Peripheral nerve and spinal cord

Question 1

what is Bell’s palsy?

Answer 1

peripheral facial paralysis

disruption of the motor branches of the facial nerve (CN VII) on one
side of the face in the absence of any other disease such as a stroke

Question 2

what is supportive care for Bell’s palsy?

Answer 2

eye protection (IMPORTANT), change in diet, corticosteroids and analgesics

Question 3

What is Guillain-barre syndrome?

Answer 3

Acute, rapidly progressing and potentially fatal form of polyneuritis. It affects peripheral nerves system and results in myelin loss

basically its a symmetrical ascending paralysis

Question 4

what are the clinical manifestations?

Answer 4

progress over hours to days

• symmetrical muscle weakness
• mild distal sensory symptoms of paresthesia
• absent and depressed deep tendon
• goes from lower limbs to upper extremities to face to respiratory muscle

Question 5

what are complications of Guillain-barre syndrome?

Answer 5

life threatening

pain is secondary to this (neuropathic pain) - parestheia

respiratory failure occurs

Question 6

what are diagnostic tests of Guillain-barre syndrome?

Answer 6

based on pt’s history and clinical signs

can check EMG and nerve condition if abnormal means demyelination

Question 7

what is the treatment of Guillain-barre syndrome?

Answer 7

supportive care

ventilatory support

prevent DVT and PE

plasma exchange

Question 8

what is a spinal cord injury?

Answer 8

watch YouTube of how it happens, her slides have too much information

Question 9

discuss tetraplegia

Answer 9

paralysis of both arms, legs and
trunk that occurs with spinal cord damage at C8 or above

Question 10

what is primary injury for spinal cord injury?

Answer 10

primary is just mechanical force so outside forces have damaged the spinal cord

Question 11

what is secondary injury for spinal cord injury?

Answer 11

inside your own body so edema, inflammation -> they cannot tel the extent of the injury until the get past the secondary phase because it depends on your body so they wait 72hours to see the extent of the damage

Question 12

what is spinal shock?

Answer 12

temporary neurological syndrome characterized by
decreased reflexes, loss of sensation and flaccid paralysis below the
level of the injury

this can mask postneurological function

Question 13

what is neurogenic shock?

Answer 13

caused by SCI at the 5th thoracic (T5) vertebra or
above

affects SNS and changes your vital signs. MASSIVE vasodilation, hypotension, bradycardia, low cardiac output basically everything LOW with no compensation

Question 14

how do we classify spinal cord classification?

Answer 14

1) mechanisms of injury
- flexion
-hyperextension
-flexion-rotation (MOST UNSTABLE)
-extenstion-rotation
- compression

2) level of injury
- skeletal level
- neurological level
- cervical and lumbar; MOST COMMON
-cervical cord ; ALL 4 EXTREMETIES
-thoracic cord in lumbar spine = PARAPLEGIA

3) degree of injury
- complete cord involvement; TOTAL LOSS of sensory and motor function below th injury
- incomplete cord involvement; mixed loss of motor and sensory function

Question 15

what should we know about spinal cord injury in terms of location of injury?

Answer 15

Higher the injury, more serious the sequelae because of the proximity
of the cervical cord to the medulla and brainstem

Question 16

what are the clinical manifestations of spinal cord injury?

Answer 16

1) respiratory
- hard for them to deep breathe and coughing so they are at risk for pneumonia
- injuries above C4 = TOTAL LOSS OF RESPIRATORY FUNCTIONS

2) cardiovascular
- Injury above T6 have bradycardia
- Vasodilation = low venous return = low cardiac output = hypotension

3) integumentary
- pressure injuries can occur quickly in areas with decrease or no sensation

4) urinary
- urinary retention
- overextended and atonic bladder
- intermittent catheterization

5) thermoregulation
- poikilothermic ; body temperature to room temperature
- body ability to shiver decreases below the injury site so the body cant thermoregulate properly

6) metabolic needs
- suctioning can lead to Metabolic alkalosis
- nutritional needs are higher

7) gastro
- sphincter tone decrease
- hypo motility = paralytic ileus and gastric distension

8) peripheral vascular conditions
- thromboembolism
- general issues are difficult to detect

Question 17

what is the diagnostic test for spinal injury?

Answer 17

• Spine radiography to assess vertebral fracture
• MRI for neuro tissues
• CT to assess degree of injury

Question 18

what is needed for inter professional care for spinal cord injury?

Answer 18

ABC

Question 19

what are non operative stabilization for spinal cord injury?

Answer 19

1) cervical collar
2) HOB 30-45 deg
3) Halo traction - halo ring secured into skull
4) Thoracic or lumbar spine injuries are stabilized with a custom thoraco-
lumbar-sacral orthosis brace controlling flexion, extension and rotation

Question 20

what is autonomic dysreflexia?

Answer 20

injury of T6 or higher may develop autonomic dysreflexia. Occurs in response to visceral stimulation once spinal shock is
resolved with patients with SCI

Most common precipitating cause is distension of bladder or rectum

Question 21

what does autonomic dysreflexia look like?

Answer 21

1) HYPERTENSION
2) throbbing headache
3) bradicardia (30-40)

Question 22

what are interprofessional care for autonomic dysreflexia?

Answer 22

HOB 45 or sitting upright

notify HP

IMMEDIATE catheterization to relieve bladder; check if theres kinks of clog if pt has one already

stool impaction - remove all constrictive clothing