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Med Surg 2 > Spinal Cord & Peripheral Nerve Problems > Flashcards

Spinal Cord & Peripheral Nerve Problems Flashcards

1
Q

Mechanism of injury

A

Flexion injury: most common
-hit steering wheel

Hyperextension:
Hit chin

Compression:
Fall, diving

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2
Q

Primary vs secondary injury

A

Primary: initial injury
-Cord compression
-Cord ischemia
-Penetrating trauma

Secondary injury: happens after injury
-edema and ischemia

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3
Q

Patho

A

Injury= edema, ischemia, vasoconstriction

Limited space, edema

Increases ischemia

Extent of injury usually after 72 hours

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4
Q

Patho
RBC and plts

A

Release:
-norepi
-serotonin
-dopamine

Lead to:
Vasoconstriction

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5
Q

Patho
Breakdown of RBCs

A

Increased free radical formation
Then
Tissue hypoxia

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6
Q

Patho
Neutrophils

A

Vasospasm/edema
Then
Decreased spinal cord blood

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7
Q

Complete vs incomplete

A

Complete:
Total loss of sensory and motor below injury

Incomplete:
Mixed loss of voluntary motor and sensory, some intact

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8
Q

Injury
C4
C6

A

C4:
Tetraplegia
Results in complete paralysis below the neck

C6:
Partial paralysis of hands and arms
And lower body

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9
Q

Injury
T6
L1

A

T6:
Paraplegia
Paralysis below the chest

L1:
Paraplegia
Paralysis below the waist

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10
Q

Complication
Spinal shock

A

Immediate response to injury
Usually c-spine injury

Complete loss of reflex activity below injury
Flaccid paralysis
Loss of sensation
No thermoregulation

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11
Q

Complication
Neurogenic shock

A

Usually c-spine injury

-Loss of vasomotor tone
-Decreased SNS leads to vasodilation (cant compensate w/ -tachycardia, only shock that does this)
-HOTN
-Brady cardiac
(Support BP/HR)

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12
Q

Diagnostic test

A

CT: gold standard (locate injury)

MRI

Xray: harder to see amount of damage

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13
Q

Emergency management
Prehospital

A

A,B,C,D
Patent airway
O2 sat >90%
SBP >90: may need IV fluids, vasoactive meds
IV 2 large bore IV or IO

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14
Q

Emergency management
Acute care

Conyinue what
D
Stabilize spine how

A

Continue prehospital support ABC

D=disability, assess neuro
-motor assessment
-sensation
-rectal tone

Stabilize spine:
-logroll
-c-collar

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15
Q

Stabilization

A

Traction
Pin care
If traction becomes displaced: Notify Provider

Decompression sx
Spinal fusion: pos op may need to wear brace/c-collar

Stable injury: no sx needed but may need Halo or Brace

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16
Q

Management
Respiratory
C1-3
C4
C5
Interventions

A

C1-3: apnea, inability to cough (req vent)

C4: poor cough, diaphragmatic breathing, hypoventilation (check CO2)

C5: decreased resp reserve

Interventions:
Chest PT
Suction
O2

*C5 keep the diaphragm alive

17
Q

Management
Cardiac

A

Early problems: shock
-HOTN: vasoactive meds & IVF(1st then meds)
-bradycardia: meds/pacemaker

orthostatic HOTN (d/t decreased SNS)
S/s: lightheaded, dizzy, dec LOC
Tx: abdominal binder, compression stocking (help venous return)
Meds: fludrocortison (inflammation)
DVT prevention

18
Q

Management
GI

A

Nutrition: high calorie, protein, fluids and fiber
Constipation risk (fiber)
Neurogenic bowel (cant go)

Bowel training daily at regular time:
-stool softener, laxatives, digital stimulation
-30-60min after meal
-up in chair if possible

19
Q

Management
GU

A

Neurogenic bladder
No sensation of bladder fullness

Tx:
Self cath 4-6 times/day
Teach aseptic technique
Teach s/s of UTI

20
Q

Autonomic hyperreflexia or dysreflexia
What is it
Where injured
What happens below injury
S/s

A

It is: the Return of reflexes after shock
Injury above T6
Bowel/bladder distension, pain

Vasoconstriction below injury:
>20 risk in BP but can go to 300

S/s
HA, flushing, diaphoresis, bradycardia, nasal stuffiness, seizures

21
Q

Autonomic hyperreflexia or dysreflexia tx

A

Pt education when to call for assistace

-Meds to lower BP
-Elevate HOB 45 degrees
-Loosen clothing
-Bladder scan then straight cath
-Digital rectal stimulation

After it subsides: monitor for 3-4 hours
Always check BP when pt with tetraplegia reports HA

22
Q

Autonomic hyperreflexia or dysreflexia management
Temp
Skin
Stress ulcers

A

Temp:
Decreased ability to sweat or shiver
No excessive covers
Careful heat loss during bath

Skin: same as always

Stress ulcrs: PPI H2

23
Q

Autonomic hyperreflexia or dysreflexia management
Pain:
Nocireceptive pain
Neuropathic pain
Reflexes return

A

Nociceptive pain:
Dull, tender, cramping
Thorax, abdominal, pelvis
Assess bowel and bladder

Neruopathic pain:
Tingling, burning shooting, electric pain
Tx: Gabapentin (neurontin)

Reflexes return:
Penile erection
Spasms
Tx: Baclofen

24
Q

Autonomic hyperreflexia or dysreflexia management
Male sexuality
Female

A

Male:
Reflex erections: uncontrolled, cant maintain
ED meds: penile pump external or implanted prosthesis
Fertility but sperm quality is low

Female:
Remains fertile
Cant feel uterine contractions (scary for pregnancy)

25
Q

Bells palsy
What is it
What nerve is effected
Long it last

A

Acute peripheral facial paresis

Inflammation facial nerve CN VII

Weeks to months

Unknown cause

26
Q

Bells palsy CM

A

Unilateral facial weakness
Numbness: face, tongue, and ear
Tinnitus
HA
Hearing deficit

Decreased muscle tone:
-face droop, flattened nasal labial fold, unable to smile/frown, difficulty chewing

Inability to close eye: risk for corneal abrasions

27
Q

Bells palsy
Diagnostic test
Tx

A

R/o stroke: H&P, CT

Tx:
Moist heat, gentle massage
Corticosteroids: done before paralysis
Antivirals: for infection
Chew on unaffected side
Articifial tears, tap eyes shut at night

28
Q

Guillain-Barre syndrome
Kind of issue
Damage to what
Often preceeded by what
Patho

A

Autoimmune
Damages peripheral nervous system (polyneuropathy)

Often preceded by GI or URI, vacinnation or sx, and Zika virus

Pathogens: damage to myelin, edema and inflam. of nerves

29
Q

Guillain-barre syndrome
Diagnostic test

A

H&P
EMG: measure muscle weakness from polyneuropathy
Nerve conduction studies: slow

30
Q

Guillain-barre syndrome CM
Begins with
Maximum deficit when
What is involved and some s/s of it
Risk for what

A

Begins w/: weakness/abnormal sensation in arms & legs
It declines distal to proximal
Return function proximal to distal

Maximum deficit by 2-4 weeks

Sympathetic and parasynmpathetic NS involved=
Orthostatic HOTN, cardiac dysrhythmias, bowel & bladder dysfunction

Risk for respiratory muscle paralysis

31
Q

Guillian-barre syndrome management

A

Hospitalized to monitor
Mechanical ventilation possible
Slowed bowels: paralytic illeus

IV ig immunoglobulin therapy (helps w/ antibodies)
Plasmapheresis(exchanging plasma) helps with/ antibodies

Recovery is slow

Med Surg 2 (5 decks)

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