SCI and Peripheral Flashcards
What are some risk factors for spinal cord injuries?
Young, male, motor vehicle accidents, ,violence, falls, sports, alcohol/ drug abuse, disease
What are some levels of injury that can occur for spinal cord injuries
cervical, thoracic, lumbar, sacral
What is a tetraplegia spinal cord injury
high cervical nerves (C1-C4)
What is a complete tetraplegia spinal cord injury
total loss of sensory and motor function below level of injury
What is a incomplete tetraplegia spinal cord injury
mixed loss of voluntary motor activity and sensation
What is a primary spinal cord injury
initial damage caused by trauma from the event like contusion, laceration or compression of the cord
What is a secondary spinal cord injury
most accurately determined at 72 hours following injury like edema and ischemia of the spinal cord
What do cervical injuries result in
tetraplegia
What do injuries below t1 result in
paraplegia
What are some techniques to minimize spine movement
of log-roll movements and a backboard for transfer and placement of a rigid cervical collar
When should traumatic spinal injury be assumed
If the patient has a head injury, is unconscious or confused, or complains of spinal pain, weakness, and/or loss of sensation
What is an ASIA A spinal cord injury
injury is complete spinal cord injury with no sensory or motor function
What is an ASIA B spinal cord injury
a sensory incomplete injury with complete motor function loss
What is an ASIA C spinal cord injury
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)
What is an ASIA D spinal cord injury
a motor incomplete injury with more than half of the muscle groups are anti gravity
What is an ASIA E spinal cord injury
normal – no effects
What are the classification of mechanism of injury
flexion, hyperextension, flexion- rotation, extension- rotation, compression
What are levels of injury classifications
skeletal (vertebral injury), neurologic (lowest level with intact sensory/motor function bilaterally)
What are some diagnostic tests for spinal cord injuries
CT scan (location and degree), cervical scan (if cant get CT scan), MRI (neurological changes), Neuro exam (LOC, visual changes, mental status, PERRLA, sensation)
What are some pharm tx for spinal cord
methylprednisolone (not recommended for pts with penetrating wounds, brain injury, trauma), VTE prophylaxis is always used unless internal bleeding, Dopamine, atropine
How is the respiratory system affecting above level of C4
total loss of respiratory muscle function aka intubate
What is the respiratory function below the level of C4
diaphragmatic breathing
What is the tx for peripheral vasodilation
ted hose
What is a neurogenic bladder
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
What should be done in the acute phase of neurogenic bladder
indwelling catheter, bc of urinary retention, bladder atonic, over distention so fails to empty
What should be done in the post acute phase of neurogenic bladder
intermitten catheterization program (4-6 times daily), bladder could become hyperirritable, loss of inhibition from brain, reflex emptying and failure to store urine
What are some effects that could happen r/t decreased GI motor ability
gastric distention (vomiting/aspiration), paralytic ileus, delayed gastric emptying , stress ulcers from too much HCI, dysphagia
What is Poikilothermic
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
What is nociceptive pain
Musculoskeletal pain dull or aching, worsens with movement, Visceral pain in thorax, abdomen, pelvis - dull, tender, or cramping
What is neuropathic pain
Located at or below level of injury, Hot, burning, tingling, pins and needles, cold, shooting, May be extremely sensitive to stimuli
What is the pain management for nociceptive pain
anti inflammatory, opioids, realignment and stabilization of cervical fracture
What is the pain management for neuropathic pain
Gabapentin (Neurontin) or pregabalin (Lyrica), Teach about pain triggers and relaxation therapy
What is spinal cord shock
depression of cord function below level of injury, happened within first hour of injury and can last days- months, ends when reflexes are regained
What are the ss of spinal cord shock
Initially hypertension due to release of catecholamines. Flaccid muscles, absent reflexes below the level of the lesion, Paralytic ileus can occur
What is neurogenic shock
Sudden depression of autonomic function below level of injury (more commonly in injuries above T6 )
What is the tx of neurogenic shock
dopamine for triad hypotension, bradycardia and hypothermia
What are the ss of neurogenic shock
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)
What is autonomic dysreflexia
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
What are the ss of autonomic dysreflexia
pounding HA, bradycardia, hypertensive crisis, flushed warm skin with profuse sweating above lesion and pale cold dry skin below, anxiety, nausea, restlessness/apprehension
What are the interventions for autonomic dysreflexia
SIT UP, Notify Provider, Remove noxious stimuli, Control B/P to prevent stroke
What is the purpose of the trigeminal nerve
responsible for sending impulses of touch, pain, pressure, and temp to brain from face, jaw, forehead and around the eyes
What is the ss of trigeminal neuralgia dysfunction
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.
What are the triggers for trigeminal neuralgia dysfunction
chewing, touch, yawning, talking
What are the risk factors for trigeminal neuralgia dysfunction
female, over 40, MS, HTN, herpes, teeth/jaw infection, brainstem infarct
How Is trigeminal neuralgia dysfunction diagnosed
History and Physical, CT Scan and MRI to rule out MS and brain tumors, Neuro exam is normal
What are the pharm tx for trigeminal neuralgia dysfunction
Anticonvulsant meds (tegretol, Dilantin, gabapentin) (FIRST LINE of drugs), Skeletal Muscle Relax- baclofen (Lioresal), GABA analogs - Neurontin (gabapentin)
What is the tx for trigeminal neuralgia dysfunction
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
What is the teaching for trigeminal neuralgia dysfunction
Oral hygiene, pain mgmt, alternative pain relief measures, environmental mgmt, warm mouthwash, soft bristle toothbrush, mechanical soft food & chew on unaffected side
what is bells palsy
HSV causes inflammation, edema, ischemia, and eventually demyelination of the facial nerve
what are the ss of bells palsy
Fever, tinnitus, hearing deficit, flaccidity of affected side, drooping of mouth and drooling,
what are the risk factors for bells palsy
Herpes outbreak & flu most common
how is bells palsy diagnosed
Exclusion diagnosis and EMG
what is the pharm management for bells palsy
Corticosteroids, Acyclovir for Herpes breakout
what is the tx for bells palsy
Moist heat, gentle massage, facial exercises
what is the teaching for bells palsy
Protect affected eye, chew on unaffected side, oral hygiene after eating, artificial tears, eye shield at night, facial exercises
what is Guillain barre
Immune reaction directed at the nerves resulting loss of myelin, edema, and inflamed nerves.
What are the ss of Guillain barre
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
What are the risk factors for Guillain barre
Viral infection, trauma, surgery, or viral immunizations. 30% of cases follow a GI illness.
How is Guillain barre diagnosed
History and Physical; Abnormal EMG; Brain MRI to r/o MS as s/s are similar
What is the pharm tx for Guillain barre
IV Immunoglobulin (IV-IG) in first 2-3 weeks wipe out your antibodies bc your body is attacking itself (Infuse slowly)
What is the tx for Guillain barre
Plasmapheresis in first 2 weeks (Like a dialysis to remove antibodies – risk for infection), Mechanical Ventilation if needed, Rehab, Supportive care
