Spinal Cord Injury Flashcards
Pathophysiology of Spinal Cord Injury (SCI)
> Complete SCI: Spinal cord is damage in a way that eliminates all innervation below the level of the injury
> Incomplete SCI: Injuries that allow some function or movement below the level of the injury
Risk Factors/Causes of SCI
- Trauma
- Falls
- Acts of violence
- Sports or recreation-related accidents
Signs and Symptoms of SCI
- Assess ABCs (airway, breathing and circulation), then vitals
- Level of Consciousness
- Spinal Shock (complete but temporary loss of motor, sensory, reflex and autonomic function)
Prioritize assessment needs for patients with SCI
> Sensory Perception and Mobility Assessment
>Pulses, Capillary Refill
>Movement, Sensation
> Cardiovascular and Respiratory Assessment
> Heart Rate, Blood Pressure
Pulse ox, Lung Sounds
> Gastrointestinal and Genitourinary Assessment
Abdominal Assessment (distention, pain, bowel sounds or paralytic ileus)
Spastic: cervical or high thoracic injuries
Flaccid: Lower thoracic and lumbosacral injuries
> Long-Term Complications
Pressure Injuries
VTE
Heterotopic Ossification (bony overgrowth; assess for swelling, redness, warmth and decreased ROM)
> Psychosocial Assessment
Functional Ability
Body Imagine
Role Performance
Self-concept
Guilt
Diagnostic Tests that are indicative of SCI
- Basic laboratory studies (WBCs, Hemoglobin and Hematocrit, Lactate)
- Spine CT and MRI (Extent and degree of injury)
- X-ray Series (Identifies vertebral fractures or dislocation)
Interventions: Managing the Airway and Breathing
- Managing Respiratory Secretions
> Assisted Coughing
> Suctioning
> Good Pulmonary Hygiene (coughing, turning, deep breathing, incentive spirometer, percussion, vibration) - Frequent Assessments
> At least every 8 hours, if not more frequent
Interventions: Monitoring for Cardiovascular Instability
- Maintain adequate hydration
- Observe for neurogenic shock, hypovolemic shock, autonomic dysreflexia
- Drug Therapy (Dextran, Atropine sulfate and Dopamine)
Interventions: Preventing Secondary Spinal Cord Injury
> Stabilization and Immobilization – to prevent further deterioration of neurological status
> Cervical collar
> Backboard
> Logrolling
> Skeletal traction
> Halo fixator
Ongoing assessments
> Motor and sensory perception
> Vital signs, pain
Drug therapy
> Pantoprazole (Protonix) – prevent stress ulcer development
> Skeletal muscle relaxants – help control severe muscle spasticity
Surgical management
> Release of spinal cord compression, removal of bone fragments, removal of hematomas, removal of penetrating objects
Interventions: Managing Decreased Mobility
> At risk for pressure injuries d/t altered sensory perception
> At risk for venous thromboembolism, contractures, orthostatic hypotension, and fractures r/t osteoporosis
> Turning & Repositioning with skin assessments
1. Alignment
2. Teaching wheelchair-“pushups”
3. Special devices – mattresses, chair pads, etc.
> Good nutrition
1. Decrease possible complications like neurogenic bowel, UTI, pressure wounds
2. Calories and protein can help protect skin and maintain healthy weight
> Coordination with PT/OT
1. ROM exercises
2. Integrating appropriate assistive or adaptive devices (braces, boots, robotics)
> Bowel and Bladder retraining
What is autonomic dysreflexia?
(1) Abnormal, overreaction of the involuntary (autonomic) nervous system in a client with a high-level SCI
(2) Very exaggerated reaction to a type of noxious (very unpleasant) stimuli
Signs/Symptoms of Autonomic Dysreflexia
(1) Sudden and significant rise in blood pressure
(2) Bradycardia
(3) Profuse, excessive sweating-especially in the face, neck and shoulders
(4) Goosebumps
(5) Blurred vision and/or spots in the patient’s field of vision
(6) Flushing of the skin-especially in the face, neck and shoulders
(7) Nasal Congestion
(8) Severe, throbbing headache (most common complaint)
(9) Feel of apprehension and/or anxiety (described as feeling of doom)
Common Causes of Autonomic Dysreflexia
Noxious Stimuli
(1) Any pain causing discomfort
(2) Bowel distention from impaction or excessive constipation
(3) Bladder distention, malfunctioning catheter (kinked, not draining properly), UTI
(4) Pressure sores or skin burns
(5) Fractures
(6) Ingrown toenails
(7) Blankets, sheets, bed pads that are wrinkled or too heavy
(8) Wrinkles in socks or tight clothing
(9) Temperature fluctuation
Interventions for Autonomic Dysreflexia
1: SIT PATIENT UP
(1) Remove noxious stimuli
(2) Monitor blood pressure
(3) Drug therapy (nifedipine)
Cervical Spinal Cord Injuries
C1-C4 lose ability to breathe on own, need assistance, possibly can’t speak
MOST COMMON SCI
Thoracic Spinal Cord Injuries
T1-T5 nerves affect muscles, upper chest, mid-back and abdominal muscles (nerves and muscles that help control rib cage, lungs, and diaphragm) (affect breathing)
T6-T12 nerves affect abdominal or back muscles (nerves and muscles important for balance and posture; help cough or expel foreign matter from airway) (importance for balance/posture, coughing)
