Peripheral nerve and spinal cord Flashcards
what is Bell’s palsy?
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
what is supportive care for Bell’s palsy?
eye protection (IMPORTANT), change in diet, corticosteroids and analgesics
What is Guillain-barre syndrome?
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
what are the clinical manifestations?
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
what are complications of Guillain-barre syndrome?
life threatening
pain is secondary to this (neuropathic pain) - parestheia
respiratory failure occurs
what are diagnostic tests of Guillain-barre syndrome?
based on pt’s history and clinical signs
can check EMG and nerve condition if abnormal means demyelination
what is the treatment of Guillain-barre syndrome?
supportive care
ventilatory support
prevent DVT and PE
plasma exchange
what is a spinal cord injury?
watch YouTube of how it happens, her slides have too much information
discuss tetraplegia
paralysis of both arms, legs and
trunk that occurs with spinal cord damage at C8 or above
what is primary injury for spinal cord injury?
primary is just mechanical force so outside forces have damaged the spinal cord
what is secondary injury for spinal cord injury?
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
what is spinal shock?
temporary neurological syndrome characterized by
decreased reflexes, loss of sensation and flaccid paralysis below the
level of the injury
this can mask postneurological function
what is neurogenic shock?
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
how do we classify spinal cord classification?
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
what should we know about spinal cord injury in terms of location of injury?
Higher the injury, more serious the sequelae because of the proximity
of the cervical cord to the medulla and brainstem
what are the clinical manifestations of spinal cord injury?
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
what is the diagnostic test for spinal injury?
- Spine radiography to assess vertebral fracture
- MRI for neuro tissues
- CT to assess degree of injury
what is needed for inter professional care for spinal cord injury?
ABC
what are non operative stabilization for spinal cord injury?
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
what is autonomic dysreflexia?
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
what does autonomic dysreflexia look like?
1) HYPERTENSION
2) throbbing headache
3) bradicardia (30-40)
what are interprofessional care for autonomic dysreflexia?
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
