SCI 2 Flashcards
Autonomic dysreflexa
occurs in lesions above T6
there is a sudden increase in BP
more common in chronic stages of injury, can occur earlier
more common in spinal shock injuries but can occur with incomplete
autonomic dysreflexia causes
caused by an irritation below the level of injury:
bladder distension or blocked catheter are common cause
pressure ulcers
kidney malfunction
labor
estim
pain
Autonomic dysreflexia symptoms
headache
sweating
inc spasticity
vasoconstriction below injury
constricted pupils
blurred vision
drastic inc in BP (change of 20-30 is diagnostically positve-systolic. Tx with emergency)
Autonomic dysreflexia treatment
interventions: treat like an emergency
monitor vitals
bring to upright position
loosen any tight clothing
check for source-start with bladder, move to bowels
Spastic hypertonia
Spastic hypertonia has been defined as a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one component of the upper motor neuron syndrome.
65% of individuals with SCI
more common in complete injuries
up to 50% of individuals report spasticity to be a problem for daily life
interventions-stretch does not work well, medications, botox, surgery
Cardiovascular impairments
imbalance between parasympathetic and sympathetic systems
orthostatic hypotension-condition in which your blood pressure falls significantly when you stand up quickly.
^^interventions-abdomical binder and ted hose
DVT- occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs.
^^interventions- ted hose, SCDs, meds, IVC filters (inf vena cava, it catches clot before gets to heart)
Pulmonary impairments
below T10 have near normal pulmonary function
important!- 3,4,5 keep the diaphragm alive!
^^interventions- phrenic nerve stimulators (cant rely on need a backup), assisted coughing, trach with vent. Need pressure in abdominals for diaphragm to function properly.
Cough
functional cough- 2+ coughs per breath. Can clear secretions.
weak functional cough- 1 cough per breath
non func cough- a clearing of the throat, not a real cough. Not clearing anything.
^^interventions- glossopharyngeal breathing, assisted cough, coughing machines, percussion
Bowel and bladder dysfunction
conus medularis controls bladder function (T12-L1)
SPASTIC bladder typically occurs if injury is ABOVE CM
FLACCID bladder typically occurs if injury is BELOW CM
Spastic bladder
often reflexively empty at a certain filling point
pulling hair, taping pubis, stroking abdomen
Flaccid bladder
requires other techniques
valsalva
crede maneuver
catheterization
Bowel/Bladder programs
timed voiding- start on schedules. Every 2 hrs try in restroom. If dont, use cath.
meds- flomax to empty all. Baclofen dec spastic bladder.
bladder-intermittent cateterization
bowel-may need adult diapers
Sexual dysfunction-Men erection capacity
erection capacity:
Greater capacity if above CM, Lower capacity if below CM
Sexual dysfunction-men erection type
reflexogenic- occur in response to external physical stimulation of genitals (must have intact reflex arch).
Psychogenic- occur through cognitive activity (much more difficult to attain).
Sexual dysfunction-men ejaculation
ejaculation-more likely if below CM
more likely if below CM
lower level vs higher level cord injuries
incomplete as compared to complete
