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Advanced MedSurg > Spinal Cord Injuries (Final exam) > Flashcards

Spinal Cord Injuries (Final exam) Flashcards

1
Q

Types of spinal cord injuries (2)

A

1) blunt trauma: d/t compression, flexion, extension, rotation of spinal column, diving, falls, motor vehicle crash, pedestrian accidents, sports injuries
2) penetrating trauma: d/t gunshot/stab wounds, stretched/torn/crushed/lacerated spinal cord

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2
Q

Primary vs secondary spinal cord injury

A

Primary: direct trauma to the spinal cord d/t blunt or penetrating trauma

Secondary: ongoing progressive damage that occurs AFTER the primary injury

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3
Q

In a primary injury, a spinal cord injury is caused by? (3)

A

bone displacement, traction from pulling on a cord, penetrating trauma (gunshot, stab)

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4
Q

Describe secondary injury (5)

A
  • begins a few mins after injury and lasts for months
  • results in EDEMA, ischemia, inflammation
  • spinal cord injury = decreased O2
  • edema is HARMFUL = limited space for tissue expansion = compression of the spinal cord occurs = INCREASING ISCHEMIC DAMAGE
  • APOPTOSIS (cell death) occurs
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5
Q

Initial assessment in the ED for a neck injury (2)

A
  • manage ABCs and vitals to maintain SaO2 >92% and MAP >85 mmHg
  • avoid SBP <90 mmHg
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6
Q

Subjective data for patients with a neck injury

A

Past health hx (motor crash, sports injury, gunshot/stabbing, falls)

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7
Q

Objective data for patients with a neck injury

- poikilothermia, integ (2), cardio (3), GI (5), GU (4), reproductive, neuro (2), musculo (2), pain (3)

A
  • poikilothermia: take on the temperature of their environment
  • integ: warm, dry skin BELOW the level of injury (neurogenic shock)
  • cardio: above T6 = bradycardic, hypotensive, s/s of internal bleeding (decreased BP and increased HR)
  • GI: paralytic ileus in injuries above T5, ABD distension, constipation, fecal incontinence and impaction
  • urinary: retention (T1-L2), flaccid bladder (acute), spasticity with reflex bladder emptying (later), hematuria indicates internal injuries
  • reproductive: priapism
  • neuro: tetra (above C8) or para (below C8), BILATERAL POSITIVE BABINSKI TEST (toes fan OUT)
  • musculo: muscle atony, contractures
  • pain: neuropathic pain, visceral = test with pinprick
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8
Q

What should be assumed for patients with a head injury?

A

“assume until proven otherwise” - patient with a head injury also has a spinal cord injury

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9
Q

What is spinal shock?

A

occurs shortly after an injury and lasts days to weeks, may mask post-injury neurologic function

characterized by: loss of deep tendon reflexes and sphincter reflexes (incontinence), loss of sensation, flaccid paralysis below the level of injury

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10
Q

What 2 medical interventions may the doctor order to reduce the chances of a secondary injury?

A

1) STABILIZATION: traction or realignment (early realignment by closed reduction through the craniocervical traction)
2) SURGICAL THERAPY: to manage instability and decompress the spinal cord

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11
Q

Objective data for respiratory in terms of the level of injury?

  • C1 to C3
  • C4
  • C5 to T6
A

C1 to C3: apnea, inability to cough
C4: poor cough, diaphragmatic breathing, hypoventilation
C5-T6: decreased respiratory reserve

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12
Q

Breathing findings for patients with a spinal cord injury according to the location of the injury?

  • above C3
  • C3-C5
  • Cervical and thoracic injuries (4)
A

Above C3: TOTAL LOSS of respiratory function = intubation

C3-C5: respiratory insufficiency; will arrest within mins if not intubated, decreased strength in chest and ABD wall

Cervical and thoracic injuries:

  • paralysis of the ABD muscles and intercostal muscles causes INEFFECTIVE COUGH = aspiration, atelectasis, pneumonia
  • hypoventilation = decreased vital capacity
  • fluid overload = pulmonary edema
  • increased SNS activity = neurogenic pulmonary edema
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13
Q

List general findings for a patient with spinal cord injury according to its location

  • C4
  • C6
  • T6
  • L1
A

C4: tetraplegic (complete paralysis below the neck
C6: partial paralysis of hands and arms as well as the lower body
T6: paraplegic (paralysis below the chest)
L1: paraplegic (paralysis below the WAIST)

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14
Q

What does a traumatic injury or lung contusion cause? Interventions? (6)

A

compromised airway function = respiratory acidosis

interventions:
- deliver oxygen (maintain PaO2 >92%)
- refractory hypoxemia = indicates when we need to intubate
- assess for respiratory distress: dyspnea, PaCO2 >20 mmHg
- maintain ventilation: admin oxygen, ventilation
- secretion management: chest physiotherapy, augment cough, IS, pain management, deep breathing exercises, suctioning
- positioning: elevate HOB at least 45 degrees

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15
Q

Intervention for patients with cervical and thoracic injury in terms of ineffective cough?

A

push up on epigastric to improve mobilization of secretions

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16
Q

Cervical fractures (4)

A
  • cause paralysis of the ABD and intercostal musculature, leads to:
  • ineffective coughing = aspiration, atelectasis, pneumonia
  • neurogenic pulmonary edema = shunts blood to the lungs
  • pulmonary edema (fluid overload)
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17
Q

Nursing management for patients with a cervical fracture? (5)

A

1) maintain proper immobilization with a traction or realignment
2) assess respiratory function if placed on ventilator
3) assess for vagal stimulation (ie: turning, suctioning) and its effect on cardio (possible cardiac arrest)
4) administer atropine for low HR, dopamine for low BP
5) lack of muscle tone to aid venous return = possible VTE (tx: heparin)

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18
Q

Goal of immobilization? (2)

A

restrict spinal motion, maintain neck in a neutral position

closed reduction with spinal traction: early realignment (reduction) for cervical injuries using a HALO RING

19
Q

Management for patients with cervical traction for immobilization

A

Pin care:

  • meticulous skin care
  • cleanse with chlorhexidine BID and apply antibiotic ointment
20
Q

Cardiovascular manifestations of a spinal cord injury (4)

A
  • injury above T6 = dysfunction of the SNS
  • leads to neurogenic shock = bradycardia, hypotension, peripheral vasodilation
  • decreased CO = hypotension
  • tachycardia may not occur with hemorrhage for patients who take beta-blockers or are young/healthy
21
Q

Cardiovascular interventions for spinal cord injury (4)

A
  • for bradycardia, admin atropine
  • fluid replacement and vasopressor (ie: norepinephrine) for hypotension
  • monitor for hypovolemic shock (possible blood transfusion)
  • for orthostatic hypotension (occurs for injuries at T6 or above): use ABD binders and compression
    socks, midodrine (promotes venous return), heparin with pneumatic compression devices
22
Q

Urinary system manifestations and intervention for a spinal cord injury? (2)

A

NEUROGENIC BLADDER leads to bladder distension, leads to rupture, leads to renal failure

intervention: insert foley catheter then intermittent foley cath

23
Q

GI system manifestations for patients with a SCI? (4)

A

1) paralytic ileus: peristalsis stops = severe nausea and cramping; increase in HCO
2) intra abdominal bleeding: difficult to diagnose, no pain or tenderness (monitor hemoglobin and hematocrit)
3) dysphagia: requires intubation
4) neurogenic bowel: loss of voluntary control; hyperreflexic bowel: increased rectal and sigmoid compliance = constipation and stool retention

24
Q

Treatment for paralytic ileus (3) and neurogenic bowel (2) in patients with SCI

A

paralytic ileus:

  • may require NG tube (first 48-72 hrs of paralytic ileus)
  • prophylactic medication for stress ulcers: H2-receptor blockers, PPIs (famotidine)
  • oral foods and fluids can be introduced if swallowing is intact and bowel sounds are present = high protein and caloric diet

neurogenic bowel:

  • enema, suppository
  • side lying position
25
Q

Thermoregulatory s/s of patients with an SCI and management (3)

A

poikilothermia: inability to maintain a constant core temperature

decreased ability to sweat or shiver BELOW the level of injury = hypo/hyperthermia = deadly arrhythmias/pulseless activity

management: monitor the environment to maintain an appropriate temperature

26
Q

Integumentary complications for patients with SCI and treatment? (2)

A

1) ulcers: painful, nociceptive visceral pain; dull or aching
- tx: opioids, ibuprofen (Motrin)

2) VTE: common d/t hypercoagulability, difficult to detect because no s/s of pain or tenderness
- tx: heparin

27
Q

Metabolic needs for patients with an SCI and intervention

A

decreased muscle atrophy

intervention: start early enteral or parenteral nutrition

28
Q

Pain in patients with an SCI

A

NEUROPATHIC pain d/t damage to spinal cord

BELOW THE LEVEL OF INJURY: hot, burning, pins/needles, shooting pain

29
Q

Equipment for tetraplegic patient with a C1-C3 injury

A

electric wheelchair with portable ventilator, requires care 24 hr/day

30
Q

Equipment for tetraplegic patient with C5 injury

A

electric wheelchair with mobile hand support, able to feed self with a setup

31
Q

Equipment for tetraplegic patient with a C6 injury?

A

push wheelchair on smooth, flat surface, feed self with hand device

32
Q

Equipment for tetraplegic patient with a C7-C8 injury

A

transfer self to wheelchair, independent use of wheelchair, performs most self-care

33
Q

Equipment for paraplegic patient with T1-T6 injury

A

full independence in self-care (eating) and in wheelchair

34
Q

Equipment for paraplegic patient with a T6-T12 injury

A

full independent use of wheelchair, can ambulate using crutches but not on stairs

35
Q

Equipment for paraplegic patient with L1-L2 injury

A

full use of wheelchair, good sitting balance

36
Q

Equipment for paraplegic patient with a L3-L4 injury

A

completely independent, unable to stand for long periods of time

37
Q

What is autonomic dysreflexia? (2)

A

massive, uncompensated cardiovascular reaction mediated by the SNS in response to a SCI

medical emergency that occurs AT or ABOVE T6

38
Q

3 main causes of autonomic dysreflexia (3 B’s)

A

Bladder: most common, overdistended bladder

Bowel: most common, hardened stool

Breakdown of skin: ingrown toe, broken skin

39
Q

Prevention for the causes of autonomic dysreflexia?

A

bladder: don’t hold in pee
bowel: avoid caffeine, increase fiber and fluids, regulate bowel movements

breakdown of skin: avoid tight shoes/clothing, repositioning q2h

40
Q

S/S of autonomic dysreflexia (3)

A
  • throbbing headache (check BP immediately)
  • hypertension (20-40 mmHg higher than baseline, eg: 106/78 to 146/92)
  • sweating and flushing ABOVE the level of injury
41
Q

Interventions for patients with autonomic dysreflexia (6)

A

1) measure BP q2-5 mins when a patient with SCI reports a headache
2) elevate HOB 45 degrees or sit upright (to lower BP)
3) report to HCP
4) assess for and remove cause (bowel impaction, urinary retention, UTI, tight shoes/clothing)
5) immediate catheterization to relieve bladder distension
6) if symptoms persist, give rapid-onset and short-duration agent (nitroglycerin, nitroprusside, hydralazine)

42
Q

Psychosocial dx for patients with a SCI?

A

difficulty coping r/t depression

goal: express feelings of grief of CHRONIC, life-long disease

43
Q

Intervention for cauda equina injury?

A

intermittent catheterization to empty the bladder 3-4 hrs

Advanced MedSurg (11 decks)

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