Seminar 11 part 2 Flashcards
Clincal manifestations of the respiratory system with a above C4 injury
- Total loss of respiratory muscle function so mechanical ventilation is need to keep pt alive. (artificial airway which is a direct access for pathogens)
- Paralysis of abdominal and intercoastal muscles (inability to cough)
- Pulmonary edema (neurogenic, fluid overload)
What respiratory system clinical manifestations are present with a below C4 injury
- Diaphragmatic breathing (if phrenic never is functional - hypoventilation is common).
- paralysis of abdominal and intercostal muscles (depending on level and degree of injury,= ineffective cough)
What are 3 common chronic respiratory complications following a SCI?
atelectasis, pneumonia, hypoventilation
cardiovascular system clinical manifestions of T5 injuries or higher
bradycardia: HR<40
- drugs such as atropine may be needed to increase HR.
peripheral vasodilation:
- hypovolemia do to increased venous capacitance.
- decrease venous return to heart= decreased CO= hypotension. May need vasopressor or IV fluids to support BP.
Cardiac monitoring if needed
urinary system- neurogenic bladder, clinical manifestations
- urinary retention is common.
- bladder is atonic and overdistended.
- in-dwelling catheter inserted (increased infection risk, start intermittent catherterization ASAP)
what is the recommended fluid intake for individuals post SCI
1800-2000ml/day
for people post SCI, what volume should their bladders NOT exceed
500 mL
Depending on level/degree of SCI injury the bladder can be either
spastic (above T12)
or
flaccid (Below T12)
What is flaccid bladder
voiding reflex is not intact between the bladder and SC.
There is a decreased or loss of bladder muscle and spinchter tone.
bladder will continue to fill, and you are unable to empty it voluntarily
injuries below T12
What is spastic bladder
voiding reflex is intact between bladder and SC.
Increased bladder muscle and sphincter tone.
messages are blocked to the brain resulting in frequent involuntary bladder emptying.
may have incomplete bladder emptying
injuries above T12
What is reflexic
Bladder is still capable of reflexive contractions, usually triggered by a certain amount of filling. However, these reflexes might not be properly coordinated with voluntary control, leading to urinary retention or incontinence.
what is areflexic
Bladder cannot contract reflexively because the neural pathways are not functioning.
This often results in urinary retention, where the bladder is unable to empty properly.
gastrointestinal system - neurogenic bowel, SCI T5 or above clincial manifestations
- constipation
- paralytic ileus
- gastric distension (NG may help)
- medications such as metoclopraminde may help motility
- stress ulcers are common (give H2 receptor blockers and PPI)
problems mostly associated with hypomotility
Gastrointestinal- neurogenic bowel clinical manifestations of T12 injury or above
reflex (spastic) bowel
- cannot voluntarily reflex the anal sphincter.
- may have constipation
- signals between colon and brain become disrupted
- reflex that triggers a BM still works, but may not be felt, bowel incontinence when rectum is full
Gastrointestinal- neurogenic bowel clinical manifestations of T12 injury or below
areflexic (flaccid) bowel
-decreased peristalsis
- loose sphincter
- risk for constipation with bowel incontinence
clinical manifestations of the integrumentary system with SCI
-lack of mobility and sensation causes skin breakdown.
- pressure ulcers can occur quickly.
- can lead to infection and sepsis:(
clinical manifestations of thermoregulation
poikilothermia
- inability to maintain core temp
- SNS interruption prevents peripheral temp sensations from reaching hypothalamus
- sweating and shivering does not occur below the level of injury
- can lead to hypo or hyperthermia
clinical manifestation of SCI- metabolic needs
- loss of body weight common post injury.
- nutritional needs > than expected for immobilized person.
- nitrogen balance and high protein diet to prevent skin breakdown and infection, and decreased rate of atrophy
If a patient who has had a SCI, and needs a NG suction, what may this lead too
metabolic alkalosis- monitor lytes levels until suctioning is d/c and normal diet is resumed
SCI clinical manifestations of peripheral vascular problems
DVT common problem during the first 3 months.
(may be asymptomatic)
do DVT assessment- doppler exam and measurement of leg and thigh girth.
What is the leading cause of death in people with SCI
PE
What is visceral pain
produced by signals from internal organs (stomach, bowel or bladder)
constipation or full bladder may send signal
What is musculoskeletal (mechanical) pain
- injury/damage to bones, muscles, tendons, joints and ligaments.
- pain signal d/t injury may illicit increased spasticity instead of pain sensation
What is neuropathic pain
- injured nerves try to reconnect, they can become over excitable, sending inaccurate messages to the brain,
- described as tingling, burning, throbbing, stabbing, cold sensations, tightness, numbess.
- non-painful sensations can feel painful even though there is no injury.
- spontaneous burst od pain but no tissue is being damage
where does neuropathic pain usually occur
where loss of some or all sensation is, or around the border between sensation and lack of sensation
criteria for early surgery after SCI
- cord decompression may result in decrease secondary injury.
- evidence of cord compression
- progressive neurological deficit
- compound fracture
- bony fragments
- penetrating wounds of spinal cord or surrounding structure
What are three common surgical procedures
decompression, realignment, anterior or posterior stabilization with instrumentation
what drug therapy can be used post SCI
steroids or vasopressor agents
what is nonoperative stabilization
- focuses on stabilization of injured spinal segment and decompression.
- through traction or realignment
- eliminated damaging motion at injury site
- intended to prevent secondary damage
what is the intention with immobilzation therapy of the cervical spine
prevent/limit secondary damage and maintain a neutral/ aligned position
traction can only be used on
A+O patients only
immobilization of the thoracic and lumbar spine intentions
prevents and limits secondary injury, maintain neutral and aligned position.
