SCI medical management Flashcards

1
Q

medical intervention

A

Steroids to reduce swelling

  • Neurological examination
  • radiography
  • immediate stabilization of spine
  • internal fixation
  • External fixation
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2
Q

spinal fusion

A

taking metal rods and screwing them into vertebrae to stabilize.
-in rehab, as progressing they will not have a lot of cervical movement (internal fixator)

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3
Q

Halo

A

Arms and legs are free but the neck is completely stabilized from the neck up.

-progress from a halo to a c collar when not as much stability is needed.

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4
Q

Spinal shock

A

complete loss of neurological function

  • diminished reflex activity below level of injury
  • affected area (decrease sensation, deep tendon reflex, BP, flaccid muscle function, frequent loss of B and B control)
  • Lasts 1 to 6 weeks.
  • initial spike in BP due to catecholamines
  • men get Priapism (penis remains erect due to retention of blood)
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5
Q

Acute management

A

positioning/deformity control

  • Skin integrity
  • Initial ADL skill
  • Education but action is primary feature
  • Start upright tolerance
  • Building blocks (skill needed to complete ADLs)
  • Strengthening/ROM- this also helps to start acclimating them to their body.

Start initial ADLs in bed

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6
Q

Inpatient (initial) rehab

A

Upright tolerance

  • Deformity control
  • Skin issues become more directive
  • ADLs
  • Strengthening/ROM
  • learning body in space skills
  • Functional mobility
  • Spinal shock resolves
  • Education

Have them work on sitting up, head control, turning pages.

-Gear towards community integration at this point (either going home or to a SNF)

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7
Q

Outpatient/Home health

A

Finishing what you started

  • ROM/strengthening
  • body in space
  • ADL skills
  • Functional mobility skills
  • Community access
  • Training family

More worried about doing things right.
-Perineal hygiene is a big one as well as sexual dysfunction.

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8
Q

Orthostatic Hypotension

A

Treatment:

  • if sitting in chair tilt chair backwards
  • if sitting EOB lie patient back down
  • Coming to upright position slowly can help decrease incidents of orthostatic hypotension
  • Use Ace wrap to help regulate blood flow
  • abdominal binder
  • gradual increase in sitting tolerance
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9
Q

Autonomic Dysreflexia

A

Lesion at T6 or above

Treatment:

  • elevate to sitting position
  • take BP in both arms (systolic can be 9-110 mmHg range normally)
  • check for blockage/kinks in bladder and bowel system
  • check for areas of restriction- tight clothing
  • relieve urinary pressure
  • seek medical attention

ingrown toenail can be a cause as well

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10
Q

DVT- deep vein thrombosis

A

Risk factors- immobilization, post op, age>40, cardiac disease, limb trauma, coagulation d/o, obesity, advanced neoplasm (abnormal growth), pregnancy.

Clinical signs:

  • pain
  • swelling
  • Superficial venous distention
  • Fever

Treatment:

  • Blood thinners- Coumadin, heparin
  • compression
  • Bed rest

If in thigh there is a greater concern.
-common after CVA or SCI

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11
Q

Pain

A

Acute:
-from injury

Chronic:
-For SCI can be at any level

Musculoskeletal (tear or injury)

Neuropathic
-Described as sharp, shooting or burning

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12
Q

Musculoskeletal

A

Secondary overuse (pressure syndromes)

  • occur months or years after injury
  • caused by overuse

Muscle spasm pain
-Involuntary movements in areas that have lost some of all motor function

Mechanical instability of spine

  • Occurs shortly after injury but can occur later
  • pain usually around area of instability
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13
Q

Neuropathic pain

A

Spinal cord injury (central) pain

  • Can begin within weeks of injury
  • Pain at or below level of injury where there is sensation loss

Segmental pain

  • Occurs around border where have normal sensation and sensation loss
  • Associated with allodynia and hyperalgesia
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14
Q

Neuropathic pain

A

Nerve root entrapment

  • Begins days or weeks after injury and may worsen over time
  • Occurs at or just below level of injury
  • Has a distinct pattern
  • Brief waves of stabbing or sharp pain or band of burning pain at point where normal sensation stops
  • Light touch increases pain
  • Compression of nerve root by bone or disk

Come from the spine

Waives of stabbing or sharp pain. Happens when the sensation stops (light touch will increase this pain)

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15
Q

pain management

A

medications
Modified activities
Self evaluation of what causes and reduces pain

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16
Q

Urinary tract infection

A

1 medical complication.

Major concern for individuals with spinal cord injury (SCI)
-UTI is more likely to effect the overall health and health care costs of individuals with SCI

Sphincter muscles may not relax
The bladder will stretch
Urine backs up into the kidneys (reflux)

Bacteria multiply rapidly and can cause symptoms of illness:

  • fever
  • chills
  • nausea
  • headache
  • increased spasms
  • extraordinary pain or burning sensation
  • autonomic dysreflexia
17
Q

Constipation

A

Decrease in frequency of person’s bowel management

  • With a SCI no messages to nerves along bowel, bowel less efficient at squeezing down
  • Risk factors

Symptoms:

  • abdominal swelling or bloating and or discomfort or pain
  • Leakage of mucus from rectum
  • Autonomic dysreflexia
  • greater than 30 minute wait between suppository and bowel movement
  • hard bowel movements
  • pain or bleeding from hemorrhoids

Prevention and remedy:

  • education
  • exercise
  • fluids
  • diet
18
Q

Pressure sores

A

Area of the skin or underlying tissue that is dead or dying as a result of the loss of blood flow to the area

19
Q

Risk factors for SCI

A
  • Aging-skin integrity
  • Circulatory problems
  • Skin disorders
  • Disease
  • -diabetes
  • -cancer
  • Weight
  • -Overweight or underweight
20
Q

early signs of pressure sores

A
  • Appearance of red area, or red spot on the skin which does not clear within 30 minutes.
  • Common areas: sacrum, heel, ischium, foot (bony areas like the ankle)
21
Q

pressure sore- stage 1

A

Limited to the top two layers of skin and the skin has not broken yet. Redness does not turn white when touched.

22
Q

Pressure sore-stage 2

A

Damage gets deeper, extends beyond top two layers (adipose tissue)

23
Q

Pressure sore- Stage 3

A

Sore goes through all superficial layers of skin through adipose tissue to the muscle. Start to get a crater. Appears as a deep crater.

24
Q

Pressure sore- Stage 4

A

Destruction of soft tissue structure. Starts to involve bone and joint structures. Undermining some of the adjacent tissue. Stating to spread.

25
Q

Heterotopic Ossification

A

Calcium deposits in the form of mature bone into soft tissue.
-More common after TBI. More associated with spasticity.

Joint may fuse (gets to a really bad point and has to get surgically fixed.)

Can take 12 to 18 months to mature once bone starts laying down (have to wait that time period before they go in and try and fix it).

Initiate ROM programs

Goal- prevent joint fusion.

Symptoms- limited ROM, swelling and redness, pain

Treatment:

  • avoid aggressive PROM/stretching/exercise
  • Medications to provide relief from pain/inflammation
  • surgical removal after maturation of bone.
26
Q

Osteoporosis

A

Physiology of bone: need weight bearing and stress to stay strong.

Bone mass loss starts as early as 30 hours of immobility. After 30-60 weeks, pts can lose 25-40% bone mass.

Common sites of fracture are usually LE:

  • femur
  • proximal tibia
  • neck of femur

Prevention methods:

  • weight bearing exercises
  • active muscle contraction
  • vitamins
  • HRT- hormone replacement therapy
  • Calcium