SCI intro pt. 3 Flashcards
acute medical management - what is the primary goal?
stabilize spine
how do they stabilize spine post SCI
surgery - closed or open reduction, spinal canal decompression
external support devices - halo brace, CTLSO, TLSO, LSO
what does methylprednisone do
stabilizes cell membranes
decrease inflammation
increase nerve impulse generation
improve blood flow to damaged area
what is the window of methylprednisone
3-8 hours post injury
what does methylprednisone do for incomplete injuries
enhances return of some function below spinal level
what does methylprednisone do for complete injuries
increases chances of return of function of the last preserved spinal level
complications of SCI
spinal shock
autonomic dysreflexia
pressure ulcers
postural hypotension
pain
spasticity
contractures
HO
edema
DVT
osteoporosis & renal calculi
respiratory compromise
bladder & bowel dysfunction
sexual dysfunction
spinal shock
temp phenomenon with injuries T6 and above
cord in its entirety ceases to function below the lesion
what are absent below the level of the lesion during spinal shock
spinal reflexes
voluntary motor control
sensory function
autonomic function
what initially happens during spinal shock
increased BP THEN decrease BP, HR, hypothermia, venous stasis
when does spinal shock resolve
within 24 hours to several days of the injury
what is the first thing to return during spinal shock
sacral/anal reflexes
autonomic dysreflexia
over activity of the autonomic nervous system with damage to T6 or above
cause of autonomic dysreflexia
irritating stimulus introduced to body below level of spinal cord injury
FULL BLADDER
full bowel, wounds/pressure sores, burns, ingrown toenails, kinked clothing, foreign object pressing against skin
response to pressure during autonomic dysreflexia
pounding HA (due to increased BP), goose bumps, sweating above level, bradycardia, skin blotching
interventions of autonomic dysreflexia
- sit them up
- if already sitting, perform pressure relief
- check catheter
- check clothing
- check skin
- emergency response if not gone in 10 mins
sequelae of autonomic dysreflexia
convulsions
LOC
death
cause of impaired thermoregulation
due to loss of sympathetic output
what are u at risk for with impaired thermoregulation first
hypothermia due to peripheral vasodilation
THEN
hyperthermia due to lack of sweat gland control
which levels have greater disturbances in impaired thermoregulation
usually higher levels
what pt education would u give when a pt has impaired thermoregulation
appropriate weather clothing
what % of pt’s will experience spasticity
65%
which lesions are more common for spasticity
cervical lesions
which levels innervate diaphragm
C3, C4, C5
what levels has normal ventilatory and respiratory function
T10
what determines the type of bladder dysfunction
level of SCI
bladder dysfunction for injury above conus medullaris/sacral segments
spastic/hyper reflexic bladder
voiding is involuntary and incomplete
bladder dysfunction for lesion to CM/sacral segments
flaccid/areflexic bladder
bladder overfills and over distends
overflow and stress incontinence may occur
management of bladder dysfunction
external collection devices
intermittent catheterizations
meds
surgery: suprapubic catheter, bladder augmentation
what % of pt’s report bowel dysfunction
98% and 34% require assistance
bowel dysfunction for injury above S2
spastic/reflex bowel
excrement is involuntary and incomplete
bowel dysfunction for injury at S2-S4
flaccid/areflexive bowel
bowel overfills and over distends
what is the second most common cause of autonomic dysreflexia
bowel dysfunction
what health problems will pt’s experience related to bowel management
rectal prolapse
hemorrhoids
abdominal pain and bloating
management of bowel dysfunction
reflex bowel programs: trigger bulbocavernosus reflex
digital stim programs
bowel suppositories
symptoms of bladder and bowel dysfunction
fever, chills, nausea, HA, increased spasticity, autonomic dysreflexia, dark or bloody urine
sexual dysfunction for males mainly looks like
directly related to level and completeness of injury
erectile capacity spared with UMN lesions, but fertility can be impacted
sexual dysfunction for females mainly looks like
menstruation and fertility more likely to be spared
pregnancy is high risk
what CV instability will u likely see with T6 and up injury
bradycardia, excessive peripheral vascular dilation
strategies for BP instability
TED stockings
abdominal binder
ace wraps
monitor fluid intake
osteoporosis and renal calculi due to what
changes in calcium metabolism
bone density decreases for up to 3 years
management of osteoporosis and renal calculi
early mobilization
therapeutic standing
administration of calcium supplements
good dietary management
