Spinal Cord Injury Flashcards

1
Q

What is a spinal cord injury?

A

Mechanical disruption to the structure & function of the spinal cord & spinal nerve pathways.

Can be a traumatic or non traumatic injury

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2
Q

What causes a traumatic spinal cord injury?

A

Damage to the spinal cord resulting from a traumatic event, fall or accident usually occurs from a fracture and/or dislocation of the spine. May also be the result of penetrating injuries from:
displaced bony fragments penetrating the spinal cord and/or the spinal nerves. bullets or weapons.

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3
Q

What causes a non-traumatic spinal cord injury?

A

Vascular disorders, tumours, infections or haematomas causing cord compression

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4
Q

What are the types of spinal cord injury?

A

Transient concussion (reversible)

Contusion (bruising)

Laceration (cut to the cord)

Compression (Squashed)

Transection (irreversible, cut through the cord)

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5
Q

What are some of the symptoms of a spinal cord injury?

A

Symptomsdepend ondegree of paralysis & potential for rehabilitation depends on the level of lesion

Paralysis from below level of injury
Loss of reflexes
Loss of bowel, bladder and sexual function
Muscle spasm
Inability to control body temperature
Loss of bone density
High risk of pressure injury

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6
Q

What is the patho of a spinal cord injury?

A

Microscopic haemorrhages occurs in the central grey matter and pia matter

Tissue volume is increased, causing compression and necrosis

Oedema occurs in the white matter, causing impaired circulation throughout spinal cord

The haemorrhage and oedema obstruct blood flow and lead to further ischaemic areas

Leads to functional impairment which may be temporary or long term

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7
Q

What are some nursing interventions for spinal cord injuries?

A

Encourage independence but assist with ADLS
Assist with bowel/bladder cares
Prompt pressure area cares
Regular position changes
Ensure environment is clutter free
Provide education surrounding rehab

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8
Q

What are some secondary spinal cord injuries?

A

Ischaemia

Hypoxia

Oedema

Inflammatory Process

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9
Q

What functions will be lost with a complete spinal cord injury?

A

Voluntary movement

Sensation of pain, temperature, pressure & proprioception

Bowel and bladder function

Loss of reflexes

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10
Q

What vertebrates are important in testing motor function?

A

C5-Elbow flexion L2-hip flexion
C6-wrist extension L3-knee extension
C7-elbow extension L4-ankle dorsiflexion
C8-finger flexion L5-toe extension
T1-finger abduction S1-ankle plantar flexion

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11
Q

What are the complications of spinal cord injury?

A

Spinal Shock

Neurogenic Shock

Autonomic Dysreflexia

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12
Q

What is Spinal Shock?

A

Areflexia (sudden depression reflex activity) < level injury

Muscles paralysed, flaccid and without sensation below level of injury

Bowel and bladder function lost

Gastric stasis

Paralytic ileus

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13
Q

What is Neurogenic Shock?

A

Loss of autonomic control leads to:
- ↓ BP, ↓ HR
- Peripheral venous pooling
- Priapism
- Loss of temperature control
- Lack of perspiration below level of injury

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14
Q

What is Autonomic Dysreflexia?

A

Occurs after spinal shock has resolved in persons with SCI above T6. Stimulus causes sympathetic nerves to become overactive

inhibitory nerves from brain travelling down spinal cord serve to moderate all spinal cord reflexes thus if someone taps your knee - your leg kicks. This is a spinal reflex
Simple response to painful stimulus makes your body react with reflexive sympathetic response at spinal cord level as well as increasing B/P. Normal circumstances inhibitory nerves from brain moderate response.

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15
Q

What is the possible aetiology of Autonomic Dysreflexia?

A

Urinary retention
Over distended bladder or bowel
Pressure ulcers
Kidney stones
Ingrown toenail

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16
Q

What is the patho of Autonomic Dysreflexia?

A

Noxious stimulus (distended bladder, constipation etc.)

Signals transmitted to spinal cord to initiate SN activation (> HR, > BP - vasoconstriction, > RR)

HTN stimulates baroreceptors in carotid bodies. Brain initiates PN activity to reduce BP by slowing HR (bradycardia)

Signals to reverse SN activity sent from brain via spinal cord to vasodilate blood vessels, slow HR. This occurs ABOVE SCI level

Signals can’t pass BELOW level of injury.
If noxious stimulus continues, ascending signals continue to initiate SN activity

Results in increasing HTN (associated headache, blurred vision) bradycardia, vasodilation ABOVE SCI level and vasoconstriction BELOW

17
Q

What are the signs and symptoms of autonomic dysreflexia?

A

HTN (>20mmHg Pt baseline) bradycardia
Headaches
Blurred vision
Facial flushing
Diaphoresis above level of injury
Anxiety and restlessness

18
Q

What are the nursing interventions for Autonomic Dysreflexia?

A

Put the person into sitting position 90◦ to help lower the BP
Loosen clothing
Assess for the probable cause and remove
Continue to assess vital signs (Q2-3min BP)
Administer GTN as prescribed if SBP > 150mmHg (short acting anti-hypertensive medications only)