Rehab Test #3 - Spinal Cord, Brain Injury, EKG

Question 1

C5-

Answer 1

Elbow Flexors

Question 2

C6-

Answer 2

Wrist Extensors

Question 3

C7-

Answer 3

Elbow Extensors

Question 4

C8-

Answer 4

Finger Flexors

Question 5

T1-

Answer 5

Finger Abductors

Question 6

L2-

Answer 6

Hip Flexors

Question 7

L3-

Answer 7

Knee Extensors

Question 8

L4-

Answer 8

Ankle Dorsiflexors

Question 9

L5-

Answer 9

Long Toe Extensors

Question 10

S1-

Answer 10

Ankle Plantar Flexors

Question 11

American Spinal Injury Association (ASIA) Impairment Scale

Answer 11

A= comlpete: no motor or sensory function is presesrved in the sacrel segment S4-S5
B=incomplete: sensory but not motor function is preserved below the neurologic level and includes the sacral segments s4-s5
C=incomplete: motor function is presereved below the neurologic level, and more than half of key muscles below the neurologic level have a muscle grade less than 3
D= incomplete: motor function is preserved below the neurologic level, and at leawst half of key muscles below the neurologic level have a muscle grade of 3 or more
E= normal: motor and sensory functions are normal/

Question 12

Initial injury

primary vs secondary

Answer 12

Primary
Actual physical disruption of axons
Secondary
Ischemia, hypoxia, microhemorrhage, and edema

Question 13

Spinal shock

Answer 13

Temporary neurologic syndrome characterized by ↓ reflexes and flaccid paralysis below level of injury

Question 14

Neurogenic shock

Answer 14

Loss of vasomotor tone characterized by hypotension, vasodilation, and bradycardia (≥T6)

Question 15

Define spinal cord injury

Answer 15

Spinal cord injury (SCI) occurs when the axons of the spinal cord are damaged

Question 16

Tetraplegia -

Answer 16

quadriplegia, is paralysis caused by illness or injury that results in the partial or total loss of use of all four limbs and torso

Question 17

Paraplegia –

Answer 17

lower parts of your body, does not affect the arms

Question 18

Upper Motor Neuron (UMN)

Answer 18

Cervical injuries
Cause loss of cerebral control over all motor activity below level of injury
Causes SPASTIC paralysis
Reflex bladder/spastic; rectal digital stimulation (by suppository)

Question 19

Lower Motor Neuron (LMN)

Answer 19

Thoracic, Lumbar and Sacral injuries (L1 & below)
Causes destruction of the reflex arc
Causes FLACCID paralysis
Areflexive bladder/Autonomous/flaccid; manual bowel evacuation
Need rectal digital stimulation

Question 20

autonomic dysreflexia

Answer 20

Autonomic dysreflexia
Also known as autonomic “hyperreflexia”
Massive uncompensated cardiovascular reaction mediated by the sympathetic nervous system in response to visceral stimulation (≥ T6 injury)
S/S Hypertension (greater than 20 mmHg over patient’s baseline systolic), throbbing headache, blurred vision, and flushing, marked diaphoresis, and piloerection above level of injury; cool, pallor below level of injury.
MEDICAL EMERGENCY

Elevate HOB, find & remove irritant (empty bladder, loosen constricted clothing), alpha-blockers and/or nitro as ordered.
Prevention is key – excellent bowel, bladder, and skin care.

Question 21

Traumatic brain injury

Answer 21

A serious form of head injury
Disruption of brain tissue resulting from an impact to the head in which the head hits, is hit by, or is penetrated by an object
Closed injury vs. open injury

Question 22

Describe the incidence of traumatic brain injury

Answer 22

5.3 million Americans currently live with disability from brain injury
1.7 million new cases each year
1,365, 000 seen in ER
275,000 are hospitalized
52,000 die
Male > female
Males 14-24 at highest risk

Question 23

Mild brain injury

Answer 23

Glasgow 13 to 15
Loss of consciousness 20 minutes or less
Posttraumatic amnesia less than 1 hour
Hallmark symptom is headache, neuroimaging is usually negative, may take weeks to months to resolve

Question 24

Moderate Brain Injury (10%)

Answer 24

Glasgow 9-12
Loss of consciousness greater than 20 minutes
Posttraumatic amnesia 1-24 hours
Symptoms depend on area of brain affected. Cerebral edema and cerebral hemorrhage often seen on imaging.
Usually requires some rehab, return to preinjury lifestyle possible but likely to have some long-term neurologic deficits

Question 25

Severe Brain Injury (10%)

Answer 25

Glasgow 8 or less
Loss of consciousness 6 hours or more
Posttraumatic amnesia is prolonged
Intracranial or subdural hemorrhage, tearing and shearing of brain tissue or penetration of brain tissue seen on neuroimaging
Numerous neurologic deficits, requires long-term rehab, some remain in vegetative states

Question 26

Increased Cranial Pressure - Clinical manifestations

Answer 26

Change in level of consciousness
Ocular signs
Headache
Vomiting
Changes in vital signs

Cushing’s triad

Widening in pulse pressure – systolic increasing and diastolic decreasing
Irregular resportory
Bradycardia
Decrease in motor

Question 27

Increased Cranial Pressure - Nursing management

Answer 27

Assess
Glasgow
Neurologic status
CSF leaks

Diagnosis
Risk for ineffective cerebral tissue perfusion, hyperthermia, potential complication increased ICP, impaired verbal communication, acute & chronic confusion, risk for injury, disturbed thought process, knowledge deficit

Plan
Overall goals:
Maintain adequate cerebral oxygenation, perfusion, and pressure
Remain normothermic
Achieve control of pain
Be free from infection
Attain maximal cognitive, motor, and sensory function

Intervene
Health Promotion
Prevent car/ motorcycle accidents, wear safety helmets and seat belts
Acute
Major focus is ICP
Rehab
Seizure disorder, personality changes, communication management, environment management, patient/family education, etc.

Evaluate
Maintain cerebral profusion/pressure
Achieve maximal cognitive, motor, and sensory function
Experience no infection, hyperthermia, etc.
Achieve pain control

Question 28

Increased Cranial Pressure - COMPLICATIONS

Answer 28

Complications
Hematomas
Epidural 
Subdural
Subarachnoid
Intracerebral

Seizures
Infection

Question 29

dura tear with CSF leak

Answer 29

The thickest outer layer of the meninges is the dura. Normally, the brain floats in this fluid. A CSF leak is when a hole or tear in the dura allows this fluid to leak out. … CSF leaks can happen after medical procedures, such as lumbar puncture (spinal tap), epidural injections or spine surgery.

Question 30

, epidural hematoma

Answer 30

Epidural hematoma, also known as epidural bleeding, is a type of traumatic brain injury (TBI) in which a buildup of blood occurs between the dura mater (the tough outer membrane of the central nervous system) and the skull.

Question 31

, subdural hematoma

Answer 31

A subdural hematoma is most often the result of a severe head injury. This type of subdural hematoma is among the deadliest of all head injuries. The bleeding fills the brain area very rapidly, compressing brain tissue. This often results in brain injury and may lead to death.

Subdural hematomas can also occur after a minor head injury. The amount of bleeding is smaller and occurs more slowly. This type of subdural hematoma is often seen in older adults. These may go unnoticed for many days to weeks, and are called chronic subdural hematomas.

With any subdural hematoma, tiny veins between the surface of the brain and its outer covering (the dura) stretch and tear, allowing blood to collect. In older adults, the veins are often already stretched because of brain shrinkage (atrophy) and are more easily injured.

Question 32

, intracranial hematoma,

Answer 32

Intracranial hematomas are accumulations of blood within the brain or between the brain and the skull. Intracranial hematomas form when a head injury causes blood to accumulate within the brain or between the brain and the skull. … Sometimes surgery is needed to drain blood from a hematoma.

Question 33

post-concussion syndrome

Answer 33

Post-concussion syndrome is a complex disorder in which various symptoms — such as headaches and dizziness — last for weeks and sometimes months after the injury that caused the concussion. Concussion is a mild traumatic brain injury, usually occurring after a blow to the head.

Question 34

seizures

Answer 34

A seizure occurs when there’s abnormal electrical activity in the brain. Seizures may go virtually unnoticed. Or, in severe cases, they may produce a change or loss of consciousness and involuntary muscle spasms called convulsions.

Question 35

Increased Cranial Pressure - MEDICAL MANAGEMENT

Answer 35

Medical Management
Observation
Manage intracranial pressure
Elevate HOB, osmotic diuretics, sedatives
Surgery if necessary
Craniotomy
Craniectomy
Cranioplasty
Burr-hole
To drain herrmages or fluid to relieve pressure

Question 36

Glasgow Coma Scale (GCS)

Answer 36

Assess level of consciousness (LOC)
Categorized into 3 assessment areas
Eye opening - 4
Verbal response - 5
Motor response - 6
Scored on scale of 3-15

Question 37

Confused -

Answer 37

unable to think or answer questions

Unable to think clearly or engage in effective problem solving: orientation to time, place, person impaired; easily aroused by verbal stimuli

Question 38

Delirious -

Answer 38

disoriented, unable to stay attentive

Restless and disoriented, may have hallucinations; easily aroused, but may have difficulty with attention

Question 39

Lethargic -

Answer 39

sluggish in activity, more sleepy

Unintersted in surroundings or events; sluggish in thought and motor activites; does not engage spontaneously in activites

Question 40

Obtunded -

Answer 40

asleep unless you wake them up to do activity, then they will go back to sleep
Fall asleep unless stimulated; arousable with voice or touch but quickly returns to sleep

Question 41

Stuporous -

Answer 41

deep sleep, cannot maintain awake

In a deep state of sleepl bigorous stimulation is required to arouse, and a wakeful state is not maintained

Question 42

Comatose-

Answer 42

cannot be awaken

Question 43

repolarization

Answer 43

Restores heart to resting state, shows up as ST segment on ECG

Question 44

depolarization

Answer 44

SA node Initiates Causes contractions and shows up as a p wave on an ECG