Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PCE - Neurology > SCI Pt. 2 > Flashcards

SCI Pt. 2 Flashcards

1
Q

What levels are the sympathetic nervous system

A

T1-L1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the effects of the sympathetic nervous system

A
  • Inc. HR and BP and blood flow to skeletal mm
  • RELAXES bronchial mm
    - (one would think it would contract them BUT if a bear was chasing you, you would want the mm to relax to increase O2 supply
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

At what spinal levels do you find the parasympathetic NS

A

Craniosacral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which parasympathetic nerve is of primary interest

A

Vagus nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

effects of the parasympathetic NS

A
  • Dec. HR and contractility
  • Inc. blood flow to smooth mm (rest and digest)
  • contracts bronchial mm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the sympathetic effect in SCI T6 and above

A

dependent on level of injury (b/c it goes from T1-L1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the parasympathetic effect in SCI T6 and above

A

remains intact and UNOPPOSED via the vagus nerve in injuries T6 and higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Normally, sympathetic increases HR but what occurs when the sympathetic NS is no longer in tact?

A

therefore must rely on removing parasympathetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the effect of relying on the parasympathetic removal to control heart response

A
  • Limits cardiac output + shunting of blood from inactive  active ones
  • Blunting of heart rate often to only 110 -120bpm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is autonomic dysreflexia caused by?

With what level of injury does it occur?

A

caused by massive sympathetic discharge from a noxious or non-noxious stimuli below level of SCI (with injuries above T6)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Autonomic dysreflexia S&S

A
  • Increase BP of 20-30mmHg from normal
  • bradycardia
  • severe headache
  • blurred vision
  • feeling of anxiety or impending doom
  • dilated pupils
  • flushing, sweating skin above level of injury
  • cool, dry, pale skin (d/t vasoconstriction) below level of injury
  • penile erection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Common causes of autonomic dysreflexia

A
  • urinary or colon irritation (full bladder, UTI, kink in catheter)
  • wound, painful stim
  • tight clothing
  • sex, pregnancy and labor
  • diagnostic or therapeutic interventions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Rx + prevention of autonomic dysreflexia?

A
  • place client in upright position!
  • remove noxious stim/triggers, if necessary use antihypertensive drugs
  • good bladder and bowel routines
  • skin care, nail care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is orthostatic hypotensioni

A

Sudden drop of 20mmHg systolic BP or 10mmHg diastolic BP upon changing positions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Orthostatic Hypotension S&S

A

o Asymptomatic
o Dizziness, fainting
o Light headedness
o Headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Orthostatic Hypotension Rx

A

o mobilize slowly w/ therapy

o use compression stocking or binders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

4 Health Risks with SCI

A
  • DVT & Pulmonary embolism
  • Heterotrophic ossification
  • Osteoporosis
  • Post traumatic Syringomyelia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is DVT + Pulmonary embolism with SCI caused by

A

Venous stasis

Transient hypercoaguable state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

DVT + Pulmonary embolism with SCI Signs

A

Sudden LE swelling + increase in temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

DVT +Pulmonary embolism with SCI prevention

A
  • Anticoagulation meds
  • Compression stockings
  • Sequential compression devices
  • PROM/AROM
  • Early mobilization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Heterotrophic ossification w/ SCI S&S

A
  • Pain (if sensory sparing)
  • INc. spasticity
  • warmth, low grade fever
  • erythema
  • local swelling
  • sudden decrease in ROM with an abnormal firm or hard end-feel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Heterotrophic ossification w/ SCI Rx

+ 2 main contraindication for Rx

A
  • PROM within tolerable range- mobilize as able
  • Meds
  • Surgery if long standing

Contraindications:
are forced PROM and serial casting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What causes OP in SCI

A

rapid increase calcium excretion within few days of SCI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is Post Traumatic Syringomyelia

A

Formation of an abnormal tubular cavity in the spinal cord

25
Q

What occurs with post Traumatic Syringomyelia

A
  • dura tethers/scars to the arachnoid blocking CSF flow
  • CSF is forced into the spinal cord progressively enlarging the cyst
  • Leads to compression of cord + vascular supply
26
Q

Does post Traumatic Syringomyelia only occur immediately following injury

A

No, can occur years after the original injury

27
Q

post Traumatic Syringomyelia S&S

A
  • pain at level and spreading upwards
  • sensory changes
  • motor weakness
  • Inc. spasticity
  • B&B dysfunction
  • Inc. autonomic dysreflexia,
  • hyperhidrosis
28
Q

post Traumatic Syringomyelia Rx

A

Surgery - decompression or shunt

29
Q

2 tests for spasticity

A

Modified Ashworth + Tardieu

30
Q

What is spasticity

A

Velocity dependent resistance to passive stretch

31
Q

Spasticity clinic characteristics

A
  • Increased mm tone/firmness
  • Increased stretch reflexes
  • uncontrolled movements
32
Q

Spasticity Pros

A
  • maintain muscle bulk, venous return, useful for transfers, moving limbs
  • reflex erection can be achieved
  • acts as warning sign
33
Q

Spasticity cons

A

o Lead to contractures
o Possibly painful
o Positioning difficulties
o Fatigue

34
Q

Spasticity Rx

A

Meds: Intrathecal bacleonfen (makes muscles weak as well) and botox (for more local use)
Therapeutic exercise

35
Q

Injuries of what level result in a spastic bladder

A

Above the conus

36
Q

What are the implications of a spastic bladder?

How does emptying occur

A
  • messages will continue to travel btw bladder and spinal cord since reflex arc is still intact
  • may be triggered by “tapping”
  • bladder can be trained to empty on its own
  • bladder management: either intermittent catheters or condom/Foley drainage
37
Q

Injuries of what level result in a flaccid bladder

A

In conus and cauda equina injuries

38
Q

What are the implications of a flaccid bladder?

How does emptying occu

A
  • messages don’t travel btw spinal cord and bladder since the reflex center is damaged
  • bladder loses ability to empty reflexively
  • bladder will continue to fill AND must be catheterized
39
Q

Are peristalsis and reflex propulsion still intact in a spastic bowel?

A

Yes

40
Q

What causes stool retention in a spastic bowel

A

Reflex contraction of sphincter

41
Q

How do you void with a spastic bowel

A

need suppository or/& digital stim within anus for voiding- can be trained

42
Q

Are peristalsis and reflex propulsion still intact in a flaccid bowel

A

not intact

43
Q

Flaccid bowel: slow or fast stool propulsion?

A

slow

44
Q

Risk of incontinence with a flaccid bowel?

A

yes

45
Q

What are the implications of a SCI above t12 for sexual health?

A

Reflex and spontaneous erection, no ejaculation, fertility reduced

46
Q

What are the implications of a SCI below t12 for sexual health?

A

psychogenic erection possible, reflex erection/ejaculation not possible

47
Q

3 types of pain experienced by people with SCI

A

Neuropathic pain
nociceptive pain
Chronic pain

48
Q

What causes neuropathic pain?
What are some descriptive words for its sensation?
Does this pain change with position changes?
Rx?

A
  • Damage to nervous system
  • Stabbing, burning, electric
  • Normally not changed by position or activity
  • Rx - Medications
49
Q

What causes Nociceptive pain?
What are some descriptive words for its sensation?
Does this pain change with position changes?
Rx?

A
  • Damage to viscera or MSK
  • Dull, crampy, achy
  • Yes
  • Physical modalities, soft tissue, therapeutic exercise, education on posture + aggravating positions
50
Q

What is Chronic pain?
Common in SCI?
Rx?

A

Pain lasting longer than 3mths
Yes, 2/3 of SCI have chronic pain
Interdisciplenary team, education, appropriate exercise

51
Q

What are some causes of wounds in SCI Pts

A
  • pressure, sheering, friction, deep tissue damage from banging and bumping
  • Sitting, lying high pressure areas
52
Q

What are some points to include in wound descriptions

A 
o	Location
o	Size
o	Wound base/edge
o	Surrounding skin
o	Stage photos
53
Q

How are wounds prevented in SCI

A 
o	regular skin checks
o	change position regularly
o	skin care
o	exercise and eating well for skin health 
o	no smoking
54
Q

What are some important considerations for Exercise in SCI

A

Decreased sympathetic impact: HR + BP will not have normal responses (levels will be relative to before exercise)

Watch for orthostatic hypotension

55
Q

How should you measure exertion during exercise for those with SCI

A

RPE and BORG

HR not reliable

56
Q

What occurs to respiration with SCI?

Where is ideal length/tension relationship of the diaphragm

A
  • paradoxical breathing
  • vital capacity dec. from supine to sitting
  • Dec. all lung volumes except residual volume

•ideal length/tension relationship of diaphragm occurs in lying

57
Q

What is the major cause of death among SCI Pts surviving 30+ years

A

CVD

58
Q

Atrophy of which part of the heart is seen in SCI

A

Left ventricular myocardial atrophy

59
Q

100x higher rate of which type of cancer in people with SCI

A

bladder cancer

PCE - Neurology (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions