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NS 406 Exam 1!! > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

Spinal Shock

A

Decreased reflexes

Loss of sensation and thermoregulation

flaccid paralysis below injury

Days to weeks

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2
Q

Neurogenic shock

A

Characterized by:

  • hypotension
  • bradycardia

Loss of Sympathetic Nervous System innervation

  • Mega peripheral vasodilation
  • Venous pooling
  • LOWER cardiac output

Assoc. with T6 or higher injury

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3
Q

Flexion Spinal injury

A

ex. Car accident,
Bent over. upper vertebrae slide forward while lower stay still, ruptures the back of spine

Compressing spinal cord because it is no longer flush

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4
Q

Hyperextension spinal injury

A

Opposite of flexion spinal injury- bend backwards, ruptures front

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5
Q

compression fracture spinal injury

A

Compression crushes vertebrae and forces bony fragments into the spinal canal

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6
Q

Flexion rotation spinal injury

A

Spine twisted, ligaments that hold it in place are ruptured and the cord is compressed.

TWISTY

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7
Q

What spinal injury locations are most common?

A

Cervical and lumbar are the most common due to being popular twisting sites

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8
Q

What location of spinal injury causes tetraplegia (quadraplegia)?

A

Cervical section of spinal cord!

The lower the level, the more function is retained in the arms

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9
Q

What spinal damage sites result in paraplegia?

A

Thoracic, Lumbar, or Sacral

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10
Q

What are the degrees of spinal injury

A

Complete:
-Total loss of sensory and motor function below injury level

Incomplete/partial:

  • Mixed loss of voluntary motor and sensation
  • Some tracts still intact

Degree of sensory and motor loss depends on level of injury

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11
Q

incomplete SCI Central Cord Syndrome

A

Damage to central spinal cord

Cervical most common

Especially old people

Results in Motor weakness and sensory loss
Lower extremities not usually affected

Dysesthetic (abnormal sensation) burning in upper extremities

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12
Q

Cauda Equina Syndrome

A

Results from damage to cauda equine (Lumbar and sacral nerve roots)

Asymmetrical distal weakness
Asymmetrical severe pain
Flaccid paralysis of lower extremities

Complete loss of sensation between legs and over butt, back of legs

Flaccid bladder and bowel

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13
Q

Manifestations of C4 injury (around jaw level)

A

Tetraplegia, complete paralysis below neck

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14
Q

Manifestations of C6 injury (around where trap meets neck)

A

Partial paralysis of hands, arms, and lower body

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15
Q

Manifestations of T6 injury (kind of at mid shoulder blade level)

A

Paraplegia, paralysis below chest

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16
Q

Manifestations of L1 injury (around belly button)

A

Paraplegia, paralysis below waist

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17
Q

ASIA impairment scale

A

A: Complete, no sensory or motor function between s4 and s5

B: Sensory incomplete- Only sensory (not motor) preserved below neurologic level and includes S4 and 5

C: Motor Incomplete- Motor function at most caudal segments (voluntary anal contraction)

D: Motor incomplete- Everything involved with C, but with at least 1/2+ of muscle functions below the level of injury having a muscle grade 3+

E: Normal

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18
Q

Respiratory system manifestations of SCI

A

Closely r/t level of injury

If above C4- total loss of respiratory function

Below C4: Diaphragmatic breathing leads to respiratory insufficiency

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19
Q

Phrenic nerve relation to SCI

A

Allows for diaphragmatic breathing if below C4

Edema and hemorrhage can further affect phrenic functioning–> respiratory dysfunction

20
Q

Affects of SCI above T6

A

Leads to nervous system dysfunction, neurogenic shock

  • Bradycardia
  • Peripheral vasodilation
  • Hypotension

Dilated veins can cause hypovolemia and reduce cardiac output

21
Q

What SCI location results in Bradycardia, peripheral vasodilation, and hypotension?

A

Above T6!

22
Q

Neurogenic bladder

A

Bladder dysfunction r/t abnormal innervation

Can be
Flacid
Spastic
Dyssynergic (lack coordination between detrusor contraction w/ urethral relaxation)

Can manifest as ugency, frequency, incontinence, inability to void, !!!high bladder pressures resulting urine backing up into kidneys

23
Q

Acute urinary manifestations (SCI)

A

CAN’T PISS OH NO
Urinary retention

Atonic bladder, overdistended and fails to emtpy
-Need indwelling catheter

24
Q

Postacute phase urinary manifestations (SCI)

A

Bladder can become hyperirritable
Loss of bladder inhibition from brain

Reflex emptying—>ALWAYS PISSIN AYEE

25
Q

SCI effects on GI

A

Decreased motor activity–>distention

Paralytic ileus–> need NG tube
Delayed gastric emptying
Excess HCL—> Ulcers

Might not be able to relay pain or sensation r/t intraabdominal bleeding–> look for lab values and BP

26
Q

SCI effects on Integumentary

A

Skin breakdown

Poikilothermism (Body becoming equal to room temp due to SNS temp sensations being interrupted)

Can’t shiver or sweat below level of injury

More common with high cervical injury

27
Q

Metabolic Needs SCI

A

NG suctioning can cause metabolic alkalosis (monitor Na/K)

Increased nutritional needs to prevent breakdown and catabolism

28
Q

Preferred method of diagnostic to dx injury (SCI)

A

CT scan is preferred
When CT not available Cervical x rays

MRI used for soft tissue injury

Cervical injuries +AMS might need CT angiogram to see vertebral artery damage

29
Q

When is spinal immobilization not recommended?

A

With penetrating trauma–> higher mortality rates`

30
Q

Emergency considerations of SCI

A

IMMOBILIZE SPINE
-Neck brace/collar w/ supportive blocks on backboard

KEEP SBP over 90!!! SHOCK
SaO2 over 90%

31
Q

Nonoperative stabilization of SCI

A

Decompression via traction or realignment–> prevents secondary edema

Early realignment by closed reduction via craniocervical traction is effective

32
Q

Surgery for SCI

A

within 24h assoc. w/ improved outcome

Fusion (attaching metal pieces to spine to keep aligned) when two or more vertebrae injured.

33
Q

SCI drug therapy

A

Lovenox to prevent VTE (don’t use if bleeding, low kidney function or recent surgery)

Vasopressors (Neo-Synephrine, Levophed) maintain MAP over 85-90mmHg

Anticholinergic (atropine) if bradycardia symptomatic

Be aware of altered drug metabolism–> higher chance for interaction

34
Q

SCI C1–3 respiratory

A

Apnea

Can’t cough

35
Q

SCI C5-T6 respiratory

A

Decreased respiratory reserved

36
Q

SCI neurologic effects below C8 (complete)

A

Pos. babinski after spinal shock resolution

Hyperactive DTR

37
Q

Halo Ring SCI considerations

A

Can be attached to vest after pt begins to mobilize again

Watch for infection around halo ring insertion sites (cleanse w/ half strength peroxide and NS bid, antibiotic ointment)

DON’T USE IF LIGAMENT INSTABILITY— need surgery

38
Q

Respiratory dysfunction extra points SCI (arterial blood oxygen’/CO2 concentrations, counting)

A

If they can’t count to 10 NEED IMMEDIATE ATTENTION

PaO2 over 60mmHg and PaCO2 under 45mmHg are acceptable ranges if uncomplicated tetraplegia

Assisted cough: place hands just below xiphoid process and exert pressure timed with pt cough.

39
Q

Combating SCI r/t constipation

A

Daily rectal stimulant- enema or suppository

Inc. fiber

Good fluid intake

Activity when possible

Valsalva maneuver if under T12

Gastrocolic reflex 30mins-1hr helps poop

40
Q

Meds to treat neuropathic pain in SCI

A

Neurontin or Lyrica

41
Q

How often to reposition patient SCI

A

every 2 hours in bed

Every 15-20 mins in chair

42
Q

Autonomic dysreflexia aka hyperreflexia (SCI)

A

Huge cardiovascular reaction uncompensated

  • Reflex arteriolar vasoconstriction—>BP inc.
  • Parasympathetic cant vasodilate due to injury
  • Heart senses HTN and slows HR–> bradycardia
  • T6 or higher
Can lead to status epilepticus, stroke, MI,death
Manifestations: 
HTN (SBP up to 300!)
Bradycardia (30-40bpm)
Diaphoresis above injury
Throbbing headache
Piloerections (hairs standing up, goosebumps)
Blurerd spots in visual field
Congestion
Anxiety
Nausea
43
Q

Most common precipitating cause of Autonomic Dysreflexia (SCI)

A

Distended bladder or rectum

44
Q

Autonomic dysreflexia nursing interventions (SCI)

A 
Elevate head
Notify HC provider
Immediate catheterization
Remove stool impaction if there
Remove constrictive clothing
Monitor BP frequently
45
Q

Drugs for Neurogenic bladder (SCI)

A

Anticholinergic drugs: Ditropan, Detrol
Alpha adrenergic blockers: Hytrin, Cardura
Antispasmodic drugs: Lioresal

NS 406 Exam 1!! (9 decks)

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