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Med Surg 2 Neuro Disorders > Spinal Cord Injuries > Flashcards

Spinal Cord Injuries Flashcards

1
Q

Primary Injury

A 
SCI due to cord compression by 
Bone displacement
Interruption of blood supply
Traction from pulling on cord
Penetrating trauma 🡪 tearing and transection
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2
Q

Secondary Injury

A

Ongoing progressive damage that occurs after initial injury
Due to vascular changes, free radical formation, inflammation
Apoptosis (programmed cell death) for weeks after injury
Leads to:
Neuronal cell death
Reduced spinal cord blood flow
Scar tissue formation
Irreversible nerve damage and extension of paralysis to higher levels

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3
Q

Permanent neurologic deficits

A

Within 24 hours: permanent damage may occur because of edema
72 hours+ after injury: extent of damage and prognosis for recovery most accurately determined
3-6 months following injury: greatest improvement occurs

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4
Q

Spinal Shock

A 
Characterized by: 
Loss of reflexes
Loss of sensation
Absent thermoregulation
Flaccid paralysis below level of injury
Lasts days to weeks
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5
Q

Neurogenic Shock

A 
T6 injury or higher
Characterized by
Hypotension 🡪 give fluids then pressors
Bradycardia 🡪 give atropine then might try to pace 
Loss of SNS innervation
Peripheral vasodilation
Venous pooling
Decreased CO
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6
Q

Mechanism of SCI

A 
Flexion
Hyperextension
Flexion-rotation
Extension-rotation
Compression
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7
Q

Level of SCI

A

Skeletal and neurologic level
Level of injury may be: cervical, thoracic, lumbar, sacral
Tetraplegia (C8) (quadriplegia)
Paraplegia (T1)

  • Phrenic @ C3-5 think breathing
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8
Q

Complete SCI

A

Total loss of sensory and motor function below level of injury

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9
Q

Incomplete SCI

A

Mixed loss of voluntary motor activity and sensation
Some tracts intact
Degree of sensory and motor loss depends on level of injury and specific damaged nerve tracts

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10
Q

Clinical Manifestations of SCI

A

Manifestations are related to level and degree of injury
Incomplete lesion results in a mixture of symptoms
Higher the injury 🡪 more severe the sequelae
Proximity of the cervical cord to the medulla and brainstem

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11
Q

C4 Injury

A

Tetraplegia, complete paralysis below the neck

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12
Q

C6 Injury

A

partial paralysis of hands and arms as well as lower body

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13
Q

T6 Injury

A

Paraplegia, paralysis below the waist

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14
Q

L1 Injury

A

paraplegia, paralysis below the waist

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15
Q

Respiratory (Edema)

A

Spinal cord edema may increase during first 48h 🡪 potential for respiratory distress
Risk for neurogenic pulmonary edema: flash pulmonary edema from inflammatory response
May need intubation and mechanical ventilation
Increased risk for pneumonia, atelectasis

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16
Q

Respiratory (Above C4)

A

total loss of respiratory muscle function

17
Q

Respiratory (Below C4)

A

diaphragmatic breathing

respiratory insufficiency

18
Q

Cervical and Thoracic Injuries

A

Paralysis of abdominal and intercostal muscles ineffective cough
risk for aspiration, atelectasis, pneumonia

19
Q

Respiratory Management

A 
Regular assessment
Intervene to maintain ventilation
Administer O2
Provide ventilatory support
Chest physiotherapy
Assisted (augmented) coughing: nurse acts as “muscle” pushing on chest to help pt cough 
Tracheal suctioning
Incentive spirometry
Appropriate pain management
20
Q

Neurogenic shock

A

Injury above T6
Dysfunction of sympathetic nervous system
Bradycardia
Peripheral vasodilation
Hypotension
Relative hypovolemia because of increase in capacity of dilated veins
Reduced venous return decreasing CO

21
Q

Cardiovascular

A

Increased risk for DVT
Dysrhythmias may occur
Chronic low BP with postural hypotension
Risk for cardiac arrest

22
Q

Cardiovascular Management

A 
Frequent assessment of VS
Anticholinergic drug/pacemaker
Fluid replacement, vasopressor agent
Only suction as needed (vagus response)
If blood loss occurred
Monitor hgb, hct
Possible blood administration
*signs of DVT
*monitor for orthostatic BP
23
Q

Gastrointestinal

A

Injury above T5
Hypomotility
Risk for paralytic ileus
Gastric distention (NG tube as long as no facial injury)
Excessive release of HCl may cause stress ulcers
Risk of aspiration, esp. high injuries
Dysphagia may be present
Intraabdominal bleeding may be difficult to diagnose

24
Q

Gastrointestinal Management

A 
Monitor F&E
Nutrition should be started within 72h
High protein, high cal diet
Possible parenteral nutrition (ileus)
Prevent skin breakdown, reduce infection, decrease muscle atrophy
Stress ulcer prophylaxis
Increased risk secondary to severe trauma and physiologic stress
Monitor stool, gastric contents, and hct
25
Q

Bowel Management

A 
Neurogenic bowel initially
Bowel program started during acute care
Daily rectal stimulant
Suppository or small-volume enema
Digital stim or manual evac
Adequate fluid, fiber intake
Increased activity and exercise
26
Q

GU

A

Neurogenic bladder: bladder dysfunction related to abnormal or absent bladder innervation
Acute phase (spinal shock)
Urinary retention
Bladder atonic, overdistended, fails to empty
Indwelling catheter

27
Q

Bladder Management

A

Post-acute phase – bladder may become hyperirritable
Once stable: remove indwelling urinary catheter
Intermittent cath program
4-6x daily
Monitor for S/S UTI
High risk UTI, bladder stones, kidney infections

28
Q

Integumentary System

A 
Potential for skin breakdown
Poikilothermism
Interruption of SNS
Decreased ability to sweat or shiver below the level of injury
More common with high cervical injury
Temp control is external
Monitor environment and body temp
Do not use excessive covers or unduly expose patient
29
Q

Skin Care

A

In from field 🡪 try to log roll as soon as level of injury known to decrease skin breakdown
Decreased sensory/motor 🡪 at risk skin breakdown for rest of life
Comprehensive visual and tactile exam
Careful positioning and repositioning q2h; wheelchair tilts q30m
Specialty mattresses, pressure-relieving cushions
Careful temp control
Assess nutritional status

30
Q

Nociceptive pain

A

musculoskeletal pain – dull or aching, worsens with movement; visceral pain in thorax, abdomen, pelvis – dull, tender, or cramping

-treat with anti-inflammatories and opioids

31
Q

Neuropathic pain

A

at or below level of injury; hot, burning, tingling, pins and needles, cold, shooting; may be extremely sensitive to stimuli
-Gabapentin (Neurontin) or pregabalin (Lyrica)
Teach about pain triggers and relaxation therapy

Med Surg 2 Neuro Disorders (3 decks)

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