Neurologic Disorders Part 3 Flashcards by Sydney Perry

spinal cord injury is impaired _____________________ due to permanently damaged areas of the spinal cord

nerve impulse transmission

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incomplete vs complete spinal cord injury

INCOMPLETE:
permits some voluntary movement below injury

COMPLETE:
no motor activity or sensation below the level of injury
(paraplegia and tetraplegia)

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paralysis of only the lower extremities

paraplegia

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paralysis of all 4 extremities

tetraplegia

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cervical nerves control

head and neck
diaphragm
deltoids, biceps
wrist
triceps
hand
some chest muscles

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thoracic nerves control

most chest muscles
abdominal muscles
leg muscles

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lumbar nerves control
sacral nerves

bowel
bladder
sexual function

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acute phase of spinal cord injury is first _______
acute consists of an initial ________ which results in _______

can result in a possible __________

________ state can cause dramatic _____ and loss of ____

can experience ________ but this resolves within ____

dysphagia can occur with SCI of ______

4 weeks
spinal shock
severe hypotension

respiratory failure

hypercatabolic
wt loss
LBM

paralytic ileus
72 hours

cervical

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effect of weight after initial SCI ?
long term ?

severe wt loss and loss of LBM

wt gain due to less LBM and physical inactivity

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for IBW use _____ subtracted for paraplegia
and _____ subtracted for tetraplegia

5-10%

10-15%

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Nutritional concerns with SCI include…

Inability to _______________, which can lead to __________

GI PROBLEMS
Neurogenic bowel=> __________
Neurogenic bladder, ______, _________

________ which Increases risk for _____

___________ and ________

Skin breakdown=> __________

obtain food, prepare food, feed self
Malnutrition

constipation
UTI
nephrolithiasis

obesity
CVD

Osteopenia & osteoporosis

pressure injury

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acute phase of SCI

_________ is recommended for energy needs
calculation ?
____ kcal/kg

Protein = ____ g/kg IBW

may need enteral nutrition due to intubation
- initiate within _____ hours of admission to ICU

if prolonged small bowel ileum post injury, give ___________

indirect calorimetry
REE x AF (1.1) x SF (1.2)
25

2.0

24-48

parenteral nutrition

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REHABILITATION PHASE OF SCI

energy for paraplegia = _____ kcal/g
energy for tetraplegia = _____ kcal/kg

protein = _____ g/kg (no pressure injuries or infection)

fluid = _______
elevated fluid needs to prevent _______ and ______

28
23

0.8-1.0

30-40 ml/kg
kidney stones
constipation

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in rehabilitation phase of SCI…

should get oral nutrition with _______, _____________, and adequate fluid.

________ for CVD prevention
_________ to promote healthy body wt
may need ____________ for eating

HBV protein
soluble and insoluble fiber

♡ healthy diet
adequate energy
adaptive devices

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If SCI patient has neurogenic bowel

fiber of _____

fluid of _____

15 g/d with gradual increase if tolerated

1 ml/kcal + 500 ml/day
OR
40 ml/kg BW + 500 mL/day

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A blow or jolt to the head or a penetrating head injury that disrupts the function of the brain

Traumatic Brain Injury (TBI)

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Persons at Higher Risk for TBI

Infants/children: 0-4 years
Elderly individuals
Teenagers: 15-19 years
Military personnel
People who experience homelessness
People who are in correctional and detention facilities
Survivors of partner violence

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Evaluates the level of consciousness by response to verbal & painful stimuli

what score is mild, moderate and severe

Glasgow Coma Scale (GCS)

MILD
13-15

MODERATE
9-12

SEVERE
3-8

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decerebrate

arms extended out and away as well as legs

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decorticate

arms curled in towards chest

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Classification of TBI

Open head injury (penetrating trauma) vs. Closed head injury (CHI) (blunt trauma)

Primary vs. Secondary

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Characterized by damaged capillaries causing bleeding and edema around damage tissues

Damage results from force of impact

Contusions & Hematomas

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Most common type of TBI?

cause?

result?

Concussions

a blow or jolt to head causing the head and brain to move rapidly back and forth

creates chemical changes in the brain and sometimes stretching and damaging brain cells

brief loss of consciousness <6 hours

Injury to neuronal axons caused by stretching & shearing forces (______ can be torn)

results from ?

LOC usually lasts _____

can result in severe ____ and ______ deficits

Diffuse Axonal Injury (DAI)
nerve fibers

acceleration/deceleration or rotational injuries

≥6 hours

cognitive and affective

The brain has a _______, ________ response to acute injury Tissue injury stimulates the release of: 1. ___________ such as _______, _______, and _______ 2. ________ 3. ________ Net effect=> _______ availability of substrates for metabolically active tissues via________ glycogenolysis, gluconeogenesis, muscle catabolism; lipolysis; fluid & Na ______

hypermetabolic, catabolic 1. Counterregulatory hormones=> - glucagon - cortisol - catecholamines 2. Cytokines 3. Aldosterone & ADH Greater increased retention

Increased Intracranial Pressure (ICP) Caused by ______ or ______ Causes secondary brain injury=>_______

hemorrhage cerebral edema compression of tissue, herniation

medication for increased ICP what do they do ? side effects ?

diuretica pentobarbital reduce cerebral metabolism decrease GI motility and gastric emtying

non medication ways to manage increased ICP

drainage of CSF position to increase venous draining - HOB to 30 degrees (reverse trendelenburg position) fluid restriction

hyperglycemia can be caused by _____, ______, or _______ after a brain injury

metabolic stress infection diuretics

Examples of two things that can affect fluid and electrolyte balances after brain injury

SIADH (syndrome of inappropriate antidiuretic hormone) diabetes Insipidus (decreased secretion of ADH)

SIADH (syndrome of inappropriate antidiuretic hormone) can result in _______ and ________

fluid retention hyponatremia

diabetes Insipidus can result in __________ and ______

increased urinary output dehydration

GI complications of brain injury ___________ ___________ due to ________

stress ulcers (AKA Cushing ulcers) delayed gastric emptying due to - damage to vagus nerve

medication for delayed gastric emptying after brain injury

pentobarbital narcotics

people with brain injury are at high risk for _________ and it is difficult to accurately assess nutrition status in acute period. how come?

malnutrition fluid retention may distort anthropometrics

Food drug interactions Mannitol=> monitor for _______ _______ ______ _______

hypokalemia hypomagnesemia hypovolemia hyperglycemia

Food drug interactions Barbiturates=>_______

may reduce energy requirements

Food drug interactions Propofol (10% lipid emulsion)=>________

provides 1.1 kcal/ml

Food drug interactions Phenytoin (Dilantin)=> ________

decreased absorption if on continuous enteral nutrition (EN) Hold EN for 1-2 hrs before & after drug administration

brain injury Energy Needs vary widely: _______ of predicted REE Average: ______ of estimated REE

100-200% 120-160%

Determinants of energy expenditure: __________ Factors that increase needs: ________ Factors that decrease needs: _______

Severity of TBI infections, posturing, seizures sedatives, barbiturates

Highest needs for => ____________ Lowest needs for =>_____________ and ____________ Pentobarbital coma=>___________

GCS 4-5: posturing Brain death patients on barbiturates or musculoskeletal blockers 100-120% REE

Use indirect calorimetry for TBI patients Ideal equation to estimate energy expenditure for TBI patients? ______ of REE or ______ kcal/kg are often used, but must individualize based on clinical course Adequate _____________- to spare protein Avoid ____________

has not been established 140% 25-30 non-protein calories (NPC) overfeeding

Protein needs for TBI patients higher due to ___________ and __________ ________ g/kg

Catabolism/increased urinary nitrogen excretion Healing 1.5-2.5

Considerations for fluid for TBI=> increased _____ additional _______ sources of _______ _____ _________ SIADH=> ________ Diabetes insipidus=> _________

ICP sources of fluid fluid loss fever constipation fluid restriction fluid replacement

Exact requirements of micronutrients unknown for TBI Provide at least ______ DRI’s Considerations=> __________, ________, and ______

100% wound healing food-drug interactions losses

Goals of MNT for Patients with TBI

Lessen catabolism Provide nutrition via the best route ASAP Prevent malnutrition

Provide nutrition in appropriate form ASAP Initiate as soon as _____________ Avoid prolonged _______ For those who require EN, initiate within _____ hours postinjury

hemodynamically stable NPO status 24-48

Many patients require enteral nutrition support due to... 1. ________ 2. ________ 3. _______ or ______

decreased LOC intubation severe dysphagia or aspiration risk

Considerations for enteral nutrition => ________ and ________

short vs. long term feeding tube location

Risks of enteral nutrition ________ and _______ what location may be best?

delayed gastric emptying high risk of aspiration Post-pyloric feeding

For Enteral nutrition... Provide a high _______ formula If critically ill=> ___________ May need a concentrated formula=> ______ or ______ Consider use of _________ containing __________

nitrogen continuous administration SIADH or increased ICP immune-modulating formula - containing omega-3 fatty acids and extra arginine

Transitioning to Oral Feeding Considerations: Patients who are _______ are not suitable for oral intake _______________ prior to initiation of oral diet When transitioning, consider __________

lethargic Swallowing evaluation cyclic tube feeding

To improve nutritional intake... 1. provide __________ 2. ____________ feedings 3. ______ if needed 4. May need____________

nutrient dense meals small frequent feedings ONS texture alterations & thickened liquids

Once on oral intake Monitor for:

Dysphagia Ability to feed self GI complaints Adequacy of intake

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