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Patho Exam 4 > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

The brain and the spinal cord is controlled by_____ nervous system

A

Central

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2
Q

The Peripheral Nervous System controls

A

Motor (Efferent) and Sensory (Afferent) Neurons

The motor controls the ANS and the Somatic Nervous System

The ANS controls the SNS and PNS

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3
Q

PNS chart (rest and digest)

A 
constricts pupil
stimulates salivation
inhibits heart
constricts bronchi
stimulates digestive activity
stimulates gall bladder
contracts bladder
relaxes rectum
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4
Q

SNS chart

A 
dilates pupil
inhibits salivation
relaxes bronchi
accelerates heart rate
inhibits digestive activity
stimulates glucose release by liver
secretion of E and NE
relaxed bladder
contracts rectum
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5
Q

Causes of spinal injury

A 
Motor Vehicle Accidents
Falls
Gunshot/Stab wounds
Sports Injuries
Lifting or minor falls
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6
Q

Plegia

A

paralysis

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7
Q

Monoplegia
Hemiplegia
Paraplegia

A

paralysis of one limb
paralysis of both limbs on one side
paralysis of BOTH upper OR lower limbs

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8
Q

Paresis

A

weakness

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9
Q

Hypotonia

A

muscle tone less than normal

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10
Q

Flaccidity

A

absent muscle tone

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11
Q

Hypertonia

A

Excessive muscle tone

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12
Q

Spasticity

A

muscle tone that causes stiff awkward movements

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13
Q

Tetany

A

Intermittent tonic spasms - paroxysmal

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14
Q

What is a subluxation

A

partial dislocation of the vertebral column

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15
Q

Compression injury

A

force to the top of the head/pushing down or up on the spine

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16
Q

Axial rotation injury

A

twisting injury to the spine

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17
Q

Primary step of spinal injury

A

This is the INITIAL INJURY. IRREVERSIBLE

Small hemorrhages in grey matter that lead to edematous changes in white matter that eventually result in necrosis of neural tissue

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18
Q

Secondary step of spinal injury

A

progressive Neurologic damage d/t

(1) vascular damage = ischemia, increased permeability and edema
(2) Neuronal injury = loss of reflexes below level of injury
(3) Vasoactive agent and cellular enzymes (released) = delayed swelling, demyelination, and necrosis

**makes everything from initial injury worse

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19
Q

INCOMPLETE TRANSECTION (spinal cord injury) is ______ and includes what types?

A

severed part of the spinal cord that results in partial preservation of sensory and motor function

Includes: (ABCC)
Central Cord syndrome
Anterior Cord syndrome
Brown-Sequard syndrome
Conus medullaris syndrome
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20
Q

Complete Transection (spinal cord injury is ______ and includes what types?

A

severed part of spinal cord results in absence of sensory and motor function
Includes:
Quadriplegia (above T1)
Paraplegia (below T1)

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21
Q

Spinal cord injury at or above C5 results in _____?

A

Respiratory paralysis; Quadriplegia

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22
Q

Spinal cord injury between C5 and C6

A

paralysis of legs, wrists and hands; weakness of shoulder abduction and elbow flexion; loss of brachioradialis reflex

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23
Q

Spinal cord injury between C6 and C7

A

paralysis of legs, wrists, and hands; but shoulder movement and elbow flexion usually still possible; Loss of Biceps jerk reflex

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24
Q

Spinal cord injury between C7 and C8

A

Paralysis of legs and hands

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25
Q

Spinal cord injury at C8 to T1

A

Homer’s syndrome (constricted pupil, ptosis, facial anhidrosis); Paralysis of legs

26
Q

Spinal cord injury between T11 and T12

A

Paralysis of leg muscles above and below the knee

27
Q

Spinal cord injury between T12 and L!

A

Paralysis below the knee

28
Q

Cauda equina spinal cord injury

A

Hyporeflex or areflexic paresis of lower extremities, usually pain and hyperasthesia in the distribution of the nerve roots, and usually loss of BOWL AND BLADDER, SENSORY IMPAIRMENT, AND ASYMMETRIC FLACCID PARALYSIS

29
Q

Spinal injury at S3 to S5 or conus meduallaris at L1

A

Complete loss of bowel and bladder control

30
Q

When doing a neurologic assessment, what are things you want to assess?

A 
Mental status and speech
Cranial nerves
Central and peripheral sensory function
Motor function
Cranial and peripheral reflexes
Cerebellar function and gait
31
Q

CT scan

A

fancy xray = takes cross section images of the body to show large disc herniations, but can miss smaller ones

32
Q

CT with Myelogram

A

CT with dye = radiopaque dyes injected into the sac around the nerve roots and helot tell if there is pressure/bleeding/inflammation around the nerve roots

**good for nerve impingement and can pick up very subtle lesions

33
Q

MRI

A

Magnetic Resonance Imaging - aids in the assessment of certain conditions providing detail of disc and nerve roots and highly refined detail of the spines anatomy

34
Q

EMG (Electromyography

A

Assess the electrical activity of a nerve root; helps distinguish nerve degeneration from nerve root compression

35
Q

radiculopathy

A

nerve root compression

36
Q

neuropathy

A

nerve degeneration

37
Q

Somatosensory-Evoked Potentials (SSEP)

A

assesses the speed of electrical conduction across the spinal cord

**if the spinal cord is pinched the electrical signals will travel slower than usual

38
Q

Spinal Injury Management

A

Immobilization (neck collars and back boards)
Log roll (roll as 1 unit
Bedrest
Methylprednisolone (steroids that suppress the immune system to prevent further swelling and stabilize cell membranes)

39
Q

What are some alterations in functional ability we as nurses should pay attention too

A

Alterations in spinal reflexes and temperature regulation problems
Sensorimotor dysfunction
Bladder/ Bowel Function
ANS dysfunction (postural hypotension)

40
Q

Upper Motor Neuron (UMN) Lesions

A

affected by any injury at the T12 or above
Results in SPASTIC paralysis, contracted stiff presentation of muscles

**want to do religious PROM for UMN to help prevent contraction

41
Q

Lower Motor Neuron Lesions

A

Below T12
damage to the peripheral nerves
FLACCID paralysis

42
Q

Spinal/Neurogenic Shock

A

happens immediately after spinal injury and is a state of areflexia (no reflexes)

flaccid paralysis, lack of tendon reflexes, and ANS function
can last minutes, hours, days, weeks etc

43
Q

Damage to C1-C3

A

Lack of respiratory effort and needs assisted ventilation

44
Q

Damage to C3 -C5

A

partial or full diaphragmatic function; DIMINISHED VENTILATION

45
Q

Damage below C5

A

cannot deep breath or cough

46
Q

Vasovagal Response

A

overstimulation of the vagus nerve will DECREASE THE HEART RATE

47
Q

Causes of vasovagal response

A

Deep tracheal suctioning
Rapid positioning changes
**Don’t need a spinal injury to get this

48
Q

Autonomic Dysreflexia

A

exaggerated SNS responses (injuries above T6)

does not occur until spinal shock has been resolved (within 6 months of injury)

49
Q

Characteristics of Autonomic Dysreflexia

A

hypertension
bradycardia
headache

skin pallor, piloerection, vasodilation, flushed skin, and profuse sweating above the level of injury

50
Q

Causes of Autonomic Dysreflexia

A

full bladder/rectum
pain (pressure ulcers, ingrown toenails)
Ejaculation problems, bladder spasms

***Body can’t sense this so have SNS exaggerated reflexes

51
Q

If untreated what can happen to a person with autonomic dysreflexia

A

Convulsions
Decreased LOC
DEATH
*** This is a medical emergency

52
Q

Interventions of Autonomic Dysreflexia

A

REMOVE/CORRECT THE CAUSE OF THE STIMULUS (ex. empty bladder)
Position upright
IV peripheral vasodilators = to dilate and decrease BP
Remove AE hose

53
Q

Postural Hypotension

A

T4-T6 and above
Results in pooling of blood in veins = decreased cardiac output

s/sx = dizziness, pallor, sweating, blurred vision

54
Q

Alterations in Temp Regulation

A

Don’t have the normal effector response = don’t shiver or sweat below the level of injury

55
Q

Poikilothermy

A

assume external temperature = dress for surrounding temperature

56
Q

Lumbar Disc Herniation

A 
MOST in (L4-L5 OR L5-S1)
L5 = foot drop d/t impingement of nerve that weakens extension of big toe and ankle (numbs/pain on top of foot and buttocks)
S1=loss of ankle reflex d/t nerve impingement; numbness and pain can radiate down to the sole or outside of foot
57
Q

Cervical Disk Herniation

A

MOST COMMON in C6-C7 and C5-C6
C5 shoulder pain/numbness
C6 weakness in biceps and wrist; pain that runs down the arm to thumb (brachioradialis reflex diminished)
C7 = pain/numbness that runs down to middle of arm (triceps reflex diminished)
C8 = hand dysfunction pain to the outside of the pinky

58
Q

Manifestations of Disk Herniations

A

PAIN!!!!
Radiating, slight motor weakness
Paresthesias and numbness
Decreased reflexes

59
Q

DX of Disk Herniations

A 
Neurological Assessment (mental status, speech, cranial nerves, cerebellar function and gain)
XRAY, CT, CT WITH MYELOGRAM, MRI, EMG SSEP
60
Q

MANAGEMENT OF DISK HERNIATION

A 
Analgesics (NSAIDS)
Antiinflammatory (steroids or cortisone injections
Muscle Relaxers
PT
Eductions (body mechanics)
61
Q

Damage to lower motor neurons is likely to result in

A

muscular atrophy

62
Q

The MOST common type of disk herniation is

A

posterolateral

Patho Exam 4 (7 decks)

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