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Applied Clinical Veterinary Nursing > Spinal Nursing > Flashcards

Spinal Nursing Flashcards

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
how can we monitor if the localisation of the spinal lesion changes post-operatively?
using the cutaneous trunci reflex
26
what are we looking for during deep pain assessment?
a reaction from the patient - turning, localising, trying to bite
27
how can we test the cranial nerves?
menace response palpebral reflex pupillary light reflex gag reflex oculocephalic reflex nystagmus
28
what is miosis?
constriction of the pupils
29
what is mydriasis?
dilation of the pupils
30
what is constriction of the pupils called?
miosis/miotic pupils
31
what is dilation of the pupils called?
mydriasis/mydriatic pupils
32
what is anisocoria?
asymmetric pupil size
33
how can we spot neurological deterioration via the eyes?
miotic to mydriatic = neurological deterioration
34
what is indicated by mid-sized pupils that are unresponsive to light?
grave prognosis
35
why do we grade spinal cord injury?
to allow for more objective assessment to allow for tracking of any progression of clinical signs
36
how do we classify spinal cord injuries?
grades 1-5
37
what is a grade 1 spinal cord injury?
pain only - no neurological deficits walking normally
38
what is a grade 2 spinal cord injury?
walking but with neurological deficits causing weakness or incoordination in both pelvic limbs = ambulatory paraparesis
39
what is a grade 3 spinal cord injury?
not able to walk without assistance but has good movement in the pelvic limbs = non-ambulatory paraparesis
40
what is a grade 4 spinal cord injury?
no voluntary movement in the pelvic limbs but can feel the toes = paraplegia with intact nociception (deep pain positive)
41
what is a grade 5 spinal cord injury?
no voluntary movement in the pelvic limbs, lack of feeling in toes = paraplegic without nociception (deep pain negative)
42
what are the important considerations when formulating a nursing plan for a neuro patient?
ambulation/recumbency whether surgery has been performed continence normal routine temperament
43
what aspects of nursing care are important to cover in neuro patients?
walking support - decreased motor activity bladder and bowel management wound management prevention of pressure sores pain management respiratory support
44
what are the advantages of physiotherapy for neuro patients?
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
how does physiotherapy aid motor recovery?
maintains joint health limits muscle wastage helps prevent contracture
46
what are the motor and sensory aspects of physiotherapy?
motor - relearning movements sensory - stimulating proprioceptive relearning and retraining gait
47
what are some of the different aspects of physiotherapy we could engage in with our patients?
massage PROM assisted exercises active exercises proprioceptive exercises NMES hot/cold therapy, hydrotherapy, laser therapy
48
what is the purpose of massage in physiotherapy?
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
how do we perform massage?
efflourage - apply light pressure to patients limbs in long strokes or circular movements push oedema back towards heart if present
50
what is the aim of PROM?
to put each joint through the normal range of motion and improve joint health without active muscle contraction
51
how can PROM be performed?
gently flex and extend each joint of the limb through it normal range of motion 10-15 times
52
what are some of the assisted exercises we can perform?
assisted sit/stand assisted standing/walking three-legged standing weight-shifting
53
what are some of the active exercises we can perform?
walking - straight line, circles, figure 8, incline sit-stand sit-down hydrotherapy
54
what are some of the proprioceptive exercises we can perform?
standing wobble board uneven/different surfaces over poles weaving poles
55
what is the benefit of NMES?
increase tissue perfusion and may aid in minimising both the onset and severity of neurogenic muscle atrophy
56
which patients may benefit from NMES?
those who can't produce active muscle contractions
57
what are our considerations when formulating a physiotherapy plan for a patient?
previous injuries/surgeries client expectations and limits (time, expertise) disease process neurolocalisation temperament
58
what indicates an upper motor bladder?
bladder is distended and difficult to express
59
what indicates a lower motor bladder?
bladder is distended but easy to express
60
what can occur as a result of failure to properly empty the bladder?
UTI - urine is static in bladder bladder atony pyelonephritis distention of the bladder and ureters can be painful
61
what is overflow incontinene?
leaking of urine as a result of being unaware that the bladder is full
62
what can occur as a result of overflow incontinence?
urine scalding UTIs
63
how can we manage the bladder?
manual expression 3-4x daily intermittent aseptic catheterisation 2x daily indwelling catheter with closed connection system drug therapy
64
which patients are more likely to leak urine?
those with lower motor neurone bladder
65
do we need to consider bowel management in neuro patients?
don't normally have issues passing faeces but may not be able to move away once they have passed it
66
why is bowel movement less affected by neuro issues?
defecation is initiated by stretch of the rectal wall
67
how is defecation affected in those with UMN injury?
the reflex can become over active, meaning a small amount of distension can initiate defecation
68
how does recumbency lead to pressure sores?
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
why is it important to treat pressure sores quickly and aggressively?
they can develop rapidly and action must be taken to prevent infection and prevent the lesion from getting bigger
70
how can we prevent pressure sores from forming?
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
how can we prevent neuro patients developing sores on the distal limbs i.e. from dragging?
bandages, commercial boots, baby socks
72
how can we treat pressure sores if they occur?
keep clean and dry debride if necessary ABs if infection suspected bandaging
73
which type of neuro surgery is likely to produce less wound complications?
ventral slot
74
why is ventral slot surgery likely to produce less wound complications than hemi?
less layers of tissue and muscle retracted during surgery
75
why is hemilaminectomy surgery more likely to produce seromas than ventral slot?
more skin movement and separation of layers of tissue, site over the midline
76
what other methods may aid wound management?
cold therapy (always wrap in towel) primapore to prevent interference do not walk ventral slot patients on a neck lead
77
why might self-mutilation occur in deep pain negative animals?
paraesthesia boredom stress look for any triggers, such as a sore
78
where can pain originate from?
intervertebral discs facets nerve roots muscles meninges
79
what are the types of pain a neuro patient may be experiencing?
inflammatory neuropathic acute chronic
80
how can we identify pain in neuro patients?
observation - demeanour in comparison to before, self-mutilation wound palpation GCPS
81
what respiratory issues might spinal patients be prone to?
hypoventilation atelectasis pneumonia
82
which neuro patients are at higher risk of respiratory issues?
those with a cervical lesion
83
what are the clinical signs of aspiration pneumonia?
coughing, tachypnoea, harsh lung sounds and crackles on auscultation
84
how can aspiration pneumonia be managed?
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

Applied Clinical Veterinary Nursing (31 decks)

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