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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
Spinal cord injury at C8 to T1
Homer's syndrome (constricted pupil, ptosis, facial anhidrosis); Paralysis of legs
26
Spinal cord injury between T11 and T12
Paralysis of leg muscles above and below the knee
27
Spinal cord injury between T12 and L!
Paralysis below the knee
28
Cauda equina spinal cord injury
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
Spinal injury at S3 to S5 or conus meduallaris at L1
Complete loss of bowel and bladder control
30
When doing a neurologic assessment, what are things you want to assess?
``` Mental status and speech Cranial nerves Central and peripheral sensory function Motor function Cranial and peripheral reflexes Cerebellar function and gait ```
31
CT scan
fancy xray = takes cross section images of the body to show large disc herniations, but can miss smaller ones
32
CT with Myelogram
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
MRI
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
EMG (Electromyography
Assess the electrical activity of a nerve root; helps distinguish nerve degeneration from nerve root compression
35
radiculopathy
nerve root compression
36
neuropathy
nerve degeneration
37
Somatosensory-Evoked Potentials (SSEP)
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
Spinal Injury Management
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
What are some alterations in functional ability we as nurses should pay attention too
Alterations in spinal reflexes and temperature regulation problems Sensorimotor dysfunction Bladder/ Bowel Function ANS dysfunction (postural hypotension)
40
Upper Motor Neuron (UMN) Lesions
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
Lower Motor Neuron Lesions
Below T12 damage to the peripheral nerves FLACCID paralysis
42
Spinal/Neurogenic Shock
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
Damage to C1-C3
Lack of respiratory effort and needs assisted ventilation
44
Damage to C3 -C5
partial or full diaphragmatic function; DIMINISHED VENTILATION
45
Damage below C5
cannot deep breath or cough
46
Vasovagal Response
overstimulation of the vagus nerve will DECREASE THE HEART RATE
47
Causes of vasovagal response
Deep tracheal suctioning Rapid positioning changes **Don't need a spinal injury to get this
48
Autonomic Dysreflexia
exaggerated SNS responses (injuries above T6) | does not occur until spinal shock has been resolved (within 6 months of injury)
49
Characteristics of Autonomic Dysreflexia
hypertension bradycardia headache skin pallor, piloerection, vasodilation, flushed skin, and profuse sweating above the level of injury
50
Causes of Autonomic Dysreflexia
full bladder/rectum pain (pressure ulcers, ingrown toenails) Ejaculation problems, bladder spasms ***Body can't sense this so have SNS exaggerated reflexes
51
If untreated what can happen to a person with autonomic dysreflexia
Convulsions Decreased LOC DEATH *** This is a medical emergency
52
Interventions of Autonomic Dysreflexia
REMOVE/CORRECT THE CAUSE OF THE STIMULUS (ex. empty bladder) Position upright IV peripheral vasodilators = to dilate and decrease BP Remove AE hose
53
Postural Hypotension
T4-T6 and above Results in pooling of blood in veins = decreased cardiac output s/sx = dizziness, pallor, sweating, blurred vision
54
Alterations in Temp Regulation
Don't have the normal effector response = don't shiver or sweat below the level of injury
55
Poikilothermy
assume external temperature = dress for surrounding temperature
56
Lumbar Disc Herniation
``` 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
Cervical Disk Herniation
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
Manifestations of Disk Herniations
PAIN!!!! Radiating, slight motor weakness Paresthesias and numbness Decreased reflexes
59
DX of Disk Herniations
``` Neurological Assessment (mental status, speech, cranial nerves, cerebellar function and gain) XRAY, CT, CT WITH MYELOGRAM, MRI, EMG SSEP ```
60
MANAGEMENT OF DISK HERNIATION
``` Analgesics (NSAIDS) Antiinflammatory (steroids or cortisone injections Muscle Relaxers PT Eductions (body mechanics) ```
61
Damage to lower motor neurons is likely to result in
muscular atrophy
62
The MOST common type of disk herniation is
posterolateral

Patho Exam 4 (7 decks)

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