Spinal Nursing Flashcards
what are the main aims of the neurological exam?
determining whether it is a neurological issue
localisation of the issue
identify its cause
where are the possible localisation sites for neurological disease?
brain (forebrain/cerebellum/brainstem)
spinal cord
peripheral nerves
neuromuscular (junction)
what can we assess ‘hands-off’ in the neurological examination?
mentation
gait and posture
what are the different ‘hands on’ aspects of the neurological examination?
postural reactions
spinal reflexes
cranial nerves
sensory evaluation
palpation
how can we assess gait in neurological patients?
owner walks animal up and down
cat let out/encouraged out of carrier
what are we looking for during gait analysis?
whether or not the animal can generate and make co-ordinated movements
what postural abnormalities might we observe in a neurological patient?
head tilt
head turn
ventroflexion of the neck
curving of the spine
decerebrate or decerebellate rigidity
wide-based stance
what is decerebrate rigidity?
extension of all limbs, head and neck
animal presents in lateral, non-ambulatory
what is decerebellate rigidity?
extension of the thoracic limbs, head and neck
how can we test postural reactions?
proprioceptive positioning
hopping
visual placing
tactile placing
hemi-walking
wheelbarrowing
what do the postural reaction tests assess?
function of:
sensory nerves
ascending and descending tracts in the spinal cord and brainstem
forebrain
motor nerves and muscles
where are the upper motor neurones located?
between the cerebral cortex and spinal cord
what do the upper motor neurones do?
send signals to lower motor neurones
where are the lower motor neurones located?
between the CNS and the effector organ
what is the function of the lower motor neurones?
send a signal to the effector organ (muscle) and make them contract
what are the signs of upper motor neurone localisation?
any existing reflexes will be more exaggerated and easier to elicit
increased muscle tone
muscle atrophy more chronic than in lower motor neurone disease
what are the signs of lower motor neurone localisation?
any existing reflexes will be weaker/absent
muscle tone reduced
can get flaccid paresis/paralysis (no muscle tone)
how can we test the spinal reflexes of the thoracic limbs?
withdrawal reflex
extensor carpi radialis reflex
biceps brachii and triceps reflex
how can we test the spinal reflexes of the pelvic limbs?
withdrawal reflex
patella reflex
cranial tibial and gastrocnemius
what other tests can we use for spinal reflexes?
perineal and panniculus reflex
what do the perineal and panniculus reflexes assess?
spinal reflexes
what is important to remember about the withdrawal reflex?
it is different to the pain response
what does the cutaneous trunci reflex test?
segmental nerves
spinal cord cranial to this up to T1
lateral thoracic nerve
what do we use the cutaneous trunci reflex for?
to monitor if the localisation of the spinal lesion changes post-operatively
how can we monitor if the localisation of the spinal lesion changes post-operatively?
using the cutaneous trunci reflex
what are we looking for during deep pain assessment?
a reaction from the patient - turning, localising, trying to bite
how can we test the cranial nerves?
menace response
palpebral reflex
pupillary light reflex
gag reflex
oculocephalic reflex
nystagmus
what is miosis?
constriction of the pupils
what is mydriasis?
dilation of the pupils
what is constriction of the pupils called?
miosis/miotic pupils
what is dilation of the pupils called?
mydriasis/mydriatic pupils
what is anisocoria?
asymmetric pupil size
how can we spot neurological deterioration via the eyes?
miotic to mydriatic = neurological deterioration
what is indicated by mid-sized pupils that are unresponsive to light?
grave prognosis
why do we grade spinal cord injury?
to allow for more objective assessment
to allow for tracking of any progression of clinical signs
how do we classify spinal cord injuries?
grades 1-5
what is a grade 1 spinal cord injury?
pain only - no neurological deficits
walking normally
what is a grade 2 spinal cord injury?
walking but with neurological deficits causing weakness or incoordination in both pelvic limbs
= ambulatory paraparesis
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
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)
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)
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
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
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
how does physiotherapy aid motor recovery?
maintains joint health
limits muscle wastage
helps prevent contracture
what are the motor and sensory aspects of physiotherapy?
motor - relearning movements
sensory - stimulating proprioceptive relearning and retraining gait
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
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
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
what is the aim of PROM?
to put each joint through the normal range of motion and improve joint health without active muscle contraction
how can PROM be performed?
gently flex and extend each joint of the limb through it normal range of motion 10-15 times
what are some of the assisted exercises we can perform?
assisted sit/stand
assisted standing/walking
three-legged standing
weight-shifting
what are some of the active exercises we can perform?
walking - straight line, circles, figure 8, incline
sit-stand
sit-down
hydrotherapy
what are some of the proprioceptive exercises we can perform?
standing
wobble board
uneven/different surfaces
over poles
weaving poles
what is the benefit of NMES?
increase tissue perfusion and may aid in minimising both the onset and severity of neurogenic muscle atrophy
which patients may benefit from NMES?
those who can’t produce active muscle contractions
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
what indicates an upper motor bladder?
bladder is distended and difficult to express
what indicates a lower motor bladder?
bladder is distended but easy to express
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
what is overflow incontinene?
leaking of urine as a result of being unaware that the bladder is full
what can occur as a result of overflow incontinence?
urine scalding
UTIs
how can we manage the bladder?
manual expression 3-4x daily
intermittent aseptic catheterisation 2x daily
indwelling catheter with closed connection system
drug therapy
which patients are more likely to leak urine?
those with lower motor neurone bladder
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
why is bowel movement less affected by neuro issues?
defecation is initiated by stretch of the rectal wall
how is defecation affected in those with UMN injury?
the reflex can become over active, meaning a small amount of distension can initiate defecation
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
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
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
how can we prevent neuro patients developing sores on the distal limbs i.e. from dragging?
bandages, commercial boots, baby socks
how can we treat pressure sores if they occur?
keep clean and dry
debride if necessary
ABs if infection suspected
bandaging
which type of neuro surgery is likely to produce less wound complications?
ventral slot
why is ventral slot surgery likely to produce less wound complications than hemi?
less layers of tissue and muscle retracted during surgery
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
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
why might self-mutilation occur in deep pain negative animals?
paraesthesia
boredom
stress
look for any triggers, such as a sore
where can pain originate from?
intervertebral discs
facets
nerve roots
muscles
meninges
what are the types of pain a neuro patient may be experiencing?
inflammatory
neuropathic
acute
chronic
how can we identify pain in neuro patients?
observation - demeanour in comparison to before, self-mutilation
wound palpation
GCPS
what respiratory issues might spinal patients be prone to?
hypoventilation
atelectasis
pneumonia
which neuro patients are at higher risk of respiratory issues?
those with a cervical lesion
what are the clinical signs of aspiration pneumonia?
coughing, tachypnoea, harsh lung sounds and crackles on auscultation
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
