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410 Patho Exam 4 > Spinal cord injury > Flashcards

Spinal cord injury Flashcards

1
Q

This following flashcard deck is going to discuss about spinal cord injury and will follow the recording that was taken in lecture class

A
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2
Q

When a patient has a spinal cord injury, one of the biggest thing to know is that a patient clinical manifestation will depend on what?

A

where in the spinal cord the injury occurred

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3
Q

She has this spinal cord injury and body system powerpoint, so the following flashcards are going to address those concerns

A
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4
Q

spinal cord injury
respiratory system

anything above c3
what happens to your respiratory

anything between c3-c5
what happens to your respiratory

below c5
what happens to your respiratory

A

total loss of function, need immediate intubation

severe insufficiency, needs intubation

  • risk for aspiration, atelectatsis, pneumonia due to paralysis of abdominal muscles
  • hypoventilation and impaired intercostal muscles lead to decreased vital capacity and till volume
  • traumatic injury (lung contusion) causing comprised function
  • fluid overload or increase SNS activity at the time of injury can cause pulmonary edema
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5
Q

what is our main goal in helping patients with the respiratory system with spinal cord injury?

A

maintain oxygen higher than 92% in order to reduce hypoxemia that causes bradycardia that can worsen secondary injury

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6
Q

what is going to happen in cardiovascular? (2)

A

neurogenic shock
hemorrhagic shock

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7
Q

how does neurogenic shock and hemorrhagic shock occur ?

A

neurogenic shock at t6 or above injury

other injuries and further decreased blood pressure

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8
Q

remember neurogenic shock will cause the blood pressure to go what?

so what do we want to assess ?

A

down

any and all causes of hypotension

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9
Q

in hemorrhagic shock tachycardia may not be present in patients who take beta blockers, are young and healthy and are older adults

however in neurogenic shock, its more than likely we are going to see

A

bradycardia !

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10
Q

what is going to happen to our patients with spinal cord injuries with their peripheral vascular ?

A

they have an increase risk of venous thromboembolism (vte)

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11
Q

why is VTE a common thing to occur with patients with spinal cord injury?

A

due to hypercoagualbility,venous status, and venous endothelia injury.

immobilization leading to venous statuses and thrombi in lower extremities

DVT can be very hard to detect and no pain or tenderness are usually present since remember, they end up getting paralysis

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12
Q

what is happening in the urinary system with a patient with a spinal cord injury?

A

urinary dysfunction occurs to patients due to the loss of autonomic and reflex control of bladder and sphincter

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13
Q

patients with spinal cord injuries end up getting a neurogenic bladder, which is ?

A

bladder dysfunction related to abnormal or absent bladder innervation

( impaired transmission between bladder muscles and micturition center in the brain )

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14
Q

in GU you can two types of bladder conditions with spinal cord injuries patients, which are?

and describe the two

A

flaccid
- hypotonic muscles causing bladder distention - can lead to bladder rupture

( meaning you can fill up bladder and not feel it, then pee all over yourself (rupture))

spastic muscles causing incontincene
- meaning you can not control when you pee, like your bladder thinks you need to pee all the time

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15
Q

at what spinal cord number can you get a spastic bladder?

A

above t12

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16
Q

spastic bladder can cause lack of coordination between muscles (dyssynerga) leading to what ?

A

reflux into the kidneys

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17
Q

what is happening in the GI system with patients with spinal cord injuries ?

A

delayed gastric emptying
constipation/impaction/
incontinence

intraabdominal bleeding

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18
Q

within the first 24-48 hours, what is our main concern when GI system ?

A

paralytic ileus

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19
Q

so within the first 24-48 hours in the GI system our main concern is a paralytic ileus, what should we do as nurses ?

A

NG tube for decompression and NPO

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20
Q

what is our main concern when it comes to talking about the skin system for patients with spinal cord injuries ?

A

pressure injury
- skin breakdown due to inability to move

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21
Q

what does pressure injury make patients at risk for when talking about skin for the spinal cord injury patients?
(2, they go hand and hand with each other )

A

infection - open wound
sepsis - infection enters the open wound and causes an systemic inflammation

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22
Q

what is our main concern with patients who have spinal cord injuries when we are talking about thermoregulation system ?

A

poikilothermia : the inability to maintain a constant core temperature due to malfunction of SNS

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23
Q

its important to note that patient who develop poikilothermia are usually those with a higher cervical injury number, but this also puts the ability for patients to not be able to do what to two things ?

A

sweat or shiver below the injury level

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24
Q

what is our concern for patient who have spinal cord injuries when we are talking about metabolic system for them?

A

increase metabolism and increased protein breakdown

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25
Q

with an increase in metabolism and increase protein breakdown, what does that put our patient at risk for ?

A

lean body mass, muscle atrophy, weight loss, and stress

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26
Q

how can we prevent metabolic increases in our patients with spinal cord injuries ?

A

start early feeding to prevent skin breakdown, reduce infection and decrease muscle atrophy

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27
Q

its important to note that a patient pain is also apart of the system. Reason why is because pain can vary due to the type and severity.

patient can have nociceptive pain which is ?

patient can have neuropathic pain which is ?

this can continue for years even after recovery from the injury by the way!

A

musculoskeletal pain ; dull or aching, starts or worsens with movement

damaged to cord or nerves, located at or below level of injury, hot burning, sensitive to stimuli and pain from light touch

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28
Q

now onto back of the video recording flashcards, just remember the other flashcards were things we still need to know but gives a great overview on each system and how a spinal cord injury can affect the body

A
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29
Q

what is the most common cause of spinal cord injuries?

A

trauma
( 38% cars and 30.5% falls)

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30
Q

there are two types of injuries when it comes to talking about spinal cord injury.

what is primary mean?
what is secondary mean ?

A

the direct cause

swelling, symptoms, complications leading to spinal cord injury

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31
Q

direct physical trauma to the spinal cord can be what ?

A

blunt, penetrating

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32
Q

spinal cord compression can be by what 3 things ?

A

bone displacement
interruption of blood supply
traction from pulling on cord

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33
Q

its important to note that with spinal cord injury, it can cause progressive damage, which we as nurses will try to do what to prevent it?

A

stabilize the spine, neck and head

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34
Q

what are 3 examples of secondary injury ?

A

edema
ishecmia
inflammation

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35
Q

how does edema cause a secondary injury to the spine ?

A

within 24 hours the edema will increase and put pressure on the spine and cause permanent damage

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36
Q

how does ischemia cause a secondary injury to the spine ?

A

lack of blood supply can lead to vasospasm in the spine causing damage

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37
Q

how does inflammation cause a secondary injury to the spine ?

A

leads to glial scar formation which restricts regeneration of the cord leading to permanent nerve and neural deficit damage

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38
Q

when it comes to spinal cord we are going to talk about two important types of shock, which are ?

A

spinal shock
neurogenic shock

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39
Q

when does spinal shock occur?

A

shortly after injury and last days to weeks

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40
Q

what is spinal shock characterized by ? (3)

A

loss of deep tendon reflexes
loss of sensation
flaccid paralysis below the level of injury(no tone)

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41
Q

how does spinal shock occur?

A

spinal cord is responding to the injury and it stops working because of the edema, damage, inflammation, ischemia

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42
Q

is spinal shock a protective mechanism ?

why is it and what is it protecting us from?

can this be resolved, if yes, how?

A

yes

protect nervous system from further injury

it can be with recovery

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43
Q

Remember, spinal shock happens directly after the injury and our body shuts down. no deep tendon reflexes, loss of sensation, flaccid paralysis ( no muscle tone ) as a protective mechanism for us.

and usually this will end up going away with recovery, however what is the issue behind this ?

A

right off the bat, we can not tell what neuro deficts they have because of the spinal shock

so we have to wait for it resolve before we know exactly what’s going on

44
Q

where does neurogenic shock occur in? (cervical number)

how long can it last?

A

in cervical or high thoracic
(at or above t6) injury

1-3 weeks

45
Q

neurogenic shock is characterized by what 3 things?

A

hypotension (less than 90)
bradycardia
temperature dysregulation

46
Q

neurogenic shock is a loss of sis innervation causing what?

that answer meaning^

A

unopposed paraysmpathic response

  • venous pooling
  • decreased cardiac output
  • peripheral vasodilation
47
Q

t6 or above we can see what type of shock?

t12 or lumbar injury are they are going have neurogenic shock?

A

neurogenic shock

we are not going to see that there

48
Q

since patients with neurogenic shock can not regulate their temperature, what temperature do you think they will end up being at?

A

room temp

49
Q

how do we classify a spinal cord injury ? (3)

A

mechanism of injury (how)
level of injury (where)
degree of injury ( how bad )

50
Q

what are some examples of mechanisms of injury patients can do to get an injury ?

A

flexion ( strong forward crash )

hyperextension ( banging head on table)

compression fracture
( diving into shallow pool )

flexion rotation
- most unstable due to ligament tearing like falling from a horse

51
Q

when talking about the level of injury, we talk about two things, which are?

A

skeletal level
neurologic level

52
Q

what is skeletal level?

what is neurologic level?

A

which vertebra is around the spinal cord is injured
(physical damage occur)
( broken )

these are the neurologic symptoms they exhibit

( nerve damage occurred )

53
Q

C1-T1 is called what?

below t2 is what?

A

tetraplegia ( quadriplegia )
( all 4 extremities )

paraplegia
( can’t use legs )

54
Q

she said to look at the picture in the powerpoint, this is the skeletal picture talking about the levels of paralysis a patient with a spinal cord injury will exhibit, so your job is to talk about what is happening at each level.

c4 injury
c6 injury
t6 injury
l1 injury

A

tetraplegia, complete paralysis below the neck

results in partial paralysis of the hands and arms and lower body

paraplegia, results in paralysis below the chest

paraplegia, results in paralysis below the waist

55
Q

when we are talking about the degree of injury we are talking about 2 things which are?

A

complete
incomplete ( partial )

56
Q

what is a complete degree of injury ?

A

total loss of sensory and motor function below level of injury

57
Q

what is incomplete (partial) degree of injury ?

A

mixed loss of voluntary motor activity and sensation

58
Q

what is the scale we use to assess the clinical manifestation for a patient with spinal cord injury ?

which helps us to?

A

American spinal injury association impairment scale
(ASIA)

  • classifies severity of impairment
  • combines assessment of motor and sensory function to determine neurologic level and completeness of injury
59
Q

clinical manifestations are a direct results of trauma that causes what 4 things ?

A

cord compression
ischemia
edama
possible cord transection

60
Q

what is a dermatome?

provide example

A

sensory region of skin corresponding to each spinal cord segment

spinal cord injury, move fingers
thumb issues - higher c6 injury

61
Q

what are some diagnostic studies for spinal cord injuries?

A

cervical x-rays
ct scan
mri
ct angiogram

62
Q

what is the emergency management for patients with spinal cord injuries ?

A

patent airway, adequate respiration

adminiser oxygen

maintain systolic blood pressure

iv access - 2 bore ivs

monitor for neurogenic shock

stablize cervcial spine

assess for other injuries

control external bleeding

obtain appropriate imaging

secure airways

keep warm

obtain brief history

63
Q

we are going to need to roll the patient, how are we going to move them ?

A

log roll them

64
Q

when you are concern with a patient for motor function, make sure you are doing what?

A

bilateral !!!

not one arm first then the other arm,

do it both!

65
Q

how are we going to assess for sensory for patients with spinal cord injuries?

A

pinprick
position sense and vibration

66
Q

inter professional care
acute care notes

brain injury and vertebral artery injury
- history of unconsciousness
- signs of concussion

musculoskeletal injuries
trauma to internal organs
- hemorrhage : decreased blood pressure, increased pulse
- hematuria

move the patient in alignment as a unit (logroll)

monitor respiratory, cardiac, urinary, gi functions

prepare for transfer to surgery or icu

A
67
Q

Stabilization of injured spinal segment and decompression

  • Traction or realignment
  • Eliminates damaging motion
  • Prevent secondary damage

Early realignment of unstable fracture-dislocation

  • Closed reduction through craniocervical traction

Used following acute SCI to manage instability and decompress the spinal cord

  • Reduces secondary injury and improves outcomes

Surgery within 24 hours of injury is recommended for central cord syndrome and adults with any SCI

A
68
Q

we use to treat patients with high dose of what _____but we dont use it anymore

A

corticosteroids
examples like
methylprednisolone

69
Q

remember patients with spinal cord injuries can not move their legs, so they are at risk for?

and we need to treat with what ?

A

VTE, DVT, blood clot

heparin

70
Q

remember what type of motion are we going to do for patients with spinal cord injuries?
and why?

A

passive range of motion because remember they are paralysis!!

71
Q

why night we need to use vasopressors agents to maintain the mean arterial pressure 85-90?

A

neurogenic shock
- they are hypotensive !
we may need to give vasopressor

72
Q

what are some examples of vasopressors ?

A

phenylephrine, norepinephrine

73
Q

nursing assessment notes
Subjective data

Health history, functional health patterns, coping

Objective data
- Poikilothermism

  • Warm, dry skin below level of injury intially (neurogenic shock)
  • Respiratory-Consider level of injury, Bradycardia, hypotension

Decreased or absent bowel sounds

Abdominal distention
Constipation, incontinence, impaction

A
74
Q

Urinary retention, flaccid, spasticity

Priapism, altered sexual function

Neurologic
Complete: areflexic, paralysis, hyperactive deep tendon reflexes, positive Babinski

Incomplete: mixed loss of motor and sensory functions

Muscle atony, contractures
Pain
Possible diagnostic findings

A
75
Q

nursing diagnoses notes

  • Impaired breathing
  • Impaired nutritional status
    -Ineffective tissue perfusion
  • Impaired tissue integrity
  • Impaired urinary system function
  • Constipation
  • Difficulty coping
A
76
Q

nursing planning notes
Overall goals

  • Maintain optimal level of neurologic functioning
  • Have minimal to no complications of immobility
  • Learn new skills, gain new knowledge, and acquire new behaviors to care for self or direct others to do so
  • Return to home at optimum level of functioning
A
77
Q

nursing implementation
health promotion notes

Identify high-risk populations and provide teaching

Support legislation to:
- Prohibit texting while driving
- Mandate use of seat belts in cars
- Mandate helmets for motorcyclists/ bicyclists
- Mandate child safety seats
- Promote programs for older adults to prevent accidental death and injury
- Recommend tougher penalties for impaired driving

A
78
Q

Health promoting behaviors after SCI impact general health and well-being

  • Teaching and counseling
  • Referring to programs
  • Performing routine physical exams
  • Facilitate wheelchair-accessible exam rooms, adjustable height tables, and extra time for appointments
A
79
Q

the higher you have a spinal cord injury, the more severe complications are going to be for patients.

so we always want to maintain a neutral neck position
- keep the body in correct alignment
- logroll to prevent movement of spine

closed reduction with skeletal traction for realignemt
- maintain traction at all times

surgical : cervical fusion or other stabilization procedure

A
80
Q

typically when patients have a high spinal cord injury we are going to put them in this what ?

A

halo vest

81
Q

what is the function of the halo vest?

main concern with

A

stabilize the neck

pins in the skull it attaches to

infection

82
Q

how do we take care of the pins ?

A

clean with cholrhexidine twice a day

apply antibiotic ointment

83
Q

if a patient has a lower spinal injury, we can put them in braces as well, only down side of this compared to the vest is that movement, like flexion, extension and rotation is very limited.

there are beds, that can move you to help prevent pressure injuries and aid with circulation , fluid mobilize so we can prevent respiratory issues

A
84
Q

remember when a patient is having spinal shock, they are going to have no reflexes, however after the resolution of spinal shock, what will they have?

A

hyper active, exaggerated responses with no control
- muscle spams

(men will have penile erections)

85
Q

its very sad to think and tell a patent, after your spinal shock reflexes, having none, has gone away and now your spinal shock has resolved, to where you have so much movement, you think youre doing better, you have to tell them what?

A

it does not mean mobility is returning back

86
Q

how can we help a patient with hyper-reflexes? like what drug and injection ? (2)

A

antispasmodic drugs
botuslim toxin injection

87
Q

autonomic dysreflexia is a what?

A

life threatening situation in where your t6 or below has a hyper stimulation of your nervous system

88
Q

what is the biggest cause of autonomic dysreflexia ? (4)

A

restrictive clothing
full bladder/urinary tract infection
pressure areas
fecal impaction

89
Q

what are clinical manifestations of autonomic dysreflexia ?(6)

vasodilation above the level of injury

A

high blood pressure
flushed face
headache
distended neck veins
decrease heart rate
increase sweating

90
Q

what are clinical manifestations of vasoconstriction below level of injury for patient with autonomic dysreflexia? (3)

A

pale
Cool
no sweating

91
Q

if autonomic dysreflexia is not resolved, it can lead to what?

A

status epilepticus
stroke
myocardial infarction
death

92
Q

what is the first thing we are going to do if we suspect a patient to be having autonomic dysreflexia?

A

elevate the head of the bed 45, sit them up!!

93
Q

after we sit them up, what are we going to assess or how are we going remove the cause for autonomic dysreflexia? (3)

think of the causes of autonomic dysreflexia In the first place

A

immediate catheriation - for the full blader

remove stool impaction

remove constrictive clothing/tight shoes

94
Q

after someone is discharged from the hospital, we are can send them home or rehab.

Complex rehabilitation
Physical and psychological care and intensive and specialized rehabilitation lead to function at highest level of wellness

Interprofessional team effort

Problems from acute injury become chronic and last throughout life

Rehabilitation focuses on retraining physiologic processes and management of changes

Organized around patient’s goals and needs

A
95
Q

Patient expected to be involved in therapies and learn self-care

Progress can be slow

Can be very stressful

Nurses provide frequent encouragement, specialized care, patient and caregiver education; and help coordinate efforts of team

A
96
Q

respiratory rehabilitation
notes

Patients with mechanical ventilation need:

Round-the-clock caregiver

Respiratory hygiene

Tracheostomy care

Education (include caregiver)

Improved function possible with nerve stimulator

If removed from the ventilator, tracheostomy downsizing will take place in rehab

Teach:
- Assisted coughing, Incentive spirometry
- Breathing exercises, Limit exposure to sick people
- Swallowing precautions ad diet recommendations to reduce aspiration

A
97
Q

notes
neurogenic bladder

Comprehensive program needed to manage bladder function

Goal is to improve quality of life and safety by:

  • Preserving renal function
  • Minimizing UTIs and bladder stones
  • Developing a plan for incontinence

Management
Patient and caregiver teaching for successful self-management
- Where to obtain supplies for selected management technique
- When to seek health care
- Bladder retraining
- Fluid schedule
- Indwelling urinary catheter-needs 3-4 L of fluid daily

Factors to consider
- Patient preference, upper extremity function, and caregiver availability

A
98
Q

what are some drainage methods for neurogenic bladder?

A

bladder reflex retraining

catherters

urinary diversion surgery

99
Q

what type of diet for bowel moment for spinal cord injuries ?

A

high fiber to help with constipation

100
Q

Voluntary control may be lost
Patient and Caregiver Teaching
High-fiber diet
Adequate fluid intake
Timing, position, activity
Drug treatment
Suppositories
Small-volume enemas
Digital stimulation
Valsalva maneuver
International Spinal Cord Injury Bowel Function Data Set

A
101
Q

spasticity

can be both beneficial and undesirable

Aids with mobility
Improves circulation
Difficult positioning and mobility from spasms

Treatment
ROM exercises
Antispasmodic drugs
Botulinum toxin injections

A
102
Q

skin care notes

Prevention of PI essential for life-long treatment plan

Patient and caregiver teaching
Comprehensive daily exam to monitor skin condition

Teach to reposition
At least every 2 hours while in bed
Every 15 to 20 minutes when in a chair

Pressure-relieving cushion, mattress, pillows
Adequate nutrition
Standard wound care procedures

A
103
Q

pain management notes
Acute pain
- Initial injury pain persists for few weeks of rehabilitation

Chronic pain
-May be result of overuse of muscles
-Sleep may be disrupted

Assess, evaluate, and treat routinely
Analgesics
Massage and repositioning
Refer to pain management specialist

A
104
Q

sexuality notes
Important issue regardless of patient’s age or gender

Nurse or rehabilitation specialist must:
Provide support for patient and partner
Discuss alternatives for sexual satisfaction

A
105
Q

grief and depression
Depression common and disabling
Overwhelming sense of loss
Loss of control
Grief Response
Shock and denial
Anger
Depression
Adjustment and acceptance

Provide Support
Allow mourning while encouraging hope
Goal of recovery: adjustment more than acceptance
Sympathy not helpful
Encourage patient participation
Consistency of care
Psychiatric consult if needed
Drugs and therapy
Caregiver and family counseling
Support group

A
106
Q

Expected outcomes
Adequate ventilation with no signs of respiratory distress
Adequate circulation and BP
Intact skin
Adequate nutrition
Bowel management
Bladder management
No autonomic dysreflexia

A
107
Q

gerontologic considerations
Increased incidence
Falls are leading cause of SCI at age 65 and older
Increased complications
Hospitalized linger
Increased mortality rates
Health promotion and screening
Rehabilitation lengthened

A

410 Patho Exam 4 (5 decks)

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