Peripheral nerve And Spinal Cord Problems Flashcards
What are clinical manifestations of Trigeminal neuralgia?
Very painful, sharp electric-like spasms that last for a fee seconds of minutes.
Usually only on one side of the face, often around the eye, cheek, and lower part of the face
Pain may be triggered by touch or sounds
What Cranial Nerve does Trigeminal Neuralgia effect?
5th CN (sensory & motor)
When can pain triggers occur in Trigeminal Neuralgia?
Brushing teeth Chewing Drinking Eating Shaving
What are some treatments for Trigeminal Neuralgia?
Relieve pressure on cranial nerve 5
Temporarily or permanently interrupt CN5
Use a nerve block
This is temporary
What are the goals of a patient with Trigeminal Neuralgia
Will be pain free
Will maintain adequate nutrition and oral hygiene
Will have minimal to no anxiety
Will return to normal of previous socialization and occupational activities
What is the nursing care for a patient with Trigeminal Neuralgia?
Assess I&O's Assess hygiene Assist patient to manage triggers If nerve function interrupted: Have patient chew on good side Monitor food temps (burns) Manual removal of pouched foods
How do you diagnose Trigeminal neuralgia?
History and Physical examination
CT scan
To rule out other problems
MRI
What is the collaborative therapy of Trigeminal Neuralgia?
Drug therapy Tegretol is the first choice Local nerve blocking Biofeedback Surgical intervention
What is Bell’s Palsy
Acute disruption of cranial nerve 7 (facial nerve)
Inability to move one side of face
Inability to move one eye, blink
Eye becomes dry, painful with excessive tearing
Requires patch for protection
What are symptoms of Bell’s Palsy?
Forehead not wrinkled Eyeball rolls up Eyelid does not close Flat nasolabial fold Paralysis of lower face
make sure to give them privacy
What is the etiology of Bell’s Palsy?
Possible reactivation of herpes vesicles in and around the earl will proceed facial paralysis
What is the treatment for Bell’s Palsy?
Corticosteroids
Antivirals
Time-85% Full recovery in 6 months
Moist heat
Gentle massage
Protect eye
Pain relief and social support
How do you diagnose Bell’s Palsy?
Blood tests for sarcoidosis or Lyme Disease
MRI - not in all patients
Electromyography (EMG)-confirms the presence of nerve damage
Nerve conduction test
What are the patient’s goals with Bell’s Palsy?
Will be pain free
Will not experience any complications
Will maintain optimal intake
Will have minimal side effects from corticosteroids
Will return to previous perception.of body image
What are the clinical manifestations of Gullain-Barre’ Syndrome?
Muscle weakness or the loss of muscle function and it effects both sides of the body
Tingling foot or hand pain, clumsiness, increased drooling
Typical symptoms include: loss of reflexes in the arms and legs and muscle weakness or loss of muscle function
May get worse over 24-72 hours
May occur in the nerves of the head only
May start in arms and legs; will move up or down
May have respiratory distress and may need to be an advance airway
What is the nursing management for Guillain-Barre’ Syndrome?
Assess- reflexes, respiratory status, watch their gait, push/pull and grips, for skin breakdown turn every 2 hours
Nursing Diagnosis-skin breakdown, risk for aspiration, ineffective breathing, fear
Watch for signs of infection because of foley
How do you diagnose Guillain-Barre’ Syndrome?
A loss of reflexes
Look at titers
How do you treat Guillain-Barre’ Syndrome?
High doses of sanuloglobbulin will help reduce the length and the extent of the symptoms
How do you classify a spinal cord injury?
Mechanisms of injury: hyperextension, flexion, etc.
Level of injury-
Skeletal: vertebral level most damage
Neurologic: lowest level: cervical, thoracic and lumbar
Degree of injury: complete or incomplete
What do the cervical spinal nerves control?
Diaphragm
Chest wall muscles
Arms
Shoulders
What do the thoracic spinal nerves control?
Upper body
Gastrointestinal function
What do the lumbar and sacral spinal nerves control?
Lower body
Bowel & Bladder
What happens of the injury is above C-4?
Paralysis of respiratory muscles and all four extremities
The higher the injury the greater the loss of function
What kind of paralysis would someone experience base on their injury?
C4 and C6 quad
T6 ANC L1 para
What is central cord syndrome?
Damage to central spinal cord
Occurs most commonly in cervical cord region
More common in older adults
Motor weakness and sensory loss are present in both upper and lower extremities
The upper extremities are affected more than the lower ones
What is anterior cord syndrome?
Caused by damage to the anterior spinal artery
Results in compromised blood flow to anterior spinal cord
Typically results from injury causing acute compression of anterior portion of spinal cord
Often aw flexion injury
Manifestations include motor paralysis and loss of pain and temperature sensation below the level of injury
Because the posterior cord tracts are not injured, sensation of touch, position, vibration, and motion remain intact
What is Brown-Sequard Syndrome?
Result of damage to one half of spinal cord
Characterized by loss of motor function and position and vibration sense
Vas improve paralysis on the same side as lesion
The opposite (contra lateral) side has loss of pain and temperature sensation below the level of the lesion
What is Posterior Cord Syndrome?
Results from compression or damage to posterior spinal artery
Very rare condition
Usually dorsal columns are damaged
Results in loss of proprioception
Pain, temperature sensation, and motor function below level of lesion remain intact
What is Conus Medullaris Syndrome and Caude Equina Syndrome?
Results from damage to very lowest portion of spinal cord (conus) and lumbar and sacral nerve roots (cauda Equina).
Injury to these areas produces flaccid paralysis of lower limbs and areflexic (flaccid) bladder and bowel
What is the emergency care needed for a spinal chord injury?
Airway
Breathing-phrenic nerve at C4
Circulation-prevent hypovolemia
Mechanical stabilization of cord
What clinical manifestations and complications can occur in a spinal cord injury?
Clinical manifestations-respiratory system
Complications correspond with level of injury
Below C4 can affect phrenic nerve function and cause respiratory insufficiency
Cervical and thoracic injuries–paralysis of abdominal and intercostal muscles
What are clinical manifestations having to do with the cardiovascular system in spinal chord injuries
Above T6 decreases influence of sympathetic nervous system
Peripheral vasodilitation
Relative hypovolemia
What are clinical manifestations having to do with the gastrointestinal system I’m spinal cord injuries?
Above T5 - hypomotility
Paralytic ileus and gastric distention
NGO tube and Reglan to slow emptying
Risk for ulcers
Stress ulcers common, intraabdominal bleeding may occur
Indications of bleeding: continued hypotension, decreased H&H and expanding girth
Neurogenic Bowel
What are clinical manifestations having to do with the integumentary system in spinal cord injuries?
Lack of sensation Potential for skin breakdown Pressure ulcers Sepsis Thermoregulation Decreased ability to sweat and shiver
What are clinical manifestations having to do with the urinary system in spinal cord surgeries?
Urinary retention
Atonic bladder
Overdistention
Insert an in dwelling catheter until large quantities of IV fluids are no longer required
Then begin intermittent catheterization which will help maintain bladder tone and decreases the risk of infection
What are complications of spinal cord injuries?
Metabolic needs
Alkalosis from auctioning
Decreased tissue perfusion may lead to acidosis
Nutritional needs
Patients need extra protein
It prevents skin breakdown and infection and decreases rate of muscle atrophy
Peripheral vascular issues
DVT or PE
More difficult to diagnose DVT because usual symptoms are pain and tenderness
What diagnostic studies will you perform to diagnose a spinal cord injury?
CT
MRI
Complete neurological assessment
What collaborative care would you perform with a spinal cord injury?
Non-operative stabilization
Surgical therapy
Drug therapy
Solumedrol-decreases inflammation and motor function and sensation
In a nursing Assessment what subjective data would you collect for a spinal cord injury?
Past medical history Health perception-health management Activity-exercise Cognitive-perceptual Coping-stress tolerance
In a nursing assessment what objective data will you collect?
General: poikilothermism Integumentary: neurogenic shock Respiratory: lesions at C1-3 Cardiovascular: lesions above T5 GI: decreased or absent bowel sounds Urinary: retention, flaccid bladder
In a nursing assessment for someone with a spinal cord injury what assessments do you perform?
Test muscle groups with and against gravity
Note spontaneous movement
Sensory examination
Position sense and vibration
Assessment involves testing muscle groups rather than individual muscles
Ask the patient to move legs and then hands, spread fingers, extend wrists and shrug shoulders
A sensory examination including touch and pain as tested by pinprick should be carried out, starting at the toes and working upward
Brain injury may have occurred-assess history for: unconsciousness, signs of concussion, increased ICP
Musculoskeletal injuries
Trauma to internal organs
Because there are no muscle, bone, or visceral sensations, the only clue to internal trauma with hemorrhage may be a rapidly falling hematocrit level
Examine the urine for hematuria, which is also indicative of internal injuries
What are some nursing diagnoses for a person with a spinal cord injury?
Depend on the severity of the injury and the level of dysfunction Impaired gas exchange Decreased cardiac output Impaired skin integrity Constipation Impaired urinary elimination Impaired physical mobility Risk for autonomic dysreflexia Ineffective coping Interrupted family process Ask them-why don't you give us your input on your plan of care
What are goals for patients with a spinal cord injury?
Maintain optimal Neurologic functioning
Have minimal or no complications of immobility
Learn new skills, gain new knowledge, and acquire new behaviors to be able to care for self or direct others to do so
Return to home and community with optimal functioning
What are some acute interventions performed by a nurse when it comes to spinal cord injury?
Immobilization (cervical traction, sternal-occipital-mandibular immobilization, halo vest) Respiratory dysfunction Cardiovascular instability Fluid and nutritional maintenance Bladder and bowel management
What are some health promotions performed by a nurse for a patient with a spinal cord injury?
Identify: high-risk populations
Counseling
Education
Support legislation on seat belt use, helmets for motorcyclists/bicyclists, and child safety seats
After injury, health-promoting behaviors can have a significant impact on the health and well-being of the individual with a spinal cord injury
What are the nursing implementations of neurogenic shock?
Acute Interventions
Rehabilitation and home care
Temperature control - below site of injury
Stress ulcers-physiologic response to severe trauma
Sensory deprivation-stimulate patient above level of injury
Reflexes-return of reflexes may complicate rehab
Autonomic dysreflexia (be concerned)
Respiratory rehabilitation
Neurogenic bladder, bowel and skin
Sexuality-multiple options
What is autonomic dysreflexia?
A spinal cord injury at T6 or higher
Return of reflexes without sensation causes life threatening hypertension
Causes: distended bladder or rectum, skin irritant, stimulation of pain receptors
Manifestations include hypertension, blurred vision, throbbing headache (take BP), marked diaphoresis above lesion level, bradycardia
Below injury level will be pale, cool and no sweating
Nursing Intervention: elevate HOB at 45 degrees or sit upright, notify physician, assess cause, provide immediate catheterization, teach patient and family causes and symptoms
What are the reasons why grief occurs in a spinal cord injuries?
Loss of control over everyday functions Feeling of uselessness Sexuality Stages of Grief Shock and denial Anger Depression Adjustment
What are some differences with the older population and spinal cord injuries?
More experience spinal cord injury due to work on the body
More complications with longer healing time
People are living longer so spinal cord injury is more frequent
Issues with bowel and bladder with increase spinal cord injury
Health promotion for the older population
What is spinal shock?
Initial inflammatory & circulatory effect on the cord
50% of people with spinal cord injury have it
Temporary and can last days to months
Flaccid paralysis, loss of sensation
Last days to months
May require rehab
What is neurogenic shock?
Loss of vasomotor tone from injury
Neurogenic shock allows blood to pool in extremities
Pressure down, pulse down
