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nurs 470 > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

primary spinal cord injury

A

actual physical disruption of axons
results in disruption of neurologic tissue or vascular supply
immediate trauma on the spinal cord

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2
Q

types of primary spinal cord injury

A

vertical compression
axial loading
hyperflexion
hyperextension
rotation
stretch
laceration
contusion

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3
Q

secondary spinal cord injury

A

progressive injury that can occur minutes to hours after injury
24 hr period following SCI
manifested by neurological deterioration over first 8-12 hrs
results in spinal cord edema, and then eventually central hemorrhagic necrosis

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4
Q

vertical compression, axial loading

A

vertical force along the spinal cord
fall from heights, landing on feet
diving
compression injuries cause burst fractures of vertebral body that often and bony fragments into spinal canal/cord

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5
Q

hyperextension

A

injuries involve backward & downward motion of head/neck
seen in rear-end collisions
spinal cord is stretched, distorted
neuro deficits caused by contusion & ischemia of cord without significant bony involvement

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6
Q

hyperflexion

A

seen in head on collisions
sudden deceleration of the motion of the head
dislocates anterior vertebrae, posterior ligaments of cervical spine torn and cord is compressed

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7
Q

flexion-rotation

A

severe rotation of neck or body results in tearing of posterior ligaments and displacement (rotation) of the spinal column
t-bone MVA
most unstable

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8
Q

causes of secondary SCI

A

ischemia
hypoxia
inflammation
edema
exctitotixicity
disturbances on ion homeostasis
apoptosis

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9
Q

effect of edema in secondary SCI

A

compression of cord and extension of edema above and below injury
causes ischemic damage

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10
Q

functional injury

A

degree of disruption of normal spinal cord function
depends on what motor structures and nerve tracts are damaged
cannot be classified for several days until spinal shock resolves

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11
Q

effects of a injury at C1-C4

A

requires electric WC with breath, head, or should controls
needs ventilatory support

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12
Q

effects of a injury at C5

A

electric WC with hand controls
may require adaptive devices for ADLs

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13
Q

effects of a injury at C6

A

independent, manual WC, hand controls, adaptive devices for ADLs

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14
Q

effects of a injury at C7

A

manual WC

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15
Q

effects of a injury at C8-T1

A

may need adaptive devices for ADLs

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16
Q

spinal shock

A

occurs shortly after injury, can last weeks, but resolve spontaneously
physiologic transection of spinal cord that results in temporary loss or depression of all or most spinal reflex activity below level of injury

17
Q

spinal shock manifestation

A

decreased reflexes
loss of sensation
absent thermoregulation
flaccid paralysis
all below level of injury

18
Q

spinal shock treatment

A

symptomatic treatment

19
Q

neurogenic shock

A

loss of SNS innervation from the brainstem
unopposed vagal stimulation
massive peripheral vasodilation
venous pooling
decreased venous return to heart
decreased cardiac output

20
Q

manifestations of neurogenic shock

A

unopposed parasympathetic stimulation
hypotension
bradycardia
decreased CO
hypothermia

21
Q

treatment for neurogenic shock

A

fluids
pacer
vasopressors
warmer
atropine

22
Q

complete SCI

A

possible inability to sustain spontaneous ventilation
total loss of sensory and motor function below the level of injury
results in quadriplegia (from C1-T1) or paraplegia (from T2-L1)

23
Q

incomplete SCI

A

mixed loss of voluntary motor and sensory function below level of lesion
if ANY function remains below the level of injury

24
Q

central cord syndrome

A

motor and sensory deficit more pronounced in UE than LE, often spastic (can move LE better)
mostly in cervical spine and caused from hyperextension

25
Q

anterior spinal cord syndrome

A

loss of motor function, pain, temp, paralysis below injury
typically flexion injury

26
Q

posterior spinal cord syndrome

A

loss of motor function, proprioception, loss of pain and sensation below level of injury

27
Q

brown-sequard syndrome

A

damage to 1/2 of spinal cord
loss of voluntary motor on same side as injury with loss of pain, temp, and sensation on other side below injury
mostly from knife or sharp instrument

28
Q

medical management of SCI

A

skeletal traction
halo vest
cervical collar (w/ skin care)
log rolling
surgery: lami, fusion, rodding

29
Q

methylprednisolone

A

improves outcomes and functional status at 6 weeks and 6 months
though to prevent secondary injury in SCI and improve nerve conduction
NOT FDA approved for SCI
harmful side effects

30
Q

autonomic dysreflexia

A

massive SNS response to noxious stimuli below level of injury but signals can’t reach brain
PNS compensates with massive vasodilation above level of injury
concern with hypertension issues and inability to regulate BP
occurs after spinal shock has resolved

31
Q

autonomic dysreflexia symptoms

A

hypertension (SBP>200, DBP>130)
facial flushing
headache
anxiety
sweating
bradycardia

32
Q

autonomic dysreflexia treatment

A

prevention (skin injury, fecal impaction, urinary retention)
find and remove noxious stimuli (pain)
sit patient up to pool blood in LE to drop BP
loosen clothes and constrictive devices
check urinary system
if SBP >150, antihypertensives
check fecal impaction
decubitus ulcers

33
Q

cardiovascular SCI nursing management

A

hemodynamic monitoring
poikilothermia -> brady-dysrhythmias
prolonged bedrest -> orthostatic hypotension
prevent DVTs

34
Q

pulmonary SCI nursing management

A

intubation, C3-C5 might only need MV at night
weaning is complex
diaphragmatic pacing to produce contraction of diaphragm
quad coughing/coughalator
suction carefully

35
Q

musculoskeletal SCI nursing management

A

ROM to prevent contractures/spasticity
PT/OT consults
hand splints, foot drop splints

36
Q

integumentary SCI nursing management

A

prevent breakdown

37
Q

elimination SCI nursing management

A

bowel program
intermittent cath schedule

38
Q

nutrition SCI nursing management

A

hypermetabolic following injury -> 3000cal/day
prone to stress ulcers -> H2 blockers or PPIs

39
Q

psychosocial SCI nursing management

A

4 Ds: dependency, depression, drug addiction, divorce
increased suicide rate
promote coping mechanisms, support groups, adaptive skills
simple, accurate, consistent info
include patient and family in all decisions

nurs 470 (28 decks)

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