Spinal cord

Question 1

a) Primary injury
b) Secondary injury

Answer 1

a) initial physical trauma
unlikely to be changed by surgery
b) Ongoing, after primary injury
the focus of nursing care

Question 2

Classification of SCI 3

Answer 2

Level of injury
Mechanism of injury
Degree of injury

Question 3

Spinal cord name
form top to the bottom

Answer 3

Cervical
Thoracic
Lumber
Sacral

Question 4

a)cervical damage ?
b) thoracic,lumber,sacral damage?

Answer 4

a) Tetraplegia
C1-T1 Level of injury
Involvement of all 4 extremities
b)Paraplegia
Below T2
Lower extremities paralyzed

Question 5

Which part is parakysis
a) C4 injury?
b) C6 injury?

Answer 5

a) complete below the neck
b) partial hand,arm and lower body

Question 6

Which part is parakysis
a) T6 injury?
b) L1 injury?

Answer 6

a) below the chest
b) below the waist

Question 7

Mechanism
Flexion

Answer 7

Force comes anteriorly
posterior ligaments rupture
Neurogic deficts
Head snaps forwad (cervical)
Snapping at waist (thoracic)
Herniated disl (lumber)

Question 8

Extension

Answer 8

Forse comes posteriorly
Disruption of anterior ligament
Tension or shearing of involved tissue with potential for fracture injury

Question 9

Flexion-Rotation

Answer 9

Force comes from the side Spinalligaments torn
Neck/spine twisitng
Often happen inmotor vehicle crashes where vehicle is hit from the side
Also occur in motorcycle crashes

Question 10

Vertical Compression

Answer 10

Force comes from top or bottom
Wedge fracture
Fractures of vertebral(shattered)
Rupture of supporting ligaments d/t bone gragments

Question 11

Simple fracture

Answer 11

Singular break/fracture
Aligment(stright line) generally remains intact

Question 12

Dislocation

Answer 12

Over vertebra overrides another
Cord becomes ischenic

Question 13

Anterior cord syndrome
a) Typically results from?
b) what effected?

Answer 13

a) flexion injury
b) Motor paralysis
pain
temperature sensation
Sensations of touch, position, vibration

Question 14

Central cord syndrome
a) Damage to?s
b) what effected?

Answer 14

a) central cord
Most commonly cervical region
Neck hyperextension
More common in older adult
b) Motor weakness
altered sensation in upper extremities
Lower extremities usually not affected

Question 15

Brown-Sequard Syndrome
a) damage to?
b) what effected?

Answer 15

a) half the cord
by penetrating injury
Loss of motor function + pressure, position, vibration sense on same side of body
Loss of light touch, pain, temperature sensation on opposite side

Question 16

a) Conus Medullaris Syndrome
b) Cauda Equina Syndrome

Answer 16

a) lowest portion of cord
Conus Medullaris Syndrome
Pain is uncommon
Areflexic bladder and bowel
b) lumbar.sacral nerve roots
Areflexic bladder and bowel
Severe, radicular, asymmetric pain
Clean intermittent catheterization

Question 17

Clean intermittent catheterization
a) how many times?
b) Urine residuals less than?

Answer 17

a) 4-6/day
b) 500mL
No prophylactic antibiotics
Clean technique – no sterile procedure

Question 18

Emergency Management
Prehospital
If suspected SCI, always suspect head injury as well

Answer 18

Ensure patent airway
No head-tilt, chin lift, no neck hyperextension
keep SaO2 > 90%
Stabilize/immobilize cervical spine
Establish IV access x 2 / NS or LR

Question 19

Immobilization of spine
a) Maintain what poosition?
b) Reduction with skeletal traction
c) Halo vest

Answer 19

a) neutral position
b) for a day, maybe before surgery
c) for a longer time
Spinal immobilization should not affect resuscitation

Question 20

After admitted hospiral
Respiratory
a) above C3
b) below C4

Answer 20

a) absence of the ability to breathe independently
-require ventilator
b) hypoventilation
-administer O2
-aggressive chest physiotherapy

Question 21

Cardiovascular
a) Any injury above what dec/absent cardiac system
b) What HR is a concern?
c) Any vagal stimulation can cause what?
d) what is a treatment goal?

Answer 21

a) T6
b) Bradycardia
c) cardiac arrest
d) constrict vessels w/vasopressors

Question 22

Urinary System
a) what immediately occurs?
b) acute phase? Chlonic phase?

Answer 22

a) urinary retention
b) catheter but want to remove ASAP
colonic intermittent catheter or surgery(bladder neck revision)

Question 23

GI System
a) any injury above what causes hypomobility?
b) what concern?

Answer 23

a) T5
b) paralytic ileus and gastric distension
NG tube to intermittent suction

Question 24

Neurogenic shock
a) what part is caused?
b) s/s?
c) TX?

Answer 24

a) T6 or higher SCI
b) Peripheral Vasodilation
Hypotension
Bradycardia
dec CO
c) Vasopressor(norepinephrine, phenylephrine, or dopamine)
Blood pressure will not be restored by fluid infusion alone

Question 25

Autonomic Dysreflexia
a) what part causesd it?
b) s/s?

Answer 25

a) level at or above T6
distended bladder is the most common cause
b) masive Hypertension
Bradycardia
Blurred vision
Throbbing headache
Flushing of skin above level of injury
-Especially face, neck, shoulders
Anxiety and nausea

Question 26

Autonomic Dysreflexia
Treatment
a) first?
b) then?

Answer 26

a)elevate head of bed 45 degrees or sit patient upright
Super important!!!
b) Immediate catheterization to relieve bladder distension
If indwelling urinary catheter present, look for kinks, constrictions, plugs – irrigate if suspected
Check for stool impaction

Question 27

The nurse is caring for a patient admitted with a spinal cord injury after a motor vehicle accident. The patient has a complete loss of motor, sensory, and reflex activity below the injury level. The nurse recognizes this condition as:
central cord syndrome.
spinal shock syndrome.
anterior cord syndrome.
Brown-Séquard syndrome.

Answer 27

spinal shock syndrome.
Rationale:
About 50% of people with acute spinal cord injury develop spinal shock, a temporary loss of reflexes,sensation, and motor activity. Central cord syndrome is manifested by motor and sensory loss greater in the upper extremities than the lower extremities. Anterior cord syndrome results in motor and sensory loss but not loss of reflexes. Brown-Séquard syndrome is characterized by ipsilateral loss of motor function and contralateral loss of sensory function.

Question 28

Which assessment finding would the nurse interpret as a manifestation of neurogenic shock in a patient with acute spinal cord injury?
Bradycardia
Hypertension
Neurogenic spasticity
Bounding pedal pulses

Answer 28

Bradycardia
Rationale:
Neurogenic shock is caused by the loss of vasomotor tone after injury and is characterized by bradycardia and hypotension. Loss of sympathetic innervation causes peripheral vasodilation, venous pooling, and decreased cardiac output. Thus hypertension, neurogenic spasticity, and bounding pedal pulses are not seen in neurogenic shock.