Spinal Cord injury Flashcards
autonomic dysreflexia, prevention, signs and symptoms & management
what is the cause for most spinal cord injuries?
motor vehicle collisions
falls
violence
sports injuries
there are two types of injury when it comes to injury to the spinal cord, what are they ?
primary and secondary
what is primary injury?
what is secondary injury?
primary
- direct trauma from blunt or penetrating trauma
secondary
- ongoing, progressive damage that occurs after primary injury
in the secondary injury, what are the 3 symptoms that patients often will experience that will cause their treatment of a spinal cord injury take longer?
edema - within 24 hours after injury
ischemia
inflammation
- nerve damage
so if we dont treat that prolong ischemia, the lack of oxygen reaching the body, the body will release epiphenrine and noepinephrine. when these two release, _____happens and leads into what condition?
vasoconstriction
autonomic dysreflexia
there 3 types of spinal cord injuries
cervical injury
thoracic injury
lumbar injury
explain to me what each site of injury will a patient end up showing. like what is the paralysis state of it ?
cervical
- 4 limbs paralyzed
- breathing is massive problem here
thoracic
- parapalegic
- legs and pelvic organs
lumbar injury
- legs and leaky bladder
what 2 types of shock can a patient experience with a spinal cord injury?
spinal shock
neurogenic (vasogenic) shock
when does a spinal shock occur?
and what are the symptoms often associated with it ?(3)
when in recovery from spinal shock, that can happen that we need to educate patients on ?
occurs shortly after injury and lasts days to weeks
- loss of senstations
- loss of deep tendon reflexes
- flaccid paralysis below level of injury
hyperreflexia
- does not indicate mobility has returned
when does neurogenic shock occur?
what are the 3 signs and symptonms associated with it?
occurs in injuries above T6
hypotension
bradycardia
polikthermia
the degree of a spinal cord injury really depends wheather if it was complex or partial. describe what each of these mean
and what is better
partial is better since you have some loss of movement and retain some paralysis
complete, you have loss total sensory and motor function below level of injury
what is the scale that we use to major the impairment of a patient with a spinal cord injury ?
american spinal injury association impairment scale (asia)
what are the diagnostic studies that we use to help confirm a spinal cord injury?
ct scan
a patient comes into the hospital with a spinal cord injury , what is the interprofessional care that we perform in an emergency setting?
- patent airway
- adminitser o2
- maintain sbp 90
- iv access
- monitor neurogenic shock
- immobilize and stabilize
- assess for other injuries
- control external bleeding
- obtain appropriate imaging
- keep warm
- vital signs
if we plan to move a patient with a spinal cord injury, what is the way we are going to move them?
logroll
what tool are we first going to use to help stabilize the injury ?
usually a traction for the mean time before having a full assessment be done
usually in acute settings, traction is used to help stablilze, but we also can do surgery, however it must be done within ____
24 hours
what are the drugs and treatments we are going to give a patient with neurogenic shock? (2)
iv fluids - vaso pressers
vte prophylaxis ( heparin )
in a high cervical spinal cord injury, what is the tool that we use to immboilize the head?
halo vest
what is the biggest risk factor that we have when it comes for a patient wearing a halo vest?
infection
what are we doing to use to clean the pins that are attached to your skull and connected to the vest to help stablize the neck?
chlorhexidine
the best advantage behind a halo vest is what?
allows for movement to occur while bones are fusing back into place
what is the main condition or how often do we see autnomic dysreflexia occur in which type of injury ?
above t-6
why is autonomic dysreflexia a deadly condition ?
extreme hypertension can lead to status epilepticus, stroke, mi or even death
what are the 4 causes of autonomic dysreflexia?
restrictive clothing
pressure areas
full bladder/uti
fecal impaction
some notes to notice is that if im taking a test and they use when talking about spinal cord injuries above t6 typically
full bladder or distended bladder
constipation
tight clothing
this is a massive warning for what?
autonomic dysreflexia
what is the patho behind autonomic dysreflexia?
- according to the simple nursing video
so typically we have sns, which helps vasoconstrict to help increase our blood pressure and we have pns, which helps vasodilate to help lower our blood pressure. in a normal person these work together to equalize the blood pressure
however in a spinal cord injury
- they are unable to communicate, so above the level of injury we have vasodilate and below the injury, vasoconstriction
- resulting in a tug-war since sns and pns are mis communicating
what are the 6 signs and symptoms of autonomic dysreflexia?
- sweating (diaphoresis)
- severe hypertension
- flushing
- headache
- bradycardia
- distended neck veins
what are the interventions, or step by step assessment for a patient with a spinal cord injury ? (6 steps)
- elevate hob 45/sit up
- assess and remove cause
( palpate bladder, ask bowel movement immediate cath, remove stool, remove clothing) - call provider
- check blood pressure
- bp meds after assessment
- educate
if a patient is having an headache in autonomic dysreflexia, do we give medications for it why or why not?
no!!
remember its being caused by obstruction of bladder, bowel or clothing
so if we treat that, the headache should resolve
