Neurological Disorders - CNS: The Spinal Cord

Question 1

Spinal Cord Injuries - Pathophysiology

Answer 1

• An injury to spinal cord, vertebral column, supporting soft tissue, or intervertebral discs caused by trauma
  > transient concussion
  > contusion
  > laceration
  > compression/transection
• Paraplegia
• Tetraplegia (quadriplegia)

Question 2

Spinal Cord Injuries - CMs

Answer 2

• Type & Level of Injury
  > Cervical (C5-C7)
  > Thoracic (T12) (loss of bowel func)
  > Lumbar (L1)
• Complete vs Incomplete
• Primary & Secondary injury

Question 3

Spinal Cord Injuries - Primary Injury

Answer 3

• Acute resp failure is a leading cause of death
• Resp dysfunc r/t lvl of injury
  > diaphragm (C4)
  > intercostal (T1-T6)
  > abdominals (T6-T12)
  > C4 or above; vent support

Question 4

Spinal Cord Injuries - Secondary Injury

Answer 4

• Hemorrhage
• Ischemia
• Hypovolemia
• Imapired tissue perfusion
• Local edema; spinal shock
• Hypoesthesia
  > dcrd sensation
• Hyperesthesia
  > incrd sensation

Question 5

Spinal Cord Injuries - Emergency Management

Answer 5

• Critical
  > improper handling of pt can cause further damage
• Pts in MVC, diving/sports injury, fall, or any direct trauma to head & neck treat as SCI until ruled out
  > immobilized on a spinal (back) board; maintained in extended position
  > head & neck maintained in neutral position
  > not allowed to sit up
  > referred to a reginal spinal injury or trauma center
  > extent on injury determined
  > placed on a rotating specialty bed or in a cervical collar

Question 6

Spinal Cord Injuries - Diagnostics

Answer 6

• Neurologic exam
• X-ray
• CT
• MRI
• EKG
• Comps: spinal shock/neurogenic shock, venous thromboembolism

Question 7

Spinal Cord Injuries - Medical Surgical Treatment

Answer 7

• Acute
• Prevent secondary injury/comps
  > pharm therapy: IV corticosteroids
  > oxygen; hypoxemia worsen injury
  > skeletal fracture reduction & traction
  > surgical management

Question 8

Spinal Cord Injuries - Nursing Diagnosis

Answer 8

• Ineffective breathing patterns
• Ineffective airway clearance
• Impaired bed & phsyical mobility
• Risk for injury
• Risk for impaired skin integrity
• Impaired urinary elimination
• Constipation

Question 9

Spinal Cord Injuries - Nursing Interventions

Answer 9

• Promoting adequate breathing & airway clearance
• Improving mobility
• Preventing injury
• Maintaining skin integrity
• Maintaining urinary elimination
  > autonomic hyperreflexia
• Improving bowel func
• Providing comfort measures

Question 10

Autonomic Dysreflexia

Answer 10

• Acute life-threatening emergency
• After spinal shock has resolved
• Severe, pounding headahce w/ paroxysmal HTN, profuse diaphoresis above spinal lvl of lesion (most often forehead), nause, nasal congestion, bradycardia
• Sudden incr in BP may cause: retinal hemorrhage, hemorrhagic stroke, MI, seizures
• Distended bladder (most common cause(; constipation, or stimulation of skin (tactile, pain, thermal stimuli, pressure ulcer)

Question 11

Care of Autonomic Dysreflexia

Answer 11

• Pt immediately placed in sitting position to lower BP
• Rapid assessment to alleviate cause
  > bladder is emptied/bowel emptied/skin examined
  > any other stimulus; object next to skin or a draft of cold air; must be removed
• Measures do not relieve HTN & headache:
  > antiHTN meds may be prescribed; slow IV route
• Med record labeled w/ risk of autonomic dysreflexia
• Instructed abt prevention & management measures