Spinal Injuries Flashcards

1
Q

Spinal cord

A
8 cervical nerves (C1-C8)
7 cervical vertebrae 
12 thoracic nerves (T1-T12)
5 Lumbar nerves (L1-L5)
5 Sacral nerves (S1-S5)
1 coccygeal pair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Function of the spinal cord

A
  1. conduction
  2. locomotion
  3. reflexes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the function of the cerebral column and spinal column?

A

Support/protect the spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are two reflexes controlled by the spinal cord?

A
  1. Micturition - external sphincter contracted to hold urine
  2. Digestion to defecation - gastrocolic and duodenocolic relflex –> peristalsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Spinal cord injury is

A

damage to the spinal cord caused by concussion, contusion, compression, laceration, transection, hemorrhage, damage to blood supply, damage to blood vessels in the cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SCI can be classified by

A
  1. Mechanism of injury
  2. Skeletal and neurological level of injury
  3. Degree of injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Examples of mechanism of injury are

A

Flexion
Hyperextension
Flexion-rotation
Extension-ratation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most unstable mechanism of injury?

A

Flexion-rotation recuasse ligaments are torn that stabilize the spine and it usually has the most severe neuro deficits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Skeletal and neurological level of injury

A

Skeletal - vertebrae and ligaments - level of damage to bones and ligaments
Neurological - lowest segment of spinal cord with sensory and motor function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Degree of injury

A

How much motor/sensory is lost
Complete = total sensory and motor loss
Incomplete = mix sensory and motor loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the American spinal injury association (ASIA)?

A

determines the level of impairment for a spinal cord injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Diagnosis of a spinal cord injury

A
  1. CT - gold standard for bone injury
  2. MRI - gold standard for degree of injury like soft tissue and neural changes
  3. ASIA - docs use this to determine specific level of injury by assessing sensory and motor level that are affected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Primary SCI

A

occurs at the time of the impact

Immediate stretch or laceration of spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Secondary SCI

A

Ongoing progressive damage that occurs minutes, hours, days after primary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What can secondary SCI cause?

A

tissue hypoxia and further damage to the spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cervical nerves function is

A

head, neck, breathing, upper arms, wrists, hands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Thoracic nerves function is

A

chest and abdominal muscles, internal organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Lumbar nerves function is

A

legs muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Sacral nerves function is

A

bathroom capabilities, ability to reproduce

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

C3, 4, 5

A

“keep a fella alive”

Breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

C1-4

A

ventilator and 24 hr/day care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

C4

A

requires mouth stick to use wheelchair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

C5

A

10hr/day care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

C6

A

might be able to use hand control on wheelchair

6hr/day care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

T6

A

non motorized wheelchair with full independence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

L1

A

can ambulate with long leg braces, control of leg and not at risk for AD, flaccid bowel and bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

L3-4

A

ambulate completely independently but can’t stand for long periods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

C8 and above are…

A

tetraplegic - can’t move legs or arms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

T1 is…

A

paraplegic - can’t move legs, breath on their own, move move upper back and arms, at risk for AD, spastic bowel and bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Phrenic nerve is responsible for

A

C3-C5

Breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Spinal shock

A

Temporary loss of reflexes and paralysis below level of injury and bowel and bladder dysfunction
Lasts days to weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Neurogenic shock

A

Loss of sympathetic NS tone for someone with a T6 injury or above.
Form of disruptive shock
Hypotension and bradycardia
Warm or cold, dry extremities, not able to auto regulate temp by sweating or shivering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Anterior cord syndorme

A

Not common
r/t flexion injury
Loss of motor, pain, and temperature below injury
Intact: position, vibration, and touch sense

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Central cord syndrome

A

More common cervical injury
Incomplete loss
Motor and sensory loss in upper and lower extemities
Upper are more weak than lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Brown-sequard syndrome

A

Usually from penetrating injuries - knives, GSW, disc rupture
Loss of pain and temp sensation on opposite side
Loss of voluntary motor control , vibration and positioning on same side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Conus medullaris injury

A

Lowest portion of spinal cord
Function in legs are preserved, weak or flaccid
Decrease in or loss of sensation in perianal area
Bladder and bowel issues
Impotence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Cauda Equine injury

A
Lumbar and sacral nerve roots 
Asymetrical distal weakness
Flaccid paralysis of lower extremities 
Complete loss of sensation in saddle area
Bladder and bowel issues 
Severe, radicular, asymmetric pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Stabilization of the spine immediately after surgery

A

rigid cervical collar and supportive backboard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How do you change positions of a patient with a SCI

A

logroll the patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

To stabilize the spine you can use..

A

Surgery or traction
Decompression laminectomy - remove part of bone to allow swelling
Fusion
Insertion of stabilizing rods, screws, and plates

41
Q

Downside to cervical traction

A

can still twist in bed

42
Q

Halo vest

A

More strict, nonsurgical procedure

Not good for ligament instability

43
Q

For both cervical traction and halo vest you should clean the pins by

A

hydrogen peroxide, alcohol, and water on a cotton pad and then apply antibiotic ointment

44
Q

Respiratory complications about C4

A

total loss of respiratory function

45
Q

Respiratory complications below C4

A

diaphragmatic breathing if phrenic nerve is functioning

46
Q

Respiratory complications cervical/thoracic

A

paralysis of abdominal muscles and intercostal muscles –> not being about to cough

47
Q

In the first 48 hours swelling occurs, why does that matter in relation to breathing?

A

it can increase the level of dysfunction and a C5 injury may look more like a C3 injury and require ventilation

48
Q

Respiratory complications r/t SCI

A
  1. hypoventilation
  2. Atelectasis
  3. Pneumonia
49
Q

Respiratory assessment with SCI

A

breath sounds, RR, airway, saturation, ABG, tidal volume, skin color, comments on breathing, color of sputum, use of accessory muscles, can they count to 10 in one breath

50
Q

Airway assessment with SCI

A

adequate oxygenation

51
Q

Chest physiotherapy SCI

A

positioning, mobilization, manual hyperinflation, percussion, chest vibrations, suction, cough, breathing exercises

52
Q

Cough and deep breathing SCI

A

incentive spirometer
assisted/quad coughing - for any patient having trouble coughing, patient takes a deep breath and provider pushes up forcefully as they cough. Should not be done if they just ate

53
Q

Suction SCI

A

tracheal or oral

54
Q

Position SCI

A

upright and possibly propped

55
Q

Pani management SCI

A

medications and massage

56
Q

Bradycardia due to neurogenic shock can lead to

A

Cardiac arrest when vagal is stimulated, while turning or suctioning

57
Q

Bradycardia intervention

A

Cardiac monitoring, atropine, pacemaker

58
Q

Hypotension intervention

A

Iv fluids, vasopressor like dopamine, NE

59
Q

Orthostatic hypotension intervention

A

abdominal binder, support stocking, gradual elevation of bed, tailback if event occurs

60
Q

DVT intervention

A

compression stockings, ROM, heparin or lovenox

61
Q

While using compression stocking when should they be removed?

A

every 8 hours for skin care

62
Q

Acute urinary issue with SCI

A

spinal bladder shock –> not able to eliminate –> distention –> needing catheter
Urinary can reflex to kidneys

63
Q

Chronic urinary issues with SCI

A

loss of control and reflex of bladder and sphincter
No sensation of fullness or distention
This can cause kidney failure as urine refluxes into kidneys, kidneys stones from bone breakdown, and UTI

64
Q

Inability to control urine intervention

A

intermitent cath, regualr bladder emptying 4-6 hours, indwelling Cath, mitrofanoff, ileostomy

65
Q

UTI interventions

A

fluid intake fo 2L/day and s/s of UTI

66
Q

Renal stone intervention

A

Watch calcium intake

67
Q

Inability to empty bladder interventions

A

ultrasound post void, should be less than 500 mL

68
Q

Bowel complications with SCI acute

A

decreased GI motility –> gastric distention
Excess Hal acid in stomach —> ulcer
Paralytic ileus

69
Q

Bowel complications with SCI chronic

A

dysphagia, neurogenic bowel, hemorrhoids, abdominal distention, constipation, incontinence, poor nutrition intake

70
Q

Mitrofanoff

A

part of appendix is removed to create a sphincter to straight cath
Must be at least 1 year out for SCI because complication rate are high especially for infection

71
Q

injury above T12 and bladder

A

can’t empty bladder on their own, intermittent catheterization

72
Q

Injury below T12 and bladder

A

decreased sensation of bladder fullness and overflow and incontinence is common
intermitent catheterization

73
Q

Reflex/ spastic bowel

A

above T12, anal sphincter remains closed

Keep stool soft

74
Q

Areflexic / flaccid bowel

A

Below T12, loss of anal sphincter tightness

Keep stool hard

75
Q

Bowel program

A

Patient knows what is best for them and what has worked in the best so don’t change what works.
Bowel program is to avoid constipation

76
Q

Intervention for gastric distention

A

NG tube with suction, NPO

77
Q

Ulcer intervention

A

H2 blocker or PPI (prazole)

78
Q

Intra-abdominal bleeding intervention

A

guaiac stool for heme positive and watch H/H, monitor abdominal girth

79
Q

Constipation interventions

A

bowel regimen, medications: reglan, cisapride, prucalopride, neostigmine, fampridine, external electrical stimulation

80
Q

Severe catabolism interventions

A

high protein, high calories, feeding tube or parenteral

81
Q

Dysphagia interventions

A

speech and swallow consult after bowel sounds or flatus is passed

82
Q

Poor PO intake interventions

A

assess for depression, make a contract, food they enjoy, how they like to be fed, rewards for eating, calorie count

83
Q

Complications with skin SCI

A

pressure ulcers –> infection –> sepsis –> death

84
Q

Interventions for pressure ulcers

A
  1. change positions every 2 hours
  2. check for any equipment like tubes under patient
  3. takes weight off of pressure points
  4. watch out for hot/cold packs
  5. Special cushions/pad - required for wheelchair bound
85
Q

Poikilothermism

A

adjustment of body temperature to room temperature

86
Q

T6 and above with temperature

A

interruption of SNS

Cant shiver or sweat to regulate temperature

87
Q

Reflexes after spinal shock

A

hyperactive or exaggerated
Spasms below level of lesion peak spacigity after 2 years
Spasms can cause contractors so may need to splint

88
Q

How to treat spasms

A

muscles relaxants such as baclofen, botulinum toxin injections of surgery like cordotomy which is cutting a nerve

89
Q

Autonomic dysreflexia

A

life threatening condition that can occur in patient with a SCI at T6 and above
Hyperteflexic due to noxious stimuli below level of injury

90
Q

When can autonomic dyreflexia occur?

A

after spinal shock because it is a reflex which only come back once spinal shock is gone

91
Q

Patho of autonomic dysreflexia

A
  1. Stimulation below injury
  2. SNS below injury –> vasoconstriction
  3. PNS cannot respond
  4. Baroreceptors in the heart respond to high BP by decrease the HR and dilating peripheral blood vessel above injury
  5. body is not communicating so above injury, vasodilation. Below injury, vasoconstriction
92
Q

S/S of autonomic dysreflexia

A

HTN (240-300), bradycardia, HA, blurred vision, flushing, diaphoresis and red above injury, cold pale skin below injury

93
Q

Autonomic dysreflexia leads to

A

status epilepticus
stroke
MI
death

94
Q

Common precipitating factor of autonomic dysreflexia are?

A
  1. Distended bladder or rectum (kinked foley, constipation, impaction)
  2. tight clothing
  3. wrinkle in bed sheet
  4. wounds
95
Q

Autonomic dysreflexia interventions

A

Elevated the HOB above 45 degree
Monitor BP every 3-5 minutes
Notify provider
Assess for cause: check bladder drainage, loosen tight clothes/shoes, check skin
Medication: nitroglycerin - drug of choice because short 1/2 life and need to find the cause to fix it, atropine, nifedipine
Teach patient

96
Q

Before giving nitroglycerin what should you do?

A

Check BP

Ask about medication like viagra or anything similar to it

97
Q

Patient with a SCI can have depression because..

A
  1. overwhelming sense of loss
  2. goal adjust instead of accept
  3. family may need counseling
  4. sympathy is not helpful
98
Q

Sexuality and SCI

A

yes can have sex and you can get pregnant