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Sophomore 2 Test 3 > Spinal Cord Injury, Brain Tumors, and Abscesses > Flashcards

Spinal Cord Injury, Brain Tumors, and Abscesses Flashcards

1
Q

Risks for Spinal Cord Injury

A
  1. African Americans
  2. Male
  3. Ages 16 - 30
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2
Q

Causes of Spinal Cord Injuries

A
  1. MVAs
  2. Violence
  3. Falls
  4. Sports Injuries
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3
Q

How are spinal cord injuries categorized?

A

May be referred to by type and cause as complete or incomplete or by level of injury

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4
Q

What physically is happening to the spinal cord to result in injury?

A
  1. Concussion
  2. Contusion
  3. Laceration
  4. Compression
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5
Q

Primary Spinal Cord Inury

A

The result of the initial trauma

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6
Q

Secondary Spinal Cord Injury

A
  • Is usually the result of ischemia, hypoxia, and hemorrhage which destroys the nerve tissues
  • Are thought to be reversible/preventable during the first 4 to 6 hours after injury
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7
Q

Cord Contusion

A

Bruising of the neural tissue causing swelling and temporary loss of function

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8
Q

Spinal Cord Injury: Hemorrhage

A

Bleeding into the neural tissues of the spinal cord

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9
Q

Spinal Cord Injury: Laceration

A

Tearing of the neural tissues of the spinal cord

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10
Q

Spinal Cord Injury: Transection

A

Severing of the spinal cord, causing permanent loss of function

 - Complete: all tracts in the spinal cord completely disrupted
 - Incomplete: some tracts in the spinal cord remain intact
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11
Q

Cervical Cord Injury

A
  1. C2-C3 usually fatal
  2. C4 and above: paralysis of diaphragm and intercostal muscles
  3. C4 and below: quadriplegia, weakened respiratory muscles, paralysis of bowel and bladder
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12
Q

Thoracic Level Injury

A
  1. Trunk, bowel, bladder, and lower extremities muscle function may be lost depending on the level of injury
  2. Client will have use of arm, neck, and thoracic muscles
  3. Paraplegia (legs and trunk)
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13
Q

Lumbar or Sacral Level Injury

A
  1. Paraplegia (paralysis of the lower extremities)

2. S2-S4 is the center for micturation

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14
Q

Skull Tongs (Crutchfield)

A
  • Inserted in the outer aspect of skull and traction applied

- Weights attached to tongs and client’s weight acts as a counter-traction

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15
Q

Nursing Care of Skull Tongs

A
  1. Ensure weights hang freely and ropes remain in pulleys
  2. Don’t remove weights
  3. Assess insertion site for infection
  4. Pin site care
  5. Turn q2h or as ordered
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16
Q

Halo Traction

A
  • Head piece with 4 pins (2 anterior and 2 posterior)
  • Inserted in client’s skull, once fracture is stable then halo jacket or cast applied to allow stabilization and client can sit up
  • Never move for turn client by holding or pulling the halo device
  • Assess for tightness of jacket by ensuring that one finger can be placed under jacket
  • Assess skin integrity: use fleece or foam inserts to relieve pressure points
  • Provide sterile pin site care
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17
Q

Immediate Management of SCI

A
  • Client should not be moved until type of injury is known
  • Treat all trauma clients as if they have an unstable SCI until a diagnosis is made
  • Any flexion or extension can result in contusion or transection of the cord
  • Transfer client on a firm, flat board with careful padding to stabilize and maintain proper alignment
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18
Q

SCI: Spinal X-ray and CT Scan

A

Can show a change in vertebral positioning and cord impingement

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19
Q

SCI: MRI

A

Can show cord edema, necrosis, and impaired blood flow in spinal cord

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20
Q

SCI: Myelograpy

A

Can show herniated intervertebral disks or blocked CSF flow

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21
Q

SCI: Evoked potential studies (EPS) and Electromyography

A

Can show the area of spinal cord lesion

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22
Q

Cervical Injury Medical Management

A
  1. Stabilization of cervical vertebrae is accomplished by skeletal traction with Crutchfield tongs or Gardner-Wells tongs or Halo vest traction
  2. Later, surgical decompression may be necessary
  3. Intubation and respiratory management may be necessary
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23
Q

Thoracic Injury Medical Management

A
  1. Bedrest, hyperextension and bracing
  2. In instantaneous paraplegia has occurred, spinal cord decompression is necessary
    * * Medication: steroids are given to decrease edema
24
Q

Nursing Management of Cervical/Thoracic Injuries

A
  1. Monitor respiratory status
  2. Turn Q2h in bed or use Circo-electric or Stryker frame
  3. Observe muscle strength and sensation in extremities, report any changes promptly
  4. Perform meticulous skin care
  5. Perform ROM
  6. Monitor elimination patterns
  7. Administer ASA or non-narcotic agents for pain
25
Q

Potential Complications of SCI

A
  1. DVT
  2. Orthostatic hypotension
  3. Spinal shock
  4. Autonomic dysreflexia
26
Q

What is spinal shock?

A

Complete loss of impulses below the level of the injury causing flaccid paralysis and complete loss of sensation and suppression of all visceral and somatic reflexes below the level of the injury

27
Q

How long can spinal shock last?

A

Lasts from 72 hours to 3 months with an average time of 4 weeks (patient will still have swelling at this time)

28
Q

How do you know when spinal shock is resolving?

A

The appearance of involuntary spastic movement

29
Q

Functions that are temporarily (and sometime permanently) lost during spinal shock

A
  1. Bowel
  2. Bladder
  3. Sexual function
30
Q

Neurogenic Shock

A
  • Due to the loss of function of the autonomic nervous system
  • Blood pressure, HR, and cardiac output decrease
  • Venous pooling occurs due to peripheral vasodilation
  • Paralyzed portions of he body do not perspire
31
Q

Autonomic Dysreflexia occurs in what kind of patients?

A
  • Occurs in patients with SCI at T6 or higher

- Occurs after spinal shock has resolved

32
Q

What is autonomic dysreflexia?

A

Severance of cord causes an exaggerated response to such stimuli as a distended bladder, fecal impaction, infection, decubiti, surgical manipulation, ejaculation in the male or strong uterine contraction in the pregnant female

33
Q

Symptoms of Autonomic Dysreflexia

A
  1. Vasodilation above the level of injury
    - Increased BP
    - Flushed face
    - HA
    - Distended neck veins
    - Decreased HR
    - Increased sweating
  2. Vasoconstriction below the level of injury
    - Pale
    - Cool
    - No sweating
34
Q

Potential Complication of Autonomic Dysreflexia

A
  1. Cerebral hemorrhage
  2. Paroxysmal hypertension
  3. Seizures
  4. Retinal hemorrhages
  5. Fatal stroke
  6. Increased ICP
35
Q

Symptoms of Brain Tumors are dependent on what?

A

Dependent upon the location and size of the lesion and the compression of associated structures
** Although other tumors may metastasize to the brain, brain tumors don’t generally metastasize

36
Q

Manifestations of Brain Tumors

A
  1. Localized or generalized neurologic symptoms
  2. Symptoms of increased ICP
  3. HA
  4. Vomiting
  5. Visual disturbances
37
Q

Manifestations of Acoustic Neuroma

A
  1. Loss of hearing
  2. Tinnitus
  3. Vertigo
38
Q

Manifestations of pituitary adenoma

A

Hormonal effects

39
Q

Glioma

A

Can arise in any part of brain connective tissue

- Astrocytoma
- Glioblastoma multiforme
40
Q

Meningioma

A
  • Arise from meningeal covering of the brain
  • Benign
  • Compress rather than invade the brain
41
Q

Acoustic Neuroma

A
  • Affects the acoustic nerve (8th cranial nerve)

- Can result in hearing and balance problem

42
Q

Neoplasms of the CNS: Assessment Findings

A
  1. Depend on tumor location and rate of growth
  2. Increased ICP (HA, vomiting)
  3. Papilledema (choked disc)
  4. Mental clouding, lethargy, change in personality
  5. Localized neurologic impairment
  6. Motor and sensory abnormalities
43
Q

Neoplasms of the CNS: Diagnostic Tests

A
  1. CT/MRI
  2. EEG
  3. PET
  4. Analysis of CSF
  5. Biopsy
44
Q

Neoplasms of the CNS: Medical Management

A
  1. Surgical excision with laser
  2. Gamma knife radiosurgery
  3. Radiation/Chemotherapy
    * * Meningiomas are surgically removed. Acoustic tumors are surgically removed with an effort to preserve facial nerves and function
45
Q

Neoplasms of the CNS: Post-Op

A
  1. Client may have physical/mental limitations: hemiplegia, aphasia, personality changes
  2. Corticosteroids may be helpful in relieving HA and alterations in LOC
  3. Osmotic Agents (Mannitol) to decrease the fluid content of the brain, which leads to a decrease in ICP
46
Q

Infectious Neurologic Disorders

A
  1. Meningitis
  2. Brain Abscesses
  3. Encephalitis
  4. Creutzfeldt-Jakob Disease and Variant Creutzfeldt-Jakob Disease
47
Q

Brain Abscesses: How do they happen?

A
  • May occur by direct invasion of the brain trauma or surgery
  • Secondary to an infection somewhere else in the body (e.g. mastoid, lung, heart, teeth, skin)
  • Organisms most often involved are streptococci, staphylococci, and pneumococci
48
Q

Brain Abscess Assessment Findings

A
  1. S/Sx similar to brain tumor
  2. HA, nausea, vomiting, papilledema, hemiparesis, ataxia, convulsions
  3. Evidence of systemic infection (fever, increased WBC, increased SED rate, tachycardia)
  4. May be signs of increased ICP
49
Q

Brain Abscess: Diagnostic Tests

A
  1. Lumbar puncture (CSF shows increased pressure, increased protein, and bacteria)
  2. CT scan
50
Q

Brain Abscess: Medical Management

A
  1. Antimicrobial treatment for 4-8 weeks
  2. Surgical excision or aspiration of abscess (thrombosis)
  3. Corticosteroids
  4. Anticonvulsants
51
Q

Brain Abscess: Nursing Management

A
  1. Thorough neurological assessment
  2. Administer antibiotics
  3. Provide measures to combat problems associated with prolonged bedrest (pressure ulcers, etc.)
  4. Provide emotional support to client/family
52
Q

Extramedullary Tumors

A
  • Outside the spinal cord
  • Tumors cause nerve root pain
  • With the growth of the tumor, motor and sensory deficits seen
  • As the tumor enlarges, it compresses the cord
53
Q

Intramedullary Tumors

A
  • Inside the spinal cord

- Tumors begin within the spinal cord

54
Q

Intravertebral or Intraspinal Tumors: Diagnostic Test

A
  1. CT scan
  2. MRI
  3. Biopsy
  4. Radionuclide bone scans
  5. Lumbar puncture (CSF shows increase in proteins)
55
Q

Intravertebral or Intraspinal Tumors: Medical Mangement of Extramedullary Tumor

A

Surgically Removed or decompressed through laminectomy

56
Q

Intravertebral or Intraspinal Tumors: Medical Mangement of Intramedullary Tumor

A

Partial removal of tumor, decompression of the spinal cord, chemotherapy, and/or radiation therapy

57
Q

Care after Laminectomy

A
  1. Position patient flat, on side
  2. Monitor VS
  3. Assess skin
  4. Turn Q2h (log roll)
  5. Assess and medication for pain
  6. Assess incision site
  7. Monitor I/O

Sophomore 2 Test 3 (4 decks)

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