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6200 Adult /Older Adult II > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

Risk factors for SCI?

A
  • males age 16-30
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2
Q

Primary SCI?

A
  • cord compression caused by:
    • Bone displaced
    • Blood supply interrupted
    • Traction-pulling on cord
    • Tearing/Transection-penetrating trauma
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3
Q

Secondary injury - SCI?

A

bodies response to the initial injury (e.g. edema)

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4
Q

Neurogenic Shock process?

A

Massive vasodilation = ↓ preload = ↓ stroke volume = ↓CO = ↓ tissue perfusion and cellular metabolism

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5
Q

Spinal Shock is characterized by?

A
  • ↓ Reflexes
  • Loss of sensation
  • Flaccid paralysis below level of injury
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6
Q

How long does spinal shock last?

A

days to months

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7
Q

How long does neurogenic shock last?

A

up to 6 wks

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8
Q

Mechanisms of SCI?

A
  • Flexion
  • Hyperextension
  • Compression
  • Flexion-rotation
  • Extension-rotation
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9
Q

What will be seen in a patient with a C1-C4 spinal injury?

A

tetra/quadroplegia, may not be able to breath on their own, speech may be affected

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10
Q

What will be seen in a patient with a C5- C8 spinal injury?

A

arms and hand movements are affected

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11
Q

What will be seen in a patient with a C5 spinal injury?

A
  • some or total paralysis of the wrist, hand, trunk and legs

- can raise arm and bend elbows

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12
Q

What will be seen in a patient with a C6 spinal injury?

A

partial paralysis of the hands and arms as well as lower body

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13
Q

What will be seen in a patient with a T6 spinal injury?

A

paraplegia, paralysis below the chest

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14
Q

What will be seen in a patient with a L1 spinal injury?

A

Paraplegia, paralysis below the waist

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15
Q

SCI syndromes with incomplete lesions ?

A
  • Central cord syndrome
  • Anterior cord syndrome
  • Brown-Séquard syndrome
  • Cauda equina syndrome
  • Conus medullaris syndrome
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16
Q

what is the most common cause of Central Cord Syndrome?

A

hyperextension (looking up) of neck that causes damage to the central spinal cord

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17
Q

Central Cord Syndrome is most common in what population?

A

older adults

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18
Q

Signs of Central Cord Syndrome?

A

extremity weakness, occurs more in UE than LE

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19
Q

what is the most common cause of Anterior Cord Syndrome?

A

flexion (looking down) injury that compresses the anterior portion of the spinal cord

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20
Q

Signs of Anterior Cord Syndrome?

A

motor paralysis and sensory loss (pain & temp) below the level of injury

21
Q

What is Brown-Séquard Syndrome?

A

damage to 1/2 of the spinal cord from a penetrating injury (e.g. gunshot)

22
Q

Signs of Brown-Séquard Syndrome?

A
  • Ipsilateral
    • loss of motor function
    • Loss of pressure, position and vibration sense
  • Contralateral:
    • loss of light touch, pain, temperature sensation
23
Q

What is Conus Medullaris Syndrome?

A

damage to the conus medullaris or lowest portion of the spinal cord

24
Q

Signs of Conus Medullaris?

A
  • motor-function lower extremities may be altered
  • sensory-loss in perianal area
  • areflexic bowel and bladder
25
Where is the damage in Cauda Equina Syndrome?
cauda equina or lumbar and sacral nerve roots
26
Signs of Cauda Equina Syndrome?
- asymmetric lower extremity weakness - patchy sensation lower extremities - saddle anesthesia - bladder and bowel dysfunction - pain-severe, radicular, asymmetric
27
What does the ASIA Impairment Scale asses?
In SCI: - Motor and sensory funtion - neurologic level - completeness of injury
28
At what level of spinal cord injury will the patient lose complete resp function?
above C4 = ventilator
29
SCI complications with lost respiratory function?
- Atelectasis - Pneumonia - Pulmonary edema
30
At what level of spinal cord injury will the patient experience cardiovascular manifestations?
T6 and above
31
SCI GI system manifestations?
- Hypomotility creates risk - Gastric distension - Paralytic ileus - Stress ulcers - Neurogenic bowel - loss of neurologic control over the bowel
32
`What is Poikilothermism
Lack of SNS communicatin with hypothalmus causing the body to lose the ability to autoregulate temp
33
SCI Interprofessional Care: Drug Therapy?
- LMW heparin (Enoxoparin/Lovenox) - IV fluids - Vasopressors - Atropine
34
What is given to prevent DVT formation in a patient with an SCI?
Enoxoparin/Lovenox
35
When is atropine given to a patient with an SCI?
HR < 40
36
When is methylprednisolone given to a patient with an SCI?
only for non-penetrating wounds at risk of edema, need to asses for hypoglycemia
37
Criteria for early surgery | in a patient with an SCI?
- Evidence of cord compression - Progressive neurologic deficit - Compound fracture or bony fragments - Penetrating wounds
38
Diet for a patient with an SCI?
high protein/calorie
39
Antispasmotic medications for a patient with an SCI?
- Baclofen (lioresal) - Dantrolene (dantrium) - Tizanidine (Zanaflex)
40
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.
41
What is the most common cause of autonomic dysreflexia?
distended bladder or constipation
42
Autonomic Dysreflexia Manifestations above the lesion?
- Profuse sweating - Headache - low BP, vasodilation - Flushing of skin - Nasal stuffiness - Blurred vision
43
Autonomic Dysreflexia Manifestations below the lesion?
piloerection
44
Nursing interventions for Autonomic Dysreflexia?
- Elevate head of bed at 45° or sit patient upright - Assess stimulus and treat - Immediate catheterization (bladder) - Notify physician
45
Neurogenic Bladder dysfunction types?
UMN lesion - Reflexic: no inhibition | LMN leasion - Areflexic: paralysis of all motor functions
46
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)
47
Medications to tx Neurogenic Bladder?
- Anti-cholinergics - Alpha-adrenergic blockers - Anti-spasmodics
48
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

6200 Adult /Older Adult II (17 decks)

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