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Neuro 2 > SCI intro pt. 3 > Flashcards

SCI intro pt. 3 Flashcards

1
Q

acute medical management - what is the primary goal?

A

stabilize spine

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2
Q

how do they stabilize spine post SCI

A

surgery - closed or open reduction, spinal canal decompression

external support devices - halo brace, CTLSO, TLSO, LSO

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3
Q

what does methylprednisone do

A

stabilizes cell membranes
decrease inflammation
increase nerve impulse generation
improve blood flow to damaged area

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4
Q

what is the window of methylprednisone

A

3-8 hours post injury

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5
Q

what does methylprednisone do for incomplete injuries

A

enhances return of some function below spinal level

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6
Q

what does methylprednisone do for complete injuries

A

increases chances of return of function of the last preserved spinal level

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7
Q

complications of SCI

A

spinal shock
autonomic dysreflexia
pressure ulcers
postural hypotension
pain
spasticity
contractures
HO
edema
DVT
osteoporosis & renal calculi
respiratory compromise
bladder & bowel dysfunction
sexual dysfunction

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8
Q

spinal shock

A

temp phenomenon with injuries T6 and above
cord in its entirety ceases to function below the lesion

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9
Q

what are absent below the level of the lesion during spinal shock

A

spinal reflexes
voluntary motor control
sensory function
autonomic function

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10
Q

what initially happens during spinal shock

A

increased BP THEN decrease BP, HR, hypothermia, venous stasis

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11
Q

when does spinal shock resolve

A

within 24 hours to several days of the injury

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12
Q

what is the first thing to return during spinal shock

A

sacral/anal reflexes

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13
Q

autonomic dysreflexia

A

over activity of the autonomic nervous system with damage to T6 or above

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14
Q

cause of autonomic dysreflexia

A

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

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15
Q

response to pressure during autonomic dysreflexia

A

pounding HA (due to increased BP), goose bumps, sweating above level, bradycardia, skin blotching

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16
Q

interventions of autonomic dysreflexia

A
  1. sit them up
  2. if already sitting, perform pressure relief
  3. check catheter
  4. check clothing
  5. check skin
  6. emergency response if not gone in 10 mins
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17
Q

sequelae of autonomic dysreflexia

A

convulsions
LOC
death

18
Q

cause of impaired thermoregulation

A

due to loss of sympathetic output

19
Q

what are u at risk for with impaired thermoregulation first

A

hypothermia due to peripheral vasodilation
THEN
hyperthermia due to lack of sweat gland control

20
Q

which levels have greater disturbances in impaired thermoregulation

A

usually higher levels

21
Q

what pt education would u give when a pt has impaired thermoregulation

A

appropriate weather clothing

22
Q

what % of pt’s will experience spasticity

A

65%

23
Q

which lesions are more common for spasticity

A

cervical lesions

24
Q

which levels innervate diaphragm

A

C3, C4, C5

25
Q

what levels has normal ventilatory and respiratory function

A

T10

26
Q

what determines the type of bladder dysfunction

A

level of SCI

27
Q

bladder dysfunction for injury above conus medullaris/sacral segments

A

spastic/hyper reflexic bladder
voiding is involuntary and incomplete

28
Q

bladder dysfunction for lesion to CM/sacral segments

A

flaccid/areflexic bladder

bladder overfills and over distends
overflow and stress incontinence may occur

29
Q

management of bladder dysfunction

A

external collection devices
intermittent catheterizations
meds
surgery: suprapubic catheter, bladder augmentation

30
Q

what % of pt’s report bowel dysfunction

A

98% and 34% require assistance

31
Q

bowel dysfunction for injury above S2

A

spastic/reflex bowel

excrement is involuntary and incomplete

32
Q

bowel dysfunction for injury at S2-S4

A

flaccid/areflexive bowel

bowel overfills and over distends

33
Q

what is the second most common cause of autonomic dysreflexia

A

bowel dysfunction

34
Q

what health problems will pt’s experience related to bowel management

A

rectal prolapse
hemorrhoids
abdominal pain and bloating

35
Q

management of bowel dysfunction

A

reflex bowel programs: trigger bulbocavernosus reflex

digital stim programs
bowel suppositories

36
Q

symptoms of bladder and bowel dysfunction

A

fever, chills, nausea, HA, increased spasticity, autonomic dysreflexia, dark or bloody urine

37
Q

sexual dysfunction for males mainly looks like

A

directly related to level and completeness of injury
erectile capacity spared with UMN lesions, but fertility can be impacted

38
Q

sexual dysfunction for females mainly looks like

A

menstruation and fertility more likely to be spared
pregnancy is high risk

39
Q

what CV instability will u likely see with T6 and up injury

A

bradycardia, excessive peripheral vascular dilation

40
Q

strategies for BP instability

A

TED stockings
abdominal binder
ace wraps
monitor fluid intake

41
Q

osteoporosis and renal calculi due to what

A

changes in calcium metabolism
bone density decreases for up to 3 years

42
Q

management of osteoporosis and renal calculi

A

early mobilization
therapeutic standing
administration of calcium supplements
good dietary management

Neuro 2 (37 decks)

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