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NUR 357 > Spinal injury including neurogenic and spinal shock > Flashcards

Spinal injury including neurogenic and spinal shock Flashcards

1
Q

Name the functions of the vertebral column

A
  • Protection of spinal cord
  • Structure
  • Allow movement - muscles
  • Nerve distribution & protection (posterior Vertebral Arch)
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2
Q

Describe the structure of the spinal column

A

Vertebrae separated by an intervertebral disk

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3
Q

What are the functions of intervertebral disks?

A

Shock absorption and movement

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4
Q

Name a section of the vertebral column that does not have intervertebral discs separating the vertebrae

A

C1 - C2

Sacrum - cocyx

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5
Q

Describe each section of the spinal column

  • Name each section
  • How many vertebrae in each column
  • Describe the characteristics of each section
A

Cervical = 7 vertebrae - C1-C7

  • Flexible + mobile
  • Allows for rotation, lateral flexion and anterior/posterior flexion

Thoracic = 12 vertebrae - T1-T12

  • Strong
  • Separated by intervertebral discs
  • Small range of movement
  • Does allow for limited rotation
  • Connected to ribs

Lumbar = 5 vertebrae - L1-L5

  • Highly mobile
  • Allows for rotation, flexion and extension
  • Large, Strong - weight bearing
Sacrum = 5 fused vertebrae
Cocyx = 4 fused vertebrae
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6
Q

Why is the spine curved?

A

To allow us to carry weight (mainly bodyweight) and support our centre of gravity.

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7
Q

Describe the natural S curve of the spine. (Medical terminology)

A

C - Lordosis
T - Kyphosis
L - Lordosis

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8
Q

What area of the spine is most likely to be damaged by wear and tear

A

Lumbar vertebrae L3-L5

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9
Q

What area of the spine is most likely to be damaged by trauma

A

C7-T1

T12 - L1

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10
Q

What condition normally causes exaggerated lordosis?

A

Pregnancy

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11
Q

What is the medical term for “hunch back”?

A

Kyphosis / exageratd kyphosis

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12
Q

Describe the term scoliosis

A

Abnormal S-shaped curvature of the spine from left to right

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13
Q

name the 3 structural parts of a vertebrae

A
  • Body
  • Arch
  • Articular processes
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14
Q

Describe the structure and function of the body of the vertebrae

A
  • Transfers weight along the axis of the column
  • Connected by ligaments
  • Separated by intervertebral discs
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15
Q

Describe the structure and function of the vertebral arch of the vertebrae

A
  • Forms the posterior margin of the vertebral foramen
  • Pedicles (walls)
  • Laminae (roof)

These three aspects form the vertebral canal

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16
Q

Why is a fractured vertebrae concerning?

A
  • Unstable fractures may press on or transect the spinal cord causing irreversible damage
  • Painful
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17
Q

Describe the structure and function of the Lumbar vertebrae

A
  • Largest vertebrae
  • Thicker vertebrae
  • Bear the most weight
  • Spinous process - surface attachment for lower back muscles
  • Separated by intervertebral disks
  • Highly mobile
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18
Q

Describe the structure of intervertebral disks

A
  • Nucleus Pulposus – soft, elastic, gelatinous core,
    compressible. Surrounded by :
  • Anulus Fibrosus – fibrous ring, shock absorber
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19
Q

How does the ageing process affect intervertebral disks?

A

less water content in Nucleus Pulposus

  • reduced shock absorbency
  • Length of the vertebral column shortens
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20
Q

What is a slipped disk?

What is it caused by?

A

Anulus Fibrosus weakens, Nucleus Pulposus herniates and puts pressure on the spinal cord.

Caused by:
. Mechanical injury 
  - heavy load, incorrect manual handling technique 
. Obesity 
. Trauma
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21
Q

What causes neurogenic shock?

A

Interuption of sympathetic stimulation at T6 or above

loss of sympathetic stimulation due to cord injury results in loss of muscle tone and loss of normal vasoconstriction

Reduced vasoconstriction = reduced peripheral resistance = reduced BP

Neurogenic shock is caused by a loss of muscle tone which reduces BP and results in inadequate perfusion of organs

22
Q

What is shock?

A

Inadequate perfusion of the vital organs

- low blood pressure

23
Q

How do you calculate BP?

A

CO x peripheral resistance

24
Q

Name 3 signs/symptoms of neurogenic shock?

A

Hypotension, bradycardia, flushed warm extremeties (due to vaodilation)

  • urine output remains within normal range
25
Q

Why would a pateint in neurogenic shock require an IDC?

Explain your answers

A
  • incontinence - Muscle tone

- monitor urine output (it’s possible to have have hypovolaemic shock AND neurogenic shock simultaneously)

26
Q

Describe what is meant by the term spinal shock and how it is different to neurogenic shock

A
  • Temporary state – lasts days to weeks
  • Loss of motor and sensory function below level of cord
    injury.
  • Loss of all spinal reflexes below injury
  • Flaccid paralysis (including bladder and bowel)
  • Priapism may be present
  • Ends when reflex arcs below level of injury start to
    return.

Different as it is related to neurological function rather than blood pressure

27
Q

What is poikilothermia?

A

Inability to maintain core body temperature

28
Q

Why is important to pay attention to the temperature of a spinal patient?

A

Spinal injury:

Impairs the ability of the hypothalamus in maintain core body temperature - unable to sweat

Results in vasodilation and loss of heat through this mechanism

29
Q

What are the 2 classifications of spinal injuries?

A
  • Tetraplegia

- Paraplegia

30
Q

Describe Tetraplegia

A
  • Impairment or loss of motor and / or sensory function in cervical segments of spinal cord as a result of damage to neural elements of cord
  • Decreased function to arms, trunk, legs and pelvic organs
31
Q

Describe Paraplegia

A
  • Impairment or loss of motor and / or sensory function in thoracic, lumbar or sacral segments of cord as a result of damage to neural elements of cord
  • Arm function remains intact
  • Trunk, legs and pelvic organs may be involved.
32
Q

What are the 3 main risk factors of spinal cord injuries?

A
  • Age
  • Gender
  • Alcohol / drug use
33
Q

What are the leading causes of traumatic spinal injury?

A
  • Motor vehicles
  • Falls
  • Snowboarding
  • Rugby
  • Diving
34
Q

What are the most common vertebrae damaged in a traumatic spinal injury?

A

C5 – 7, T12 and L1

35
Q

Classification of blood pressure levels in adults

SYSTOLIC (mmHg) AND/OR DIASTOLIC (mmHg)

  • normal
  • high normal
  • mild hypotension
A

Classification of blood pressure levels in adults
SYSTOLIC (mmHg) AND/OR DIASTOLIC (mmHg)

Normal 120–129 and/or 80–84

High-normal 130–139 and/or 85–89

(mild) hypertension) 140–159 and/or 90–99
(moderate) hypertension 160–179 and/or 100–109
(severe) hypertension ≥180 and/or ≥110

36
Q

How does the SNS cause HTN

3 causes

A
  • ^SNS activity = ^HR and systemic vasoconstriction
  • SNS activity -> vascular remodelling -> permanent increases in peripheral resistance
  • renal sodium retention, insulin resistance, increased renin and angiotensin levels and procoagulant effects are all induced by the sympathetic nervous system
37
Q

Primary spinal cord injury

A

Mechanical – bone fragments, direct trauma

Damage to axons, blood vessels, cell membranes of cord

38
Q

Secondary spinal cord injury

A

Occurs minutes to years after the primary injury

Changes in blood supply
Electrical activity

39
Q

Application of cervical collar

- Indications

A

Alteration in sensory or motor function

Unconscious

40
Q

AE cervical collar

A

increased ICP

41
Q

Immediate care

A

? Application of cervical collar

Inline spinal control

Observe airway - vomit

Aim to prevent secondary injury:

  • Observe for neurogenic shock
  • Further movement causing further damage
  • Reduce inflammation

Assessment and stabilise patient:

  • CT / MRI scan with xray
  • Consider patient pressure areas!
42
Q

Ongoing care

A

May require Halo frame

Gastrointestinal dysfunction:

  • May require nasogastric tube for first 48 hrs
  • Distension and inability to empty bowel
  • Slow digestive processes

Genito urinary dysfunction

  • Urinary catheter required, Loss of voluntary bladder control
  • Priapism in men
  • Impotence in men
  • Pressure care crucial
43
Q

Ongoing care

A

May require Halo frame

Gastrointestinal dysfunction:

  • May require nasogastric tube for first 48 hrs
  • Distension and inability to empty bowel
  • Slow digestive processes

Genito - urinary dysfunction

  • Urinary catheter required, Loss of voluntary bladder control
  • Priapism in men
  • Impotence in men
  • Pressure care crucial
44
Q

Explain th purpose of a cervical collar

A

The purpose of a cervical collar is to support your neck and spinal cord, and to limit the movement of your neck and head. They’re typically meant for short-term use

45
Q

Explain what a log roll is and its’ purpose

A

to maintain alignment of the spine during movement

46
Q

Explain what autonomic dysreflexia is

A

Occurs in people who experience an SCI at or above T6

An imbalance in the autonomic nervous system (SNS and PSNS)

Bowel or bladder is stimulated and try to send a signal to your brain but the impulse only reaches the point of injury where it triggers the SNS causing vasoconstriction -> hypertension. Body compensates by activating PSNS -> bradycardia.

PSNS is triggered to counteract SNS excitibility but this signal only reaches the level of injury.

therefore,

PSNS - excited above level of injury
SNS - excited below the level of injury

47
Q

What will happen if Autonomic Dysreflexia is not treated

A

it can lead to status epilepticus, stroke, myocardial infarction and even death.

48
Q

Name some nursing interventions for Autonomic Dysreflexia

A
  • sitting the patient upright,
  • removing any constrictive clothing
  • Monitor BP frequently during the episode (every 2–5 minutes)
  • notifying the medical practitioner and determining the cause.
  • If symptoms persist after the source has been relieved, administration of a short-acting antihypertensive should be considered

The most common cause is bladder irritation.
- Immediate catheterisation to relieve bladder distension may be necessary. If a catheter is already in place, check it for kinks or folds. If the catheter is blocked, perform small-volume bladder irrigation gently (with no more than 10–15 mL of sterile 0.9% saline at body temperature).

Stool impaction can also result in autonomic dysreflexia. - - A digital rectal examination can be performed,
- application of lignocaine ointment will decrease rectal stimulation and avoid increasing symptoms.

49
Q

What are some symptoms of Autonomic Dysreflexia

A
  • hypertension (up to 300 mmHg systolic),
  • bradycardia (30–40 beats/minute),
  • piloerection (erection of body hair) as a result of pilomotor spasm,
  • blurred vision or spots in the visual fields,
  • nasal congestion,
  • anxiety and
  • nausea

• Sudden onset of acute, pounding headache

• Flushed face and upper chest (above the level of injury)
and pale extremities (below the level of injury)

  • Sweating above the level of injury
  • Nasal congestion
  • Feeling of apprehension
50
Q

At what level of injury should the nurse monitor the patient for autonomic dysreflexia

A

Occurs in people who experience an SCI at or above T6

51
Q

Common causes of Autonomic dysreflexia

A

often initiated by an issue with the bladder - IDC, UTI, distension

issues in the bowel - impaction, distension.

NUR 357 (4 decks)

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