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Critical Care > Spinal Cord > Flashcards

Spinal Cord Flashcards

1
Q

SCI: Top Causes

A

MVC
Falls
Violence (street and veterans)
Sports Injuries

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2
Q

SCI: Level of Injury (Skeletal vs. Neurologic)

A

skeletal level: injury is at the vertebral level, where there is most damage to vertebral bones and ligaments

neurologic level: lowest segment of spinal cord w/ normal sensory and motor function on both sides of the body

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3
Q

SCI: Level of Injury

A

C4 Injury: tetraplegia, results in complete paralysis below the neck

C6 Injury: results in partial paralysis of hands and arms as well as lower body

T6 Injury: paraplegia, results in paralysis below the chest

L1 Injury: Paraplegia, results in paralysis below the waist

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4
Q

SCI: Complete vs. Incomplete

A

complete: total loss of sensory and motor function below the level of injury
incomplete: results in mixed loss of voluntary motor activity and sensation and leaves some tracts intact

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5
Q

Two Functions of Nerves

A
  1. Motor: starts from head down

2. Sensory: starts from feet up

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6
Q

Deficits that can occur w/ Level of Injry

A 
C4: Diaphragm
C5: Elbow flexion
C6: Wrist flexion
C7: Elbow and wrist extension
C8-T1: Fingers
T2-T7: Chest muscles
T9-T12: Abdominal muscles
L1-L5: Leg muscles
S2-S5: Bowel, bladder and sexual fx
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7
Q

Parasthesia

A

numbness

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8
Q

Quad (tetraplegic)

A

paralysis of all four extremities

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9
Q

Quadriparesis

A

numbness of all four extremities

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10
Q

Paraplegic

A

paralysis of lower extremities

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11
Q

Paraparesis

A

numbness of two extremities

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12
Q

Diaphragmatic Breathing

A
  • occurs when intercostal muscles are paralyzed (C4 or above)
  • abnormal in adults and considered using accessory muscles (common in children under 3YO)
  • crucial to re-assess often
  • diaphragm will wear out and pt won’t breath so need to secure airway before they get fatigued and go into respiratory failure

*hypoxia increases cerebral edema!

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13
Q

SCI: Types of Injuries

A

Hyperflexion and Hyperextension Injuries:

  • damage to ligaments, discs, cord
  • accompany coup/contracoup injuries

Compression Injuries:
-shattered vertebrae, disc/cord compression

Rotation Injuries:
-torn ligaments, fractures

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14
Q

Neurogenic Shock

A
  • systemic
  • fx w/ pressure on cord at thoracic level
  • affects sympathetic NS - can’t vasoconstrict > running on PSNS
  • decreased BP and pulse
  • tx: fluids
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15
Q

Spinal Shock

A
  • local: below level of injury
  • decreased reflexes
  • loss of sensation
  • flaccid paralysis below the level of the injury
  • loss of thermoregulation
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16
Q

Dermatomes

A

illustration of the areas where sensory and motor nerves cause loss of sensation or pain (innervation) as a result of nerve root compression

the offending nerve root can often be identified by the distribution (dermatomes) of symptoms

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17
Q

SCI: Primary vs. Secondary Injury

A

primary:

  • immediate effect of the trauma on spinal cord itself
  • flexion, compression, rotation
  • complete or partial transection of spinal cord

secondary:

  • further injury in minutes/hours/days following primary injury
  • ischemia, hypoxia, inflammation, edema (of cord from primary injury)
  • neuro deterioration can occur in the first 8-12 hours
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18
Q

SCI Clinical Manifestations: Motor and Sensory

A

ASIA recommends classification for severity of SCI according to sensory deficits

Sensory regions are called dermatomes

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19
Q

SCI Clinical Manifestations: Respiratory

A

cervical injuries above C4 result in total loss of respiratory muscle function

will require mechanical ventilation for the rest of their life

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20
Q

SCI Clinical Manifestations: Cardiovascular

A

any cord injury above T6 leads to dysfunction of the SNS (neurogenic shock)

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21
Q

SCI Clinical Manifestations: Urinary

A

neurogenic bladder:

  • flaccid or hypotonic
  • or spastic
  • or dyssynergia

urinary incontinence

22
Q

SCI Clinical Manifestations: GI System

A

neurogenic bowel:

  • incontinence
  • or retention
23
Q

SCI Clinical Manifestations: Integumentary

A

risk for skin breakdown over bony prominences

24
Q

SCI Clinical Manifestations: Thermoregulation

A

poikilothermic: adjustment of body temperature to room temperature

decreased ability to sweat or shiver below the level of the injury

25
Q

SCI Clinical Manifestations: Metabolic Needs

A

monitor Na+ and K+, especially when NGT suction

increased nutritional needs d/t increased metabolism

26
Q

SCI Clinical Manifestations: Peripheral Vascular

A

elevated risk for VTE and DVT > PE b/c they aren’t moving, no venous return back to heart, blood pools in legs

27
Q

SCI Clinical Manifestations: Pain

A
  • differs in type and severity following injury
  • nociceptive pain (phantom pain)
  • neuropathic pain
28
Q

Stages of SCI

A
  1. Prehospital
  2. Acute Care
  3. Rehabilitation and Home Care
29
Q

Methylprednisolone

A
  • evidence as to its efficacy to improve neurological outcomes is limited, inconclusive, or conflicting so its use/utility is debated
  • clinicians concerned about complication of glucocorticoid use, esp. infections
  • contraindicated w/ a pt who has both SCI and TBI
30
Q

Nursing Management: Respiratory Problems

A
  • respiratory failure is leading cause of death in acute and chronic phases
  • signs of impending respiratory failure = RR > 30 and/or decreasing vital capacity
  • prevent atelectasis and pneumonia (deep breathing and incentive spirometer q2hrs)
31
Q

Nursing Management: Hemodynamics

A

neurogenic shock

hypovolemic shock:

  • may receive IVF but excess fluids can cause further cord swelling and increase damage
  • careful I&O and electrolyte monitoring
  • MAP goal: 85-90
  • fluids, transfusion, vasopressors as needed

Orthostatic or Postural Hypotension:

  • develops cerebral hypoxia and loss of consciousness if moved too fast
  • change position slowly
  • adequate fluids, elastic stockings, tilt table

DVTs:

  • can lead to PEs
  • heparin/lovenox
32
Q

Nursing Management: Thermoregulation

A

Poikilothermia

  • avoid temperature extremes
  • person w/ a fever may need a cooling blanket
33
Q

Nursing Management: Nutrition

A
  • for the immobilized pt, nutritional needs are greater than one would expect
  • high calorie, high protein diet to prevent infection, promote wound healing

if pt doesn’t have gag reflex:

  • feed via Dobhoff
  • move to PEG if missing gag reflex becomes permanent

if pt gut doesn’t work:
-TPN

people w/ SCIs are 4x more likely to develop diabetes b/c of difficulty w/ glucose metabolism

34
Q

Nursing Management: Mobilization and Skin Care

A
  • big risk for pressure ulcers and foot drop so use splints
  • risk of flaccidity and/or spasticity d/t can’t stand or walk > osteoporosis > fractures
  • tx for spasticity = ROM and meds (dantrolene, baclofen, tizanidine hydrochloride)

PT/OT

35
Q

Alteration in Urinary Elimination

A
  • failure to empty > urinary retention

- failure to store > urinary incontinence

36
Q

Failure to Empty

A

d/t flaccid bladder or areflexic bladder

can lead to UTIs and then renal failure

tx:

  • continuous catheterization early on
  • intermittent catheterization later (every 3-4 hours)
37
Q

Failure to Store

A

d/t spastic bladder or reflexic bladder

may happen once spinal shock subsides

tx:

  • pads
  • condom catheters
  • urinary diversion (such as a urostomy)
  • meds to suppress bladder contractions (oxybutynin, tolterodine)
38
Q

Neurogenic Bowel

A

loss of voluntary neurological control over bowel

  • early stage of SCI: bowel is areflexive (sphincter tone is decreased and pt is constipated)
  • later stage of SCI: if reflexes return, bowel becomes reflexive as sphincter tone is increased (pt has fecal incontinence)
39
Q

Nursing Management: Alteration in Bowel Elimination

A
  • good hydration and nutrition
  • stool softeners and fiber
  • elimination planned for 30 min after breakfast to utilize peristalsis
  • rectal stimulation and/or suppository may be needed to trigger defecation
40
Q

Sexual Activity and Fertility

A

males:
- fewer erections
- tx: ED meds, devices, surgical implants

females:

  • lubrication issue
  • risk of autonomic dysreflexia
41
Q

SCI: Meds

A
  • methylprednisolone
  • vasopressors or vasodilators
  • muscle relaxants/antispasmodics
  • analgesics
  • antidepressants
  • anticoagulatns
  • stool softeners
  • laxative suppositories
  • PPIs
42
Q

Cord Syndromes

A

3 major cord syndromes

Central Cord Syndrome:

  • paralyzed upper extremities
  • some motor loss of chest (including diaphragm)

Anterior Cord Syndrome:

  • paralysis from nipple line down
  • position sense and touch intact in extremities

Brown-Sequard Syndrome:

  • hemiplegic on one side
  • loss of sensation on opposite side
43
Q

Nelson’s Phases of Reintegration

A

buffering
transcending
toughening
launching

44
Q

Surgical Options for Fx of Vertebrae

A

fusion: attach metal hardware to the spline to keep alignment
laminectomy: removal of a portion of the vertebrae that’s damaged and pinching nerves
discectomy: removes damaged portion of disk that’s compressing nerve root, decompresses nerve root
rods: can be inserted to correct curvature of spine

45
Q

Autonomic Dysreflexia

A

massive uncompensated cardiovascular reaction mediated by SNS

occurs in response to visceral stimulation once spinal shock is resolved in pts w/ spinal cord lesions

life threatening

46
Q

Autonomic Dysreflexia: Causes

A
  • full bladder
  • full bowel
  • local pressure, pressure ulcers
  • tight clothing
  • catheterization
  • labor
47
Q

Autonomic Dysreflexia: S/Sx

A
  • paroxysmal HTN (BP 280/14)
  • major HA
  • visual changes (d/t vasoconstriction)
  • decreased HR
  • cool/pale below lesion level
  • vasodilation above lesion
48
Q

Autonomic Dysreflexia: Tx

A
  • raise HOB
  • legs dangle
  • tx cause (check catheter, impaction, loosen clothing)
  • call providder
  • check BP q2-5min
  • vasopressors as needed (Nipride, captopril)
  • stay w/ pt
49
Q

Best Way to Manage Airway

A
  • head tilt/chin lift
  • modified jaw-thrust/chin lift
  • tracheostomy
50
Q

SCI: Imaging

A
  • c-spine plain films (before c-collar is removed)
  • thoracic/lumbar imaging
  • CT scan
  • MRI if pt is stable enough

Critical Care (14 decks)

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