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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
Q

Where is the damage in Cauda Equina Syndrome?

A

cauda equina or lumbar and sacral nerve roots

26
Q

Signs of Cauda Equina Syndrome?

A
  • asymmetric lower extremity weakness
  • patchy sensation lower extremities
  • saddle anesthesia
  • bladder and bowel dysfunction
  • pain-severe, radicular, asymmetric
27
Q

What does the ASIA Impairment Scale asses?

A

In SCI:

  • Motor and sensory funtion
  • neurologic level
  • completeness of injury
28
Q

At what level of spinal cord injury will the patient lose complete resp function?

A

above C4 = ventilator

29
Q

SCI complications with lost respiratory function?

A
  • Atelectasis
  • Pneumonia
  • Pulmonary edema
30
Q

At what level of spinal cord injury will the patient experience cardiovascular manifestations?

A

T6 and above

31
Q

SCI GI system manifestations?

A
  • Hypomotility creates risk
    • Gastric distension
    • Paralytic ileus
  • Stress ulcers
  • Neurogenic bowel
    • loss of neurologic control over the bowel
32
Q

`What is Poikilothermism

A

Lack of SNS communicatin with hypothalmus causing the body to lose the ability to autoregulate temp

33
Q

SCI Interprofessional Care: Drug Therapy?

A
  • LMW heparin (Enoxoparin/Lovenox)
  • IV fluids
  • Vasopressors
  • Atropine
34
Q

What is given to prevent DVT formation in a patient with an SCI?

A

Enoxoparin/Lovenox

35
Q

When is atropine given to a patient with an SCI?

A

HR < 40

36
Q

When is methylprednisolone given to a patient with an SCI?

A

only for non-penetrating wounds at risk of edema, need to asses for hypoglycemia

37
Q

Criteria for early surgery

in a patient with an SCI?

A
  • Evidence of cord compression
  • Progressive neurologic deficit
  • Compound fracture or bony fragments
  • Penetrating wounds
38
Q

Diet for a patient with an SCI?

A

high protein/calorie

39
Q

Antispasmotic medications for a patient with an SCI?

A
  • Baclofen (lioresal)
  • Dantrolene (dantrium)
  • Tizanidine (Zanaflex)
40
Q

What is autonomic dysreflexia?

A

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
Q

What is the most common cause of autonomic dysreflexia?

A

distended bladder or constipation

42
Q

Autonomic Dysreflexia Manifestations above the lesion?

A
  • Profuse sweating
  • Headache
  • low BP, vasodilation
  • Flushing of skin
  • Nasal stuffiness
  • Blurred vision
43
Q

Autonomic Dysreflexia Manifestations below the lesion?

A

piloerection

44
Q

Nursing interventions for Autonomic Dysreflexia?

A
  • Elevate head of bed at 45° or sit patient upright
  • Assess stimulus and treat
  • Immediate catheterization (bladder)
  • Notify physician
45
Q

Neurogenic Bladder dysfunction types?

A

UMN lesion - Reflexic: no inhibition

LMN leasion - Areflexic: paralysis of all motor functions

46
Q

Neurogenic Bladder training?

A
  • 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
Q

Medications to tx Neurogenic Bladder?

A
  • Anti-cholinergics
  • Alpha-adrenergic blockers
  • Anti-spasmodics
48
Q

Nursing management for a patient with Neurogenic Bladder?

A
  • 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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