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Med Surg 3 Exam 3 > SCI and Peripheral > Flashcards

SCI and Peripheral Flashcards

1
Q

What are some risk factors for spinal cord injuries?

A

Young, male, motor vehicle accidents, ,violence, falls, sports, alcohol/ drug abuse, disease

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2
Q

What are some levels of injury that can occur for spinal cord injuries

A

cervical, thoracic, lumbar, sacral

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3
Q

What is a tetraplegia spinal cord injury

A

high cervical nerves (C1-C4)

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4
Q

What is a complete tetraplegia spinal cord injury

A

total loss of sensory and motor function below level of injury

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5
Q

What is a incomplete tetraplegia spinal cord injury

A

mixed loss of voluntary motor activity and sensation

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6
Q

What is a primary spinal cord injury

A

initial damage caused by trauma from the event like contusion, laceration or compression of the cord

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7
Q

What is a secondary spinal cord injury

A

most accurately determined at 72 hours following injury like edema and ischemia of the spinal cord

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8
Q

What do cervical injuries result in

A

tetraplegia

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9
Q

What do injuries below t1 result in

A

paraplegia

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10
Q

What are some techniques to minimize spine movement

A

of log-roll movements and a backboard for transfer and placement of a rigid cervical collar

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11
Q

When should traumatic spinal injury be assumed

A

If the patient has a head injury, is unconscious or confused, or complains of spinal pain, weakness, and/or loss of sensation

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12
Q

What is an ASIA A spinal cord injury

A

injury is complete spinal cord injury with no sensory or motor function

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13
Q

What is an ASIA B spinal cord injury

A

a sensory incomplete injury with complete motor function loss

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14
Q

What is an ASIA C spinal cord injury

A

a motor incomplete injury, where there is some movement but less then half the muscle groups are anti-gravity (can life up against the force of gravity with a full range of motion)

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15
Q

What is an ASIA D spinal cord injury

A

a motor incomplete injury with more than half of the muscle groups are anti gravity

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16
Q

What is an ASIA E spinal cord injury

A

normal – no effects

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17
Q

What are the classification of mechanism of injury

A

flexion, hyperextension, flexion- rotation, extension- rotation, compression

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18
Q

What are levels of injury classifications

A

skeletal (vertebral injury), neurologic (lowest level with intact sensory/motor function bilaterally)

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19
Q

What are some diagnostic tests for spinal cord injuries

A

CT scan (location and degree), cervical scan (if cant get CT scan), MRI (neurological changes), Neuro exam (LOC, visual changes, mental status, PERRLA, sensation)

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20
Q

What are some pharm tx for spinal cord

A

methylprednisolone (not recommended for pts with penetrating wounds, brain injury, trauma), VTE prophylaxis is always used unless internal bleeding, Dopamine, atropine

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21
Q

How is the respiratory system affecting above level of C4

A

total loss of respiratory muscle function aka intubate

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22
Q

What is the respiratory function below the level of C4

A

diaphragmatic breathing

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23
Q

What is the tx for peripheral vasodilation

A

ted hose

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24
Q

What is a neurogenic bladder

A

Bladder dysfunction related to abnormal or absent bladder innervation, No reflex detrusor contractions (flaccid, hypotonic), Hyperactive reflex detrusor contractions (spastic), Lack of coordination between detrusor contraction and urethral relaxation

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25
Q

What should be done in the acute phase of neurogenic bladder

A

indwelling catheter, bc of urinary retention, bladder atonic, over distention so fails to empty

26
Q

What should be done in the post acute phase of neurogenic bladder

A

intermitten catheterization program (4-6 times daily), bladder could become hyperirritable, loss of inhibition from brain, reflex emptying and failure to store urine

27
Q

What are some effects that could happen r/t decreased GI motor ability

A

gastric distention (vomiting/aspiration), paralytic ileus, delayed gastric emptying , stress ulcers from too much HCI, dysphagia

28
Q

What is Poikilothermic

A

temperature may vary with the environment and need to be maintained caused by interruption of SNS, decreased Ability to sweat or shiver below the level of injury - More common with high cervical injury

29
Q

What is nociceptive pain

A

Musculoskeletal pain dull or aching, worsens with movement, Visceral pain in thorax, abdomen, pelvis - dull, tender, or cramping

30
Q

What is neuropathic pain

A

Located at or below level of injury, Hot, burning, tingling, pins and needles, cold, shooting, May be extremely sensitive to stimuli

31
Q

What is the pain management for nociceptive pain

A

anti inflammatory, opioids, realignment and stabilization of cervical fracture

32
Q

What is the pain management for neuropathic pain

A

Gabapentin (Neurontin) or pregabalin (Lyrica), Teach about pain triggers and relaxation therapy

33
Q

What is spinal cord shock

A

depression of cord function below level of injury, happened within first hour of injury and can last days- months, ends when reflexes are regained

34
Q

What are the ss of spinal cord shock

A

Initially hypertension due to release of catecholamines. Flaccid muscles, absent reflexes below the level of the lesion, Paralytic ileus can occur

35
Q

What is neurogenic shock

A

Sudden depression of autonomic function below level of injury (more commonly in injuries above T6 )

36
Q

What is the tx of neurogenic shock

A

dopamine for triad hypotension, bradycardia and hypothermia

37
Q

What are the ss of neurogenic shock

A

Loss of vasomotor tone – pooling of blood, Loss of cardiac sympathetic tone – bradycardia, Blood pressure will not be restored by fluid infusion alone (massive fluid administration may lead to overload and pulmonary edema)

38
Q

What is autonomic dysreflexia

A

Injury at T6 or above, Typically occurs after the period of spinal shock is resolved, Uninhibited sympathetic discharge, can lead to stroke or death, Sudden onset, Caused by noxious stimuli: full bladder or bowel, wrinkle in sheets, tight clothing

39
Q

What are the ss of autonomic dysreflexia

A

pounding HA, bradycardia, hypertensive crisis, flushed warm skin with profuse sweating above lesion and pale cold dry skin below, anxiety, nausea, restlessness/apprehension

40
Q

What are the interventions for autonomic dysreflexia

A

SIT UP, Notify Provider, Remove noxious stimuli, Control B/P to prevent stroke

41
Q

What is the purpose of the trigeminal nerve

A

responsible for sending impulses of touch, pain, pressure, and temp to brain from face, jaw, forehead and around the eyes

42
Q

What is the ss of trigeminal neuralgia dysfunction

A

Characterized by sudden, severe, electric shock-like or stabbing pain felt on one side of jaw or cheek, twitching, lasting seconds-3mins and reoccurs several times a day, weeks, mths.

43
Q

What are the triggers for trigeminal neuralgia dysfunction

A

chewing, touch, yawning, talking

44
Q

What are the risk factors for trigeminal neuralgia dysfunction

A

female, over 40, MS, HTN, herpes, teeth/jaw infection, brainstem infarct

45
Q

How Is trigeminal neuralgia dysfunction diagnosed

A

History and Physical, CT Scan and MRI to rule out MS and brain tumors, Neuro exam is normal

46
Q

What are the pharm tx for trigeminal neuralgia dysfunction

A

Anticonvulsant meds (tegretol, Dilantin, gabapentin) (FIRST LINE of drugs), Skeletal Muscle Relax- baclofen (Lioresal), GABA analogs - Neurontin (gabapentin)

47
Q

What is the tx for trigeminal neuralgia dysfunction

A

Nerve Block: temporary 6-18mths, Glycerol rhizotomy: percutaneous chemical ablation, Radiofrequency rhizotomy: destroying area by radiofrequency (risk of sensory loss), Gamma knife radiosurgery: precise radiation, Microvascular decompression: Surgical relocation of the artery that compresses the trigeminal nerve

48
Q

What is the teaching for trigeminal neuralgia dysfunction

A

Oral hygiene, pain mgmt, alternative pain relief measures, environmental mgmt, warm mouthwash, soft bristle toothbrush, mechanical soft food & chew on unaffected side

49
Q

what is bells palsy

A

HSV causes inflammation, edema, ischemia, and eventually demyelination of the facial nerve

50
Q

what are the ss of bells palsy

A

Fever, tinnitus, hearing deficit, flaccidity of affected side, drooping of mouth and drooling,

51
Q

what are the risk factors for bells palsy

A

Herpes outbreak & flu most common

52
Q

how is bells palsy diagnosed

A

Exclusion diagnosis and EMG

53
Q

what is the pharm management for bells palsy

A

Corticosteroids, Acyclovir for Herpes breakout

54
Q

what is the tx for bells palsy

A

Moist heat, gentle massage, facial exercises

55
Q

what is the teaching for bells palsy

A

Protect affected eye, chew on unaffected side, oral hygiene after eating, artificial tears, eye shield at night, facial exercises

56
Q

what is Guillain barre

A

Immune reaction directed at the nerves resulting loss of myelin, edema, and inflamed nerves.

57
Q

What are the ss of Guillain barre

A

weakness of lower extremities, paresthesia (numbness & tingling), resulting in paralysis of extremities, Pain, orthostatic hypotension, HTN, bowel and bladder dysfunction, lack of reflexes, Autonomic dysfunction: bradycardia & dysrhythmias

58
Q

What are the risk factors for Guillain barre

A

Viral infection, trauma, surgery, or viral immunizations. 30% of cases follow a GI illness.

59
Q

How is Guillain barre diagnosed

A

History and Physical; Abnormal EMG; Brain MRI to r/o MS as s/s are similar

60
Q

What is the pharm tx for Guillain barre

A

IV Immunoglobulin (IV-IG) in first 2-3 weeks wipe out your antibodies bc your body is attacking itself (Infuse slowly)

61
Q

What is the tx for Guillain barre

A

Plasmapheresis in first 2 weeks (Like a dialysis to remove antibodies – risk for infection), Mechanical Ventilation if needed, Rehab, Supportive care

Med Surg 3 Exam 3 (6 decks)

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