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Module 2 > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

Injury to the

______ paralysis of lower body

_____ paralysis of all four extremities (formerly called quadriplegia)

Life expectancy continues to increase for patients with SCI due to improvements in health care

A

spinal cord, vertebral column, the supporting soft tissue, or intervertebral discs caused by trauma

Paraplegia:

Tetraplegia:

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2
Q

Causes & Risk Factors:

A

Most common causes:
Motor vehicle accidents
Falls
Violence (predominantly gun shot wounds)
Sports related injurie

Risk factors:
Younger age
Male gender (78% of population with spinal cord injury)
Alcohol/drug use

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3
Q

Vertebrae and Spinal Cord Areas

A

Cervical Vertebrae- C1-C7
Head, neck, diaphragm, deltoids, biceps, wrist extenders, triceps, hand

Thoracic Vertebrae T1-T12
Chest muscles, abdominal muscles

Lumbar vertebrae L1-L5
Leg muscles

Sacral Nerves S1-S5
Bowel, bladder, sexual function

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4
Q

Spinal Cord Injury: Pathophysiology

_______: client fully recovers

_____, _____, _____ of spinal cord tissue (alone or in combination)

__________ (severing of the spinal cord)

Vertebrae most commonly affect:

A

Transient concussion

Contusion, laceration, compression

Complete transection

C5, C6, & C7, T12, and L1
These vertebrae are more susceptible to injury due to the greater range of mobility

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5
Q

Types of Injuries

A

Transient concussion

Contusion (bruising)

Laceration (deep cut)

Compression (pressure placed on cord)

Complete transection (severing of cord)

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6
Q

Spinal Cord Injury: Primary & Secondary

A

Primary Injury: Result of initial trauma or injury, usually permanent

Secondary Injury:
-Result of edema and hemorrhage
-Major concern for critical care nurses
-Early treatment needed to prevent long-term damage or permanent damage

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7
Q

Clinical Manifestations

Depends on the type and level of the injury

A

Complete spinal cord lesion:
Loss of both sensory and voluntary motor communication from brain to periphery
Results in paraplegia or tetraplegia

Incomplete spinal cord lesion:
Ability of the spinal cord to relay messages to/from the brain is NOT completely absent
Sensory and/or motor fibers are preserved below the injury

Effects of Spinal Cord Injuries:
Central Cord Syndrome
Anterior Cord Syndrome
Lateral Cord Syndrome (Brown-Sequard Syndrome)

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8
Q

Central Cord Syndrome

Characteristics:

Cause:

A

Characteristics:
motor deficits
–Sensory loss more pronounced in the upper extremities
bowel/bladder dysfunction is variable
–Or can be completely preserved

Cause:
Injury or edema to the central cord (typically cervical area)…hyperextension

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9
Q

Anterior Cord Syndrome

Characteristics

Causes

A

Characteristics:
Loss of pain, temperature, and motor function below the level of the lesion
Light touch, position, and vibration sensation remain intact

Cause:
Acute disc herniation or hyperflexion injuries with fracture/dislocation of vertebra.
Injury to the spinal artery

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10
Q

Lateral Cord Syndrome(Brown-Sequard Syndrome)

A

Characteristics:
Ipsilateral paralysis or paresis with ipsilateral loss of touch, pressure and vibration
Contralateral loss of pain and temperature

(Ipsilateral- belonging to or occurring on the same side of the body.)

Cause:
Transverse hemisection of the cord (half of the cord is transected from north to south)
Knife or missile injury (GSW, shrapnel)
Fracture/dislocation of unilateral articular process
Acute ruptured disc

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11
Q

Lateral Cord Syndrome(Brown-Sequard Syndrome)

Loss of _____ and ____ sensation on the opposite side

Loss of _________ on the same side as the cord damage

A

pain and temperature

voluntary motor control

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12
Q

Assessment & Diagnostics

A

Full neuro exam with frequent neuro checks

Full head to toe exam

Diagnostics:
Lateral cervical spine x-rays
CT Scan
MRI (if further injury suspected)
If MRI is contraindicated, a myelogram may be used

Continuous ECG monitoring
Bradycardia and asystole are common in acute spinal cord injuries

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13
Q

Emergency Management

ALL the following clients must be ruled out for spinal cord injury:

ANY OF THESE INJURIES … YOU MUST ASSUME THERE IS A SCI UNTIL IT IS RULED OUT

A

MVC
Diving or contact sports injury
Fall
Direct trauma to head/neck

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14
Q

Emergency Management Cont:

At the scene

Trauma Center:

A

At the scene:
Immobilization of head/neck must occur
Focus upon maintaining head/neck in neutral position
to prevent flexion, rotation, or extension

Use hands, back board, or cervical immobilizing device-including head blocks working together

Client must be lifted in one movement with all team members

Trauma Center:
Referral to a regional spinal injury or trauma center
Many changes occur within the first 24 hours
It is important to have multiple disciplines working with patient

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15
Q

Medical Management

Respiratory therapy:
____________
Intubation may be required

In high cervical spine injuries, ______ is damaged (which stimulates the diaphragm)

Intramuscular diaphragmatic pacing is currently in clinical trial phase

A

O2 to maintain paO2

phrenic nerve

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16
Q

Medical Management

Skeletal fracture reduction and traction:

Surgical management indicated:

A

Skeletal fracture reduction and traction:
Traction (weights are applied)
Halo device (ring fixed to skull by 4 pins)

Surgical management indicated:
Compression is evident
fragmented/unstable vertebral body
wound that penetrates cord
bony fragments in spinal canal
neuro status is deteriorating

17
Q

Non-Surgical Treatments

A

Steroid infusion
-Decrease inflammation and swelling
-High dose within 24-48hrs
-Controversial / only slight benefits

Stabilization with cervical (neck) traction/alignment (see next slide):
-Braces
-Halo traction
-Gardner-Wells Tongs traction

18
Q

Types of Equipment used

A

Philadelphia collar
Miami J colloar
Aspen cervical thoracic orthosis (CTO)
Halo vest
Gardner with tongs traction
Jewett brace- lower thoracic/lumber injuries

19
Q

Surgical Treatments

A

Decompression
-Releasing pressure on the spinal cord
Causes: bone, disc, blood clot, tumor

Internal fixation and instrumentation
-Placing metal rods, screw, and/or hooks to prevent further injury

Bone grafting for fusion

20
Q

Spinal and Neurogenic Shock

Spinal shock:
-Sudden decrease of reflex activity below level of injury with:

-BP and HR may be decreased
-Prolonged hypotension and bradycardia can worsen damage to the spinal cord; therefore, important to keep ______
-Bladder and bowel function affected
-_____ most often occurs within first 2-3 days after SCI and resolves within 3-7 days

Neurogenic shock:
-Loss of ____ function below level of lesion
-Hypotension, bradycardia, decreased CO, pooling in extremities and peripheral vasodialtion
-Patient will not ____ in paralyzed portions of the body…. watch for ____
-_______ problems:

A

No sensation, paralyzed, flaccid, and reflexes are absent
Paralytic ileus
MAP > 85 mmHg

ANS
perspire…S&S of fever
Respiratory problems: secretion retention, increased paCO2, decreased paO2, respiratory failure, and pulmonary edema

21
Q

Other complications:

A

Venous thromboembolism / PE
Respiratory failure / pneumonia
Autonomic dysreflexia
Pressure injuries
Infections
-Urinary
-Local infection at the pin sites

22
Q

Nursing Interventions

A

Promoting adequate breathing and airway clearance
Preventing injury
Maintaining skin integrity
Maintaining urinary elimination
Improving bowel function
Providing comfort measures
DVT/PE anticoagulant therapy/SCDs
Recognizing Autonomic Dysreflexia

23
Q

Autonomic Dysreflexia

Occurs as a result of _______ responses that have an injury above ___

Occurs after _____ is resolved

Triggers:

Signs/symptoms:

A

exaggerated autonomic
T6
spinal shock

Distention of bladder/bowels
Stimulation of the skin
Pressure ulcers
infection

Causes:
Bladder/organ distention
Urinary tract infection
hemorrhoids
Constrictive clothing
Sexual intercourse
Pregnancy
Scrotal compression
Menstruation

Severe, pounding headache
Profuse diaphoresis above spinal lesion
Nausea
Nasal congestion
Bradycardia
Extreme HTN

24
Q

Autonomic dysrelexia

See slide

A
25
Q

Long-Term Care for Paraplegia/Tetraplegia Patients

A

Increasing mobility:
-Exercise programs
-Mobilization

Preventing disuse syndrome:
-ROM, repositioning, proper body alignment

Promoting skin integrity:
-Frequent skin assessments and repositioning to decrease risk of pressure ulcers

Improving bladder management:
-Encourage 2.5 liters of intake/day

Establishing bowel control:
-Bowel training program

26
Q

Long-Term Care (cont.)

A

Counseling on sexual expression:
Assistance with erectile dysfunction

Enhancing coping mechanisms:
Managing grief and depression

Decreased life expectancy

27
Q

Long-Term Care
Risk for:

A

Autonomic dysreflexia
Bladder/kidney infections
Orthostatic hypotension
VTE
Spasticity
Mental health issues
Pressure ulcers…leading to fistulas, osteomyelitis, and sepsis

30
Q

Autonomic Dysreflexia treatment

A

Sit up or raise head to 90 degree. Remain upright until BP is normal.

Loosen or remove tight clothing

Check/empty bowel or bladder

Call health care professional, even if symptoms go away

Monitor BP every 5 minutes

31
Q

Major causes of death for those with SCI are:
*

A

Pneumonia
* PE
* Sepsis

32
Q

Transient concussion - disturbance of the spinal cord with or without vertebral damage usually resolves with ______
- eg:

A

24-48 hours
hyperflexion or hyperextension

33
Q
  • Respiratory dysfunction
  • Related to the level of the injury
  • C4 controls diaphragm
  • T1-T6 intercostal muscles
  • T6-T12 abdominals
  • Injury to ____ or above causes paralysis of the diaphragm and the patient will need ventilator support ** _____ is the leading cause of death **
A

C4

acute respiratory failure in

34
Q

Continuous ECG monitoring
____ and _____ are common in acute spinal cord injuries

A

Bradycardia and asystole

35
Q

Best to have at least __ people to move the patient in one movement

During examination in the ED and Xray departments the patient must remain on the transfer board

No twisting or turning

Must be in an ____ position

Will need a rotating specialty bed – if a specialty bed is not available the patient needs to be put on a:

A

4

extended

firm bed with a cervical collar

36
Q

Fractures can be reduced and aligned with skeletal traction
Traction – allows the vertebrae to move back into place
Halo device – can be used with traction initially or after traction
* They provide _______

__________ injuries are usually treated with surgery
- Followed by immobilization (fitted brace)
Surgical management
- Early may improve the patients clinical outcome
- Goals are to preserve neurological function

A

early ambulation

Thoracic and lumbar

37
Q

Spinal shock

The highest MAP is correlated with greatest degree of neurological recovery
* Induced hypertension helps to enhance spinal cord perfusion
Paralytic ileus – muscles that move your food are temporarily paralyzed
* Treated with ____________

Neurologic shock

ANS (autonomic nervous system) Vital organs affected
* Controls involuntary actions (heartbeat, breathing, narrowing or widening of vessels)
Vital organs are affected:
* Hypotension
* Bradycardia
* Decreased cardiac output
* Pooling of blood in extremities
* Peripheral vasodilation

A

intestinal decompression
* Insertion of NG tube

38
Q

Autonomic dysreflexia – is a sudden onset of _________

Only way to resolve is to change the situation
E.g.: ___________

Can cause hemorrhagic stroke, retinal hemorrhage, MI, seizures

Treatment:

A

high blood pressure
SCI patients cannot restore their BP because of damage

remove tight clothing, empty bladder

Sit up immediately
Alleviate cause
Empty bladder, check for fecal impaction
Skin assessment for any sores or ulcers
Cold air
Antihypertensive

Module 2 (6 decks)

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