Spinal Cord Injury Flashcards
What is a spinal cord injury?
- many pts remain independent
- ## high cost of rehab and long term health care
What are some common causes of death in tetraplegia patients?
compromised, respiratory function (pneumonia), impaired renal function(UTI), impaired skin integrity(ulcer)
What happens in the initial injury of a spinal cord injury?
-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
What is the primary injury in an initial injury of a spinal cord injury?
Result of the initial trauma
- The result of concussion, contusion, laceration, or compression of the spinal cord
What is the secondary injury in a spinal cord injury?
- 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
What is spinal shock?
- 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
What are the symptoms of spinal shock?
↓ reflexes
Loss of sensation
Flaccid paralysis below level of injury
What is neurogenic shock?
Loss of vasomotor tone caused by injury
Characterized by hypotension and bradycardia (important clinical cues)
Paralyzed portions of the body do not perspire
What are the symptoms of neurogenic shock?
Loss of sympathetic nervous system innervation causes
- Peripheral vasodilation
- Venous pooling
- ↓ cardiac output
How are spinal cord injuries classified?
- Injury
- Skeletal level of injury
- Neurological level of injury
- Completeness or degree of injury
What are the five mechanisms of injury?
- Flexion
- Hyperextension
- Flexion-rotation
- Extension-rotation
- Compression
What is a flexion injury?
force to the heck often from car accidents
What is a hyperextension injury?
head getting hit back stretching of spinal cord. force is hitting chin up
What is a flexion-rotation injury?
hit back of neck
What is a extension-rotation injury?
hit front of neck
What is a compression injury?
hit top of head compressing neck
What is the two levels of injury for spinal cord injuries?
- skeletal level
- neurological level
What is a skeletal level injury?
- Injury is at the vertebral level, where there is most damage to vertebral bones and ligaments.
What is a neurological level injury?
- 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
What is a tetraplegia?
(quadriplegia) - paralysis of all four extremities occurs if cervical cord is involved.C6 and up
What is a paraplegia?
results if thoracic or lumbar cord is damaged. T6 and down
What is the clinical manifestations of a spinal cord injury?
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.
How is the respiratory system affected in a cervical injury?
- 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.
How is the cardiovascular system affected in a cervical injury?
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
How is the urinary system affected in injury?
- 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
How is the gastrointestinal system affected in injury?
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
How is the integumentary system affected in a cervical injury?
- Consequence of lack of movement is skin breakdown.
- Pressure ulcers can occur quickly.
- Can lead to major infection or sepsis
- poikilothermism
How is the metabolic needs affected in a cervical injury?
- Positive nitrogen and high-protein diet
- loss of body weight
- gastric suctioning may lead to metabolic alkalosis
What are some peripheral vascular problems that occur with injury?
DVT
What is the diagnostic studies for a spinal cord injury?
- neurological examination is performed along with assessment of head, chest, and abdomen for additional injuries or trauma.
- CT and MRI
What are the three MOST important goals in collaborative care of a spinal cord injury?
- Patent airway
- Adequate ventilation
- Adequate circulating blood volume
What is immobilization of a spinal cord injury?
- 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
What is a halo fixation?
It is a skeletal traction to help realign or reduct an injury.
- Most commonly used method of stabilizing cervical injuries
How do you improve mobility in a spinal cord injury?
- Maintain proper body alignment
- turn only if spine is stable and indicated by doctor
- Monitor BP with position changes
- Move gradually to erect position
What are some potential complications in a spinal cord injury?
- DVT
- Orthostatic hypotension
- autonomic dysreflexia
What is autonomic dysreflexia?
- 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.
What are the S&S of autonomic dysreflexia?
HTN, blurred vision, headache, diaphoresis, bradycardias, piloerection spasm, flushing, nasal congestion, nausea, anxiety
What are the nursing interventions of autonomic dysreflexia?
- 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.
What is a neurogenic bladder and bowel?
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
What is neurogenic skin?
- prevention of pressure ulcers and other injuries
- careful positioning every 2hr
- teach pt and family member about taking care of skin
