

SSEP

X ray and CT may not tell much but MRI and CT w/ Myelogram can

244
Q

Management of Herniated Disks

A

Analgesics

Anti Inflammatory meds

Muscle Relaxants

conditioning exercises

PT

chiropractic manipulations

education

surgery

245
Q

What analgesics are used with herniated disks

A

NSAIDS and short term opiods

246
Q

What anti inflammatory meds are used with herniated disks

A

oral steroids

epidural (cortisone) injections

247
Q

What is included in education for herniated disks

A

correct mechanics for lifting

methods for protecting your back

248
Q

What are some surgical indications for herniated disk management

A

documented herniation

consistent pain or neurologic deficit

failure to respond to conservative therapy

incontinence

foot drop

249
Q

What may be able to get a herniated disk back into place?

A

PT

N361: Pathophysiology II (20 decks)

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