SCI intro pt. 3

Question 1

acute medical management - what is the primary goal?

Answer 1

stabilize spine

Question 2

how do they stabilize spine post SCI

Answer 2

surgery - closed or open reduction, spinal canal decompression

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

Question 3

what does methylprednisone do

Answer 3

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

Question 4

what is the window of methylprednisone

Answer 4

3-8 hours post injury

Question 5

what does methylprednisone do for incomplete injuries

Answer 5

enhances return of some function below spinal level

Question 6

what does methylprednisone do for complete injuries

Answer 6

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

Question 7

complications of SCI

Answer 7

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

Question 8

spinal shock

Answer 8

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

Question 9

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

Answer 9

spinal reflexes
voluntary motor control
sensory function
autonomic function

Question 10

what initially happens during spinal shock

Answer 10

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

Question 11

when does spinal shock resolve

Answer 11

within 24 hours to several days of the injury

Question 12

what is the first thing to return during spinal shock

Answer 12

sacral/anal reflexes

Question 13

autonomic dysreflexia

Answer 13

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

Question 14

cause of autonomic dysreflexia

Answer 14

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

Question 15

response to pressure during autonomic dysreflexia

Answer 15

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

Question 16

interventions of autonomic dysreflexia

Answer 16

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

Question 17

sequelae of autonomic dysreflexia

Answer 17

convulsions
LOC
death

Question 18

cause of impaired thermoregulation

Answer 18

due to loss of sympathetic output

Question 19

what are u at risk for with impaired thermoregulation first

Answer 19

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

Question 20

which levels have greater disturbances in impaired thermoregulation

Answer 20

usually higher levels

Question 21

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

Answer 21

appropriate weather clothing

Question 22

what % of pt’s will experience spasticity

Answer 22

65%

Question 23

which lesions are more common for spasticity

Answer 23

cervical lesions

Question 24

which levels innervate diaphragm

Answer 24

C3, C4, C5

Question 25

what levels has normal ventilatory and respiratory function

Answer 25

T10

Question 26

what determines the type of bladder dysfunction

Answer 26

level of SCI

Question 27

bladder dysfunction for injury above conus medullaris/sacral segments

Answer 27

spastic/hyper reflexic bladder voiding is involuntary and incomplete

Question 28

bladder dysfunction for lesion to CM/sacral segments

Answer 28

flaccid/areflexic bladder bladder overfills and over distends overflow and stress incontinence may occur

Question 29

management of bladder dysfunction

Answer 29

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

Question 30

what % of pt's report bowel dysfunction

Answer 30

98% and 34% require assistance

Question 31

bowel dysfunction for injury above S2

Answer 31

spastic/reflex bowel excrement is involuntary and incomplete

Question 32

bowel dysfunction for injury at S2-S4

Answer 32

flaccid/areflexive bowel bowel overfills and over distends

Question 33

what is the second most common cause of autonomic dysreflexia

Answer 33

bowel dysfunction

Question 34

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

Answer 34

rectal prolapse hemorrhoids abdominal pain and bloating

Question 35

management of bowel dysfunction

Answer 35

reflex bowel programs: trigger bulbocavernosus reflex digital stim programs bowel suppositories

Question 36

symptoms of bladder and bowel dysfunction

Answer 36

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

Question 37

sexual dysfunction for males mainly looks like

Answer 37

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

Question 38

sexual dysfunction for females mainly looks like

Answer 38

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

Question 39

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

Answer 39

bradycardia, excessive peripheral vascular dilation

Question 40

strategies for BP instability

Answer 40

TED stockings abdominal binder ace wraps monitor fluid intake

Question 41

osteoporosis and renal calculi due to what

Answer 41

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

Question 42

management of osteoporosis and renal calculi

Answer 42

early mobilization therapeutic standing administration of calcium supplements good dietary management