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Nursing Theory IV A- Cindy'S Class > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

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1
Q

What is a spinal cord injury?

A
  • many pts remain independent
  • ## high cost of rehab and long term health care
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2
Q

What are some common causes of death in tetraplegia patients?

A

compromised, respiratory function (pneumonia), impaired renal function(UTI), impaired skin integrity(ulcer)

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3
Q

What happens in the initial injury of a spinal cord injury?

A

-Spinal cord is wrapped in tough layers of dura.
- Rarely torn or transected by direct trauma
- Spinal cord injury due to cord compression by
–> Bone displacement, Interruption of blood supply to cord, Traction resulting from pulling on cord
- Penetrating trauma (gunshot wound or stab wounds)
- By 24 hours, permanent damage may occur due to edema

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4
Q

What is the primary injury in an initial injury of a spinal cord injury?

A

Result of the initial trauma
- The result of concussion, contusion, laceration, or compression of the spinal cord

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5
Q

What is the secondary injury in a spinal cord injury?

A
  • Ongoing, progressive damage that occurs after initial injury
  • result of ischemia, hypoxia, and hemorrhage, which destroys the nerve tissues
  • Thought to be reversible or preventable during the first 4 to 6 hours after injury
    Treatment: prevent partial injury from developing into more extensive, permanent damage
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6
Q

What is spinal shock?

A
  • Temporary neurological syndrome
  • A sudden depression of reflex activity below the level of spinal injury
  • Experienced by about 50% of people with acute spinal cord injury
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7
Q

What are the symptoms of spinal shock?

A

↓ reflexes
Loss of sensation
Flaccid paralysis below level of injury

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8
Q

What is neurogenic shock?

A

Loss of vasomotor tone caused by injury
Characterized by hypotension and bradycardia (important clinical cues)
Paralyzed portions of the body do not perspire

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9
Q

What are the symptoms of neurogenic shock?

A

Loss of sympathetic nervous system innervation causes
- Peripheral vasodilation
- Venous pooling
- ↓ cardiac output

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10
Q

How are spinal cord injuries classified?

A
  • Injury
  • Skeletal level of injury
  • Neurological level of injury
  • Completeness or degree of injury
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11
Q

What are the five mechanisms of injury?

A
  1. Flexion
  2. Hyperextension
  3. Flexion-rotation
  4. Extension-rotation
  5. Compression
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12
Q

What is a flexion injury?

A

force to the heck often from car accidents

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13
Q

What is a hyperextension injury?

A

head getting hit back stretching of spinal cord. force is hitting chin up

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14
Q

What is a flexion-rotation injury?

A

hit back of neck

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15
Q

What is a extension-rotation injury?

A

hit front of neck

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16
Q

What is a compression injury?

A

hit top of head compressing neck

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17
Q

What is the two levels of injury for spinal cord injuries?

A
  1. skeletal level
  2. neurological level
18
Q

What is a skeletal level injury?

A
  • Injury is at the vertebral level, where there is most damage to vertebral bones and ligaments.
19
Q

What is a neurological level injury?

A
  • Lowest segment of spinal cord with normal sensory and motor function on both sides of the body
  • Level of injury may be: cervical, thoracic, lumbar
20
Q

What is a tetraplegia?

A

(quadriplegia) - paralysis of all four extremities occurs if cervical cord is involved.C6 and up

21
Q

What is a paraplegia?

A

results if thoracic or lumbar cord is damaged. T6 and down

22
Q

What is the clinical manifestations of a spinal cord injury?

A

Immediate postinjury problems include:
- Maintaining a patent airway
Adequate ventilation
- Adequate circulating blood volume
- Preventing extension of cord damage (secondary damage)
- Respiratory complications closely correspond to level of injury.

23
Q

How is the respiratory system affected in a cervical injury?

A
  • paralysis of abdominal and intercostal muscles and not able to cough effectively
    Above C4: Presents special problems because of total loss of respiratory muscle function, Mechanical ventilation is required to keep patient alive.
    Below C4:
  • Diaphragmatic breathing if phrenic nerve is functioning
  • Spinal cord edema and hemorrhage can affect function of phrenic nerve and cause respiratory insufficiency.
  • Hypoventilation almost always occurs with diaphragmatic breathing.
24
Q

How is the cardiovascular system affected in a cervical injury?

A

Any cord injury above level T6 greatly ↓ the influence of the sympathetic nervous system
- bradycardia, hypotension, hypovolemia, peripheral vasodilation
- IV fluids of vasopressor drugs may be required to support BP

25
Q

How is the urinary system affected in injury?

A
  • Urinary retention common
  • Bladder is atonic and overdistended.
  • In-dwelling catheter inserted: Increased risk of infection
  • Bladder may become hyperirritable: Loss of inhibition from brain, Reflex emptying
26
Q

How is the gastrointestinal system affected in injury?

A

If cord injury is above T5, primary GI problems related to hypomotility
- potententially cause paralytic ileus, gastric distention, stress ulcers, intra-abdominal bleeding
injury below T12: bowel os areflexic, ↓ sphincter tone

27
Q

How is the integumentary system affected in a cervical injury?

A
  • Consequence of lack of movement is skin breakdown.
  • Pressure ulcers can occur quickly.
  • Can lead to major infection or sepsis
  • poikilothermism
28
Q

How is the metabolic needs affected in a cervical injury?

A
  • Positive nitrogen and high-protein diet
  • loss of body weight
  • gastric suctioning may lead to metabolic alkalosis
29
Q

What are some peripheral vascular problems that occur with injury?

A

DVT

30
Q

What is the diagnostic studies for a spinal cord injury?

A
  • neurological examination is performed along with assessment of head, chest, and abdomen for additional injuries or trauma.
  • CT and MRI
31
Q

What are the three MOST important goals in collaborative care of a spinal cord injury?

A
  1. Patent airway
  2. Adequate ventilation
  3. Adequate circulating blood volume
32
Q

What is immobilization of a spinal cord injury?

A
  • Proper immobilization involves maintenance of a neutral position.
  • Stabilize neck to prevent lateral rotation of cervical spine and body correctly aligned
  • turning pt to prevent movement of spine
33
Q

What is a halo fixation?

A

It is a skeletal traction to help realign or reduct an injury.
- Most commonly used method of stabilizing cervical injuries

34
Q

How do you improve mobility in a spinal cord injury?

A
  • Maintain proper body alignment
  • turn only if spine is stable and indicated by doctor
  • Monitor BP with position changes
  • Move gradually to erect position
35
Q

What are some potential complications in a spinal cord injury?

A
  • DVT
  • Orthostatic hypotension
  • autonomic dysreflexia
36
Q

What is autonomic dysreflexia?

A
  • Massive uncompensated cardiovascular reaction mediated by sympathetic nervous system. Full bladder, fecal impaction, pressure areas, restrictive clothing
  • Occurs in response to visceral stimulation
  • Life-threatening
  • Most common precipitating factor is distended bladder or rectum.
37
Q

What are the S&S of autonomic dysreflexia?

A

HTN, blurred vision, headache, diaphoresis, bradycardias, piloerection spasm, flushing, nasal congestion, nausea, anxiety

38
Q

What are the nursing interventions of autonomic dysreflexia?

A
  • Elevate head of bed at 45 degrees, or sit patient upright.
  • Notify physician.
  • Assess cause.
  • Provide immediate catheterization.
  • Teach patient and family causes and symptoms.
39
Q

What is a neurogenic bladder and bowel?

A

bladder:Any type of bladder dysfunction related to abnormal or absent bladder innervation
bowel: voluntary control may be lost, high-fibre diet and adequate fluid intake, suppositories, enemas, or stimulation, record BM

40
Q

What is neurogenic skin?

A
  • prevention of pressure ulcers and other injuries
  • careful positioning every 2hr
  • teach pt and family member about taking care of skin

Nursing Theory IV A- Cindy'S Class (17 decks)

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