Spinal Cord Injury Flashcards
Risk factors for SCI?
- males age 16-30
Primary SCI?
- cord compression caused by:
- Bone displaced
- Blood supply interrupted
- Traction-pulling on cord
- Tearing/Transection-penetrating trauma
Secondary injury - SCI?
bodies response to the initial injury (e.g. edema)
Neurogenic Shock process?
Massive vasodilation = ↓ preload = ↓ stroke volume = ↓CO = ↓ tissue perfusion and cellular metabolism
Spinal Shock is characterized by?
- ↓ Reflexes
- Loss of sensation
- Flaccid paralysis below level of injury
How long does spinal shock last?
days to months
How long does neurogenic shock last?
up to 6 wks
Mechanisms of SCI?
- Flexion
- Hyperextension
- Compression
- Flexion-rotation
- Extension-rotation
What will be seen in a patient with a C1-C4 spinal injury?
tetra/quadroplegia, may not be able to breath on their own, speech may be affected
What will be seen in a patient with a C5- C8 spinal injury?
arms and hand movements are affected
What will be seen in a patient with a C5 spinal injury?
- some or total paralysis of the wrist, hand, trunk and legs
- can raise arm and bend elbows
What will be seen in a patient with a C6 spinal injury?
partial paralysis of the hands and arms as well as lower body
What will be seen in a patient with a T6 spinal injury?
paraplegia, paralysis below the chest
What will be seen in a patient with a L1 spinal injury?
Paraplegia, paralysis below the waist
SCI syndromes with incomplete lesions ?
- Central cord syndrome
- Anterior cord syndrome
- Brown-Séquard syndrome
- Cauda equina syndrome
- Conus medullaris syndrome
what is the most common cause of Central Cord Syndrome?
hyperextension (looking up) of neck that causes damage to the central spinal cord
Central Cord Syndrome is most common in what population?
older adults
Signs of Central Cord Syndrome?
extremity weakness, occurs more in UE than LE
what is the most common cause of Anterior Cord Syndrome?
flexion (looking down) injury that compresses the anterior portion of the spinal cord
Signs of Anterior Cord Syndrome?
motor paralysis and sensory loss (pain & temp) below the level of injury
What is Brown-Séquard Syndrome?
damage to 1/2 of the spinal cord from a penetrating injury (e.g. gunshot)
Signs of Brown-Séquard Syndrome?
- Ipsilateral
- loss of motor function
- Loss of pressure, position and vibration sense
- Contralateral:
- loss of light touch, pain, temperature sensation
What is Conus Medullaris Syndrome?
damage to the conus medullaris or lowest portion of the spinal cord
Signs of Conus Medullaris?
- motor-function lower extremities may be altered
- sensory-loss in perianal area
- areflexic bowel and bladder
Where is the damage in Cauda Equina Syndrome?
cauda equina or lumbar and sacral nerve roots
Signs of Cauda Equina Syndrome?
- asymmetric lower extremity weakness
- patchy sensation lower extremities
- saddle anesthesia
- bladder and bowel dysfunction
- pain-severe, radicular, asymmetric
What does the ASIA Impairment Scale asses?
In SCI:
- Motor and sensory funtion
- neurologic level
- completeness of injury
At what level of spinal cord injury will the patient lose complete resp function?
above C4 = ventilator
SCI complications with lost respiratory function?
- Atelectasis
- Pneumonia
- Pulmonary edema
At what level of spinal cord injury will the patient experience cardiovascular manifestations?
T6 and above
SCI GI system manifestations?
- Hypomotility creates risk
- Gastric distension
- Paralytic ileus
- Stress ulcers
- Neurogenic bowel
- loss of neurologic control over the bowel
`What is Poikilothermism
Lack of SNS communicatin with hypothalmus causing the body to lose the ability to autoregulate temp
SCI Interprofessional Care: Drug Therapy?
- LMW heparin (Enoxoparin/Lovenox)
- IV fluids
- Vasopressors
- Atropine
What is given to prevent DVT formation in a patient with an SCI?
Enoxoparin/Lovenox
When is atropine given to a patient with an SCI?
HR < 40
When is methylprednisolone given to a patient with an SCI?
only for non-penetrating wounds at risk of edema, need to asses for hypoglycemia
Criteria for early surgery
in a patient with an SCI?
- Evidence of cord compression
- Progressive neurologic deficit
- Compound fracture or bony fragments
- Penetrating wounds
Diet for a patient with an SCI?
high protein/calorie
Antispasmotic medications for a patient with an SCI?
- Baclofen (lioresal)
- Dantrolene (dantrium)
- Tizanidine (Zanaflex)
What is autonomic dysreflexia?
a strong stimulus from below the level of an SCI cause vasoconstriction and sends a signal to the brain. the brain sends a signal to decrease the blood pressure, but the signal cannot pass the level of injury.
What is the most common cause of autonomic dysreflexia?
distended bladder or constipation
Autonomic Dysreflexia Manifestations above the lesion?
- Profuse sweating
- Headache
- low BP, vasodilation
- Flushing of skin
- Nasal stuffiness
- Blurred vision
Autonomic Dysreflexia Manifestations below the lesion?
piloerection
Nursing interventions for Autonomic Dysreflexia?
- Elevate head of bed at 45° or sit patient upright
- Assess stimulus and treat
- Immediate catheterization (bladder)
- Notify physician
Neurogenic Bladder dysfunction types?
UMN lesion - Reflexic: no inhibition
LMN leasion - Areflexic: paralysis of all motor functions
Neurogenic Bladder training?
- Train for reflex voiding after bladder fills to capacity
- Goal = keep residual bladder volume < 500cc
- initially – clamp catheter to develop bladder tone (e.g., initially clamp released q 2 hrs)
- After catheter removal- cath every 4-6 hours
- Stimulus to trigger voiding (more intense stimuli for LMN lesion)
Medications to tx Neurogenic Bladder?
- Anti-cholinergics
- Alpha-adrenergic blockers
- Anti-spasmodics
Nursing management for a patient with Neurogenic Bladder?
- High-fiber diet, adequate fluid intake
- Carefully record bowel movements
- assess pattern
- utilize schedule
- Suppositories, small-volume enemas
- UMN - reflex emptying, meds
- LMN- digital stimulation, meds
