Spinal Cord Injury New Flashcards by Elizabeth Gausin

Spinal cord injury

Result of trauma
Degenerative loss of motor , sensory and autonomic function

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Apoptosis

Programmed cell death
Lesion in spinal cord and similar cells began to die in a programmed aesthetic

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Spinal shock

Not a true shock
Loss of deep tendon and sphincter reflexes ..loss of sensation .. flaccid paralysis below the lesions

Only temporary ..last days2weeks

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Neurogenic shock

Pipe problem ( vessels)
Vessels vasodilate and increase HR , decrease BP .. blood rushes to peripheral and does not go to the heart to be oxygenated so blood is not going to the brain

Pt present as warm and dry not blue or pale or pink..

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Intervention for neurogenic shock

Give 500 ml-1L of fluid to see if it work ..if not D/C
Treat with a vasopresser

Give ted hose, compression hose, sequential compression , belly binder - according to physician orders.

NOT a true shock

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How long does it take to diagnosis a spinal cord injury?

One year

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How do you know if spinal shock resolved ?

Return of movement or motor skills

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How to avoid Hyperextension injury in the hospital

Important to teach pt to use the call light so they dont hurt themselves even more

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Compression fracture

Falling on feet
Or directly on head which causes spine to compress

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Common cause of flexion rotation injury

Car accident spinning

Look for fractured calcaneus .. tells us large possibility that we have spinal column injury

Forced one way but twisted another

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How is SCI classified by?

Mechanism of injury
Level of injury
Degree of injury

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Level of injury consist of

Skeletal level and neurologic level

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Skeletal level

Bones and ligaments

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Neurologic level

Lowest segment of spinal cord with normal sensory and motor function on both sides of body

if all i can do is nod head .. pretty bad

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If cervical cord is involved (c4 injuries)

Can cause tetraplegia ( all 4 limbs)

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Para plegia

Two limbs (c6)

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Degree of injury

Complete cord involvement
Incomplete (partial ) cord involvement)

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Cervical and lumbar

Most common places to be injured

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Complete cord involvement

Internal decapitation , gun shot wound, stab wound, penetrating injury to the cord

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Incomplete partial cord involvement

Mixture of anything

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Incomplete syndrome

Central cord
Brown séquard

Central cord

Occurs most commonly in cervical cord region
Motor weakness and sensory loss is present
But loss in the arms is greater than loss in the legs

Be watchful with these pt .. dont have enough to bare their own weight

Does not last forever

Brown séquard

Damage to half of spinal cord

Loss of motor function, position , vibration sense,
On same side of injury

On opposite side loss of pain and temp sensation below level of lesion

Results from penetrating injury to spinal cord

Proprioception

Not being able to tell the position of your limb
What is being experiences of brown séquard

Sequelae

Secondary things that happen to spinal cord injury Such as pneumonia , bed sores ,

higher the injury

The more serious the sequelae

What is a big thing we worry about with spinal cord injuries and their respiratory system

Atelectosis ( collapsed aveoli) - PREVENTION Use IS with Fio2 , TCDB , consistently turning pt to suction or get pt to cough it up or (forcibly have them cough)

Injury at c1-3

Apnea, inability to cough Big injury and may not be able to breath on own May have to be intubated right away .. Get the box for meds, tube , scope, wire and tape

Injury at c4 level

Poor cough, diaphragmatic breathing , hypoventilation SOOOO lay them flat on back , put hands under diaphragm (Heinrich maneuver) tell them to cough and push on diaphragm… also know as assisted coughing… teach family this!!!

Injury at c5-t6

Decrease respiratory reserve c6-t8 lose intercostal muscles Have pt and family involved in care

SPI is a million dollar injury in the first

7 days

In regards to the cardiovascular perspective ..Above level t6 can cause

Brady cardia <60 bpm Give vasopressor or atropine Plan for a pacemaker at some point Avoid increase in vagal stimulation

Examples of increase in vagal stimulation

Rest in between turning and suctioning

Urinary retention

Most common in SPI

Why should we wait to insert a permanent catheter for SCI

Bladder reflex may come back so we want to wait If we put a permanent when they dont need one and it can increase risk for infection ..

What becomes available for urinary retention for SCI

Intermittent catheterization program And another thing we look at is do they need a suprapubic catheter.. much cleaner

What can we do for SCI and bowel issues

Start a bowel program so we can tell when they need to go Taking stool softener or laxative

As bowel reflexes return what is important that we teach on

Bowel program

Poikilothermism

Spinal cord pt takes on the ambient room tempature .. antipyretics do not help So at risk for for hypothermia or heat exhaustion We are the keeper of tempature

As far as thermoregulation SPI pt have decrease

Ability to seat and ability to shiver

Why do we stabilize SCI through traction ro realignment?

Eliminate damaging motion at injury site Intended to prevent secondary damage

Bone graft is going to come off of where?

Illiac crest

If cord is compressed they decompress it .. why do they do the anterior first

If we turn them over on belly we run the risk of a code if something happens to them

Kinetic roto- rest bed

Moves from flat to 90 degrees to help move secretion Good thing

Nursing intervention for autonomic dysreflexia

High fowlers Assess the cause Call physician Immediate catheterization Teach s/s and causes to fam and pt

What is autonomic dysreflexia caused by

Sustained at t6 or below Restrictive clothing Full bladder Pressure areas Fecal impaction

S/s of autonomic dysreflexia

Increase BP ( severe and rapid) Flush faced Headache Distended neck veins Decrease hr Increase sweating Vasodialation above

Below level of injury autonomic dysreflexia s/s

Vasoconstriction below level of injury Pale Cool No Sweating

Age groups from SCI

Young men and elderly

What is a problem with SCI and when we intubate them

They may never get exubated

SCI at risk for

Ulcers, atelectasis and pneumonia