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Applied Clinical Veterinary Nursing > Spinal Nursing > Flashcards

Spinal Nursing Flashcards

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1
Q

what are the main aims of the neurological exam?

A

determining whether it is a neurological issue

localisation of the issue

identify its cause

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2
Q

where are the possible localisation sites for neurological disease?

A

brain (forebrain/cerebellum/brainstem)

spinal cord

peripheral nerves

neuromuscular (junction)

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3
Q

what can we assess ‘hands-off’ in the neurological examination?

A

mentation

gait and posture

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4
Q

what are the different ‘hands on’ aspects of the neurological examination?

A

postural reactions

spinal reflexes

cranial nerves

sensory evaluation

palpation

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5
Q

how can we assess gait in neurological patients?

A

owner walks animal up and down

cat let out/encouraged out of carrier

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6
Q

what are we looking for during gait analysis?

A

whether or not the animal can generate and make co-ordinated movements

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7
Q

what postural abnormalities might we observe in a neurological patient?

A

head tilt
head turn
ventroflexion of the neck
curving of the spine
decerebrate or decerebellate rigidity
wide-based stance

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8
Q

what is decerebrate rigidity?

A

extension of all limbs, head and neck

animal presents in lateral, non-ambulatory

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9
Q

what is decerebellate rigidity?

A

extension of the thoracic limbs, head and neck

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10
Q

how can we test postural reactions?

A

proprioceptive positioning

hopping

visual placing

tactile placing

hemi-walking

wheelbarrowing

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11
Q

what do the postural reaction tests assess?

A

function of:
sensory nerves
ascending and descending tracts in the spinal cord and brainstem
forebrain
motor nerves and muscles

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12
Q

where are the upper motor neurones located?

A

between the cerebral cortex and spinal cord

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13
Q

what do the upper motor neurones do?

A

send signals to lower motor neurones

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14
Q

where are the lower motor neurones located?

A

between the CNS and the effector organ

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15
Q

what is the function of the lower motor neurones?

A

send a signal to the effector organ (muscle) and make them contract

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16
Q

what are the signs of upper motor neurone localisation?

A

any existing reflexes will be more exaggerated and easier to elicit

increased muscle tone

muscle atrophy more chronic than in lower motor neurone disease

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17
Q

what are the signs of lower motor neurone localisation?

A

any existing reflexes will be weaker/absent

muscle tone reduced

can get flaccid paresis/paralysis (no muscle tone)

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18
Q

how can we test the spinal reflexes of the thoracic limbs?

A

withdrawal reflex
extensor carpi radialis reflex
biceps brachii and triceps reflex

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19
Q

how can we test the spinal reflexes of the pelvic limbs?

A

withdrawal reflex
patella reflex
cranial tibial and gastrocnemius

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20
Q

what other tests can we use for spinal reflexes?

A

perineal and panniculus reflex

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21
Q

what do the perineal and panniculus reflexes assess?

A

spinal reflexes

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22
Q

what is important to remember about the withdrawal reflex?

A

it is different to the pain response

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23
Q

what does the cutaneous trunci reflex test?

A

segmental nerves

spinal cord cranial to this up to T1

lateral thoracic nerve

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24
Q

what do we use the cutaneous trunci reflex for?

A

to monitor if the localisation of the spinal lesion changes post-operatively

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25
Q

how can we monitor if the localisation of the spinal lesion changes post-operatively?

A

using the cutaneous trunci reflex

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26
Q

what are we looking for during deep pain assessment?

A

a reaction from the patient - turning, localising, trying to bite

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27
Q

how can we test the cranial nerves?

A

menace response
palpebral reflex
pupillary light reflex
gag reflex
oculocephalic reflex
nystagmus

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28
Q

what is miosis?

A

constriction of the pupils

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29
Q

what is mydriasis?

A

dilation of the pupils

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30
Q

what is constriction of the pupils called?

A

miosis/miotic pupils

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31
Q

what is dilation of the pupils called?

A

mydriasis/mydriatic pupils

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32
Q

what is anisocoria?

A

asymmetric pupil size

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33
Q

how can we spot neurological deterioration via the eyes?

A

miotic to mydriatic = neurological deterioration

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34
Q

what is indicated by mid-sized pupils that are unresponsive to light?

A

grave prognosis

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35
Q

why do we grade spinal cord injury?

A

to allow for more objective assessment

to allow for tracking of any progression of clinical signs

36
Q

how do we classify spinal cord injuries?

A

grades 1-5

37
Q

what is a grade 1 spinal cord injury?

A

pain only - no neurological deficits
walking normally

38
Q

what is a grade 2 spinal cord injury?

A

walking but with neurological deficits causing weakness or incoordination in both pelvic limbs
= ambulatory paraparesis

39
Q

what is a grade 3 spinal cord injury?

A

not able to walk without assistance but has good movement in the pelvic limbs
= non-ambulatory paraparesis

40
Q

what is a grade 4 spinal cord injury?

A

no voluntary movement in the pelvic limbs but can feel the toes
= paraplegia with intact nociception (deep pain positive)

41
Q

what is a grade 5 spinal cord injury?

A

no voluntary movement in the pelvic limbs, lack of feeling in toes
= paraplegic without nociception (deep pain negative)

42
Q

what are the important considerations when formulating a nursing plan for a neuro patient?

A

ambulation/recumbency
whether surgery has been performed
continence
normal routine
temperament

43
Q

what aspects of nursing care are important to cover in neuro patients?

A

walking support - decreased motor activity

bladder and bowel management

wound management

prevention of pressure sores

pain management

respiratory support

44
Q

what are the advantages of physiotherapy for neuro patients?

A

improves local and whole body circulation

can help reduce pain and likelihood of pressure sore formation

creates bond between nurse/physio and patient, provides enrichment

aids motor recovery

45
Q

how does physiotherapy aid motor recovery?

A

maintains joint health

limits muscle wastage

helps prevent contracture

46
Q

what are the motor and sensory aspects of physiotherapy?

A

motor - relearning movements

sensory - stimulating proprioceptive relearning and retraining gait

47
Q

what are some of the different aspects of physiotherapy we could engage in with our patients?

A

massage
PROM
assisted exercises
active exercises
proprioceptive exercises
NMES

hot/cold therapy, hydrotherapy, laser therapy

48
Q

what is the purpose of massage in physiotherapy?

A

helps calm patient and gets used to handling

aids with improvement in local and whole body circulation

mobilises dermal and subdermal tissues

warms muscles and tissues

49
Q

how do we perform massage?

A

efflourage - apply light pressure to patients limbs in long strokes or circular movements

push oedema back towards heart if present

50
Q

what is the aim of PROM?

A

to put each joint through the normal range of motion and improve joint health without active muscle contraction

51
Q

how can PROM be performed?

A

gently flex and extend each joint of the limb through it normal range of motion 10-15 times

52
Q

what are some of the assisted exercises we can perform?

A

assisted sit/stand

assisted standing/walking

three-legged standing

weight-shifting

53
Q

what are some of the active exercises we can perform?

A

walking - straight line, circles, figure 8, incline

sit-stand

sit-down

hydrotherapy

54
Q

what are some of the proprioceptive exercises we can perform?

A

standing
wobble board
uneven/different surfaces
over poles
weaving poles

55
Q

what is the benefit of NMES?

A

increase tissue perfusion and may aid in minimising both the onset and severity of neurogenic muscle atrophy

56
Q

which patients may benefit from NMES?

A

those who can’t produce active muscle contractions

57
Q

what are our considerations when formulating a physiotherapy plan for a patient?

A

previous injuries/surgeries

client expectations and limits (time, expertise)

disease process

neurolocalisation

temperament

58
Q

what indicates an upper motor bladder?

A

bladder is distended and difficult to express

59
Q

what indicates a lower motor bladder?

A

bladder is distended but easy to express

60
Q

what can occur as a result of failure to properly empty the bladder?

A

UTI - urine is static in bladder
bladder atony
pyelonephritis

distention of the bladder and ureters can be painful

61
Q

what is overflow incontinene?

A

leaking of urine as a result of being unaware that the bladder is full

62
Q

what can occur as a result of overflow incontinence?

A

urine scalding
UTIs

63
Q

how can we manage the bladder?

A

manual expression 3-4x daily

intermittent aseptic catheterisation 2x daily

indwelling catheter with closed connection system

drug therapy

64
Q

which patients are more likely to leak urine?

A

those with lower motor neurone bladder

65
Q

do we need to consider bowel management in neuro patients?

A

don’t normally have issues passing faeces but may not be able to move away once they have passed it

66
Q

why is bowel movement less affected by neuro issues?

A

defecation is initiated by stretch of the rectal wall

67
Q

how is defecation affected in those with UMN injury?

A

the reflex can become over active, meaning a small amount of distension can initiate defecation

68
Q

how does recumbency lead to pressure sores?

A

puts increased pressure over bony prominences e.g. ischial tuberosities, lateral humeral condyles

leads to compression of local circulation, leading tissue to undergo ischaemic necrosis

69
Q

why is it important to treat pressure sores quickly and aggressively?

A

they can develop rapidly and action must be taken to prevent infection and prevent the lesion from getting bigger

70
Q

how can we prevent pressure sores from forming?

A

thick padded bedding

turn patient every 2-4 hours

donut bandages

porous bedding (vetbeds), clean and dry

incontinence pads

physical therapy

regular monitoring of patients - checklists

71
Q

how can we prevent neuro patients developing sores on the distal limbs i.e. from dragging?

A

bandages, commercial boots, baby socks

72
Q

how can we treat pressure sores if they occur?

A

keep clean and dry
debride if necessary
ABs if infection suspected
bandaging

73
Q

which type of neuro surgery is likely to produce less wound complications?

A

ventral slot

74
Q

why is ventral slot surgery likely to produce less wound complications than hemi?

A

less layers of tissue and muscle retracted during surgery

75
Q

why is hemilaminectomy surgery more likely to produce seromas than ventral slot?

A

more skin movement and separation of layers of tissue, site over the midline

76
Q

what other methods may aid wound management?

A

cold therapy (always wrap in towel)

primapore to prevent interference

do not walk ventral slot patients on a neck lead

77
Q

why might self-mutilation occur in deep pain negative animals?

A

paraesthesia
boredom
stress

look for any triggers, such as a sore

78
Q

where can pain originate from?

A

intervertebral discs
facets
nerve roots
muscles
meninges

79
Q

what are the types of pain a neuro patient may be experiencing?

A

inflammatory
neuropathic
acute
chronic

80
Q

how can we identify pain in neuro patients?

A

observation - demeanour in comparison to before, self-mutilation

wound palpation

GCPS

81
Q

what respiratory issues might spinal patients be prone to?

A

hypoventilation
atelectasis
pneumonia

82
Q

which neuro patients are at higher risk of respiratory issues?

A

those with a cervical lesion

83
Q

what are the clinical signs of aspiration pneumonia?

A

coughing, tachypnoea, harsh lung sounds and crackles on auscultation

84
Q

how can aspiration pneumonia be managed?

A

careful and close monitoring of patients

early admin of ABs

fluids, oxygen therapy

respiratory physiotherapy e.g. nebulisation, vibration, coupage

mechanical ventilation if severe

85
Q
A

Applied Clinical Veterinary Nursing (31 decks)

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