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Adult Health 1 - (Josh) > T3 - Probs of CNS (Spinal Cord) (Josh) > Flashcards

T3 - Probs of CNS (Spinal Cord) (Josh) Flashcards

1
Q

What are some non-surgical methods of relieving Lumbrosacral Back Pain?

A

Pillow under knees

Meds (Acetaminopen and NSAIDs)

Heat

PT

Weight control

C and A Therapies (yoga, etc)

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2
Q

What are the Minimally Invasive Surg options of Lumbrosacral Back Pain?

A

Percutaneous Lumbar Discectomy

Thermodiscectomy

Laser-assisted Laparoscopic Lumbar Discectomy

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3
Q

What are the conventional surgeries for Lumbrosacral Back Pain?

A

Discectomy

Laminectomy

Spinal Fusion

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4
Q

Post-surgical care for Lumbrosacral Back Pain surgery?

A

Neuro assessments and vitals

Patient’s ability to void

Pain control

Wound care

CSF check

Positioning/Mobility

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5
Q

What are the 5 types of Spinal Cord Injuries?

A

Hyperflexion

Hyperextension

Axial Loading (Vertical Compression)

Excessive Head Rotation

Penetration

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6
Q

Which section of SC are Hyperflexion SC injuries typically seen?

A

C5 and C6

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7
Q

Whiplash is an example of a — SC injury.

A

Hyperextension

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8
Q

Jumping head first into shallow water is an example of which SC injury?

A

Axial Loading (Vertical Compression)

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9
Q

What is a Complete SC injury?

A

total loss of sensory and motor function below level of injury

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10
Q

What are the two types of Complete SC injuries?

A

Tetraplegia (quad)

Paraplegia

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11
Q

With Tetraplegia, where is the injury at?

A

C1-C8 region

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12
Q

Which section of Spinal Cord will result in paralysis of diaphragm if injured (Christopher Reeve)?

A

above C3

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13
Q

With —, paralysis is of both legs.

A

paraplegia

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14
Q

Where is the injury with a Paraplegia SC injury?

A

Thoracolumbar Region (T2-L1)

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15
Q

What are Incomplete Spinal Cord Injuries?

A

mixed loss of voluntary motor activity and sensation below level of injury

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16
Q

What are the types of Incomplete SC injuries?

A

Brown-Sequard

Central Cord

Anterior

Posterior

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17
Q

Which type of Incomplete SC Injury:

  • Transection/Damage of one side of SC below injury site
  • Loss of voluntary motor function on SAME SIDE as injury
  • Loss of pain, temp, and sensation on OPPOSITE SIDE of injury
A

Brown-Sequard

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18
Q

Which type of Incomplete SC Injury:

  • Hematoma formation in central or cervical cord
  • motor weakenss (more in upper extremities)
  • Sensor function varies
  • Varying degrees of bowel and bladder dysfunction
A

Central Cord Injury

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19
Q

Which Incomplete SC Injury is associated with Cervical Flexion and Cervical Extension injuries?

A

Central Cord Injury

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20
Q

Which Incomplete SC Injury:

  • Loss of motor function below site of injury
  • Loss of pain, temp, and crude sensation
A

Anterior Injury

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21
Q

Anterior Incomplete SC Injuries are associated with which injuries?

A

Flexion injuries

Acute Herniation of an intervertebral disc

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22
Q

Posterior Incomplete SC injuries are associated with which injuries?

A

Cervical Hyperextension Injuries

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23
Q

Which Incomplete SC Injury:

  • Loss of position sense, vibration, and pressure
  • May lose ability to walk due to loss of position sense
  • Motor function, pain and temp sensation are INTACT
A

Posterior

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24
Q

What is Spinal Shock?

A

Complication of SCI where you lose complete sensation for a while before it gradually returns

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25
Q

How long can Spinal Shock last before sensation returns?

A

48 hrs to several weeks

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26
Q

What is the first reflex to typically return with Spinal Shock?

A

Anal Sphincter

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27
Q

What is med management for Spinal Shock?

A

Corticosteroids

***high dose of methylprednisolone IV within 8 hrs used to be done but is controversial b/c of immunosuppression

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28
Q

What is Neurogenic Shock?

A

complication of SCI

Neurogenic shock is a distributive type of shock resulting in low blood pressure, occasionally with a slowed heart rate, that is attributed to the disruption of the autonomic pathways within the spinal cord.

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29
Q

With Neurogenic Shock, what are the blood vessels unable to do?

What do you do to treat?

A

unable to constrict, which leads to decreased SVR, decreased preload, and decreased CO

IV fluids

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30
Q

What is HR like with Neurogenic Shock?

A

low HR

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31
Q

What is temp like with Neurogenic Shock?

A

Poikilothermic

**take on temp of room

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32
Q

What is skin like with Neurogenic Shock?

A

warm and dry

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33
Q

Management of Neurogenic Shock

A

Fluid resuscitation

Vasopressors

Maintain normothermia

Position to avoid orthostasis

  • NO trendelenberg
  • HOB slowly raised
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34
Q

Management goals with SC Injuries?

A

Prevent UTIs

Scheduled bowel program

Increase fluid intake

Relieve spasms with warm baths, muscle relaxants, antispasmadics

Position changes

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35
Q

What beverages can help prevent UTIs?

A

Cranberry juice

Apple juice

Grape juice

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36
Q

What is Autonomic Dysreflexia?

A

BP in perso with SCI above T5-T6 becomes excesssively high due to overactivity of the Autonomic Nervous System

37
Q

What causes Autonomic Dysreflexia?

A

a painful stimulus occurs below the level of spinal cord injury.

The stimulus is then mediated through the CNS and PNCS

38
Q

S/S of Autonomic Dysreflexia

A

Severe HTN (SBP may be 300)

Bradycardia

Severe HA with blurred vision

Nausea / Restlessness

Skin flushed above injury and pale below

Distended bladder, bowel

39
Q

Autonomic Dysreflexia:

Above the injury, the skin will be –

Below the injury, the skin will be –

A

flushed

pale

40
Q

Management for Autonomic Dysreflexia

A

If supine, immediately site patient up

Frequent VS (q 5 mins)

Look for instigating causes

Loosen clothing and constrictive devices

Catheter (check for kinks if one already is in)

AntiHTN meds

41
Q

Autonomic Dysreflexia:

When looking for instigating causes, what should we inspect first?

A

urinary system

42
Q

Autonomic Dysreflexia:

If acute symptoms persist, what should we suspect?

A

fecal impaction

43
Q

Patho of MS.

A

Chronic disease with no known cure that progresses over time

marked by relapses and remissions that may or may not return client to their previous baseline level of function

44
Q

Risk factors for MS

A

Virus or Infections agents

Cold climate

Physical injury

Emotional stress

Pregnancy

Overexertion

Temp extremes

Hot shower/bath

45
Q

S/S of MS

A

Fatigue

Pain or Parasthesia (tingling)

Diplopia

Tinnitus

Dysphagia

Muscle spasticity

Ataxia

Bladder dysfunction

46
Q

Meds for MS

A

Immunosuppressive agents

Prednisone

Interferon Beta

Carbamazepine

47
Q

What are the immunosuppressive agents for MS?

A

Azathioprine

Cyclosporine

***with both, assess for HTN and Kidney Dysfunction

48
Q

With MS, we have lots of — probs.

A

eye

  • diplopia
  • nystagmus
  • changes in peripheral vision
  • loss of visual accuity
49
Q

ALS is aka — — —

A

Lou Gehrig’s Disease

50
Q

With ALS, which pathways are affected?

A

motor pathway

***sensory pathway is NOT affected

51
Q

ALS is a progressive — neuron disease that affects — and —

A

motor

UMN

LMN

52
Q

S/S of ALS

A

Muscle weakness, wasting, atrophy

Muscle spasticity and hyperreflexia

Fasciculations

Brainstem signs (dysarthria, dysphagia)

Dyspnea, resp paralysis

Fatigue

53
Q

What is cure for ALS?

A

no known cure

54
Q

Which medication can slow the progression of ALS?

A

Riluzole

***Hepatotoxic

55
Q

Collaborative care of ALS

A

PT

Speech Therapy

Occupational Therapy

56
Q

Which disease is marked by RELAPSES and REMISSIONS?

A

Multiple Sclerosis

57
Q

— is an autoimmune disorder characterized by development of plague in white matter of the CNS.

This plaque damages the myelin sheath, interfering with impulse transmission b/t the CNS and the body.

58
Q

T/F: MS is more common in women.

A

True

***ages 20-40

59
Q

MS:

What should we remember about Azathriprine and Cyclosporine?

A

Monitor for long-term effects

Be alert for infection

Assess for HTN

Assess for kidney dysfunction

60
Q

Prednison is used for MS.

What are some adverse effects?

A

Infection

Hypervolemia

Hypokalemia

Hyperglycemia

GI bleeding

Personality changes

61
Q

MS:

How does Interferon B work to treat MS?

A

prevents and treats relapses

62
Q

With ALS, what is the prognosis?

A

death usually occurs within 3-5 yrs due to respiratory failure

63
Q

ALS:

How well does Riluzole work?

A

adds 2-3 months to lifespan

64
Q

ALS:

What to remember about Riluzole?

A

Hepatoxic (no ETOH)

Store away from bright light

Assess for dizziness, vertigo, and somnolence

65
Q

ALS:

What are the Anitspasmadics that can be used for symptoms?

A

Baclofen

Dantrolene

Diazepam

66
Q

SCI:

Why are urinary problems so bad?

A

they retain urine due to loss of autonomic and reflex bladder control

results in overextended bladder (UTI) that can reflux into kidneys

67
Q

SCI Urinary Symptoms:

— — for initial injury.

— — for long term care.

A

Foley Cath

Intermittent Cath

68
Q

SCI:

How can we help with bowel problems?

A

Scheduled bowel program

High fiber food

Increase fluids

Suppositories and Stool softeners

Digital Stimulation for UMN injuries

Enemas

69
Q

Autonomic Dysreflexia:

Where will Spinal Cord injury be?

A

above T5-T6

70
Q

SCI:

When you see low BP, think — —

When you see high BP, think — —

A

Neurogenic Shock

Autonomic Dysreflexia

71
Q

SCI:

When you see that they are weaker in upper extremities than lower extremities, assume it is what type of injury?

A

Central Cord Syndrome

72
Q

SCI:

Hematomas are associated with which Spinal Cord injury?

A

Central Cord

73
Q

SCI:

Which type of injury displaces spinal column and may disrupt ligaments, vessels, tissue, bone, and related organs?

A

Excessive Head Rotation

74
Q

SCI:

Which type of injury results in compression of cord from fractures and rupture/tearing of muscles/ligaments?

A

Hyperflexion

75
Q

Lumbrosacral Back Pain:

With an Anterior Cervical Discectomy, what is our main concern?

A

it comes from the front side, so our main concern is MAKING SURE AIRWAY IS NOT COMPROMISED

76
Q

When you see brisk, jerky (choreoform) movements, think — —

A

Huntington’s Disease

77
Q

Huntington’s Disease:

Which neurotransmitter decreases?

Which one increases?

A

GABA (inhibitor)

Glutamate (excitatory)

***why you have the jerky movements

78
Q

T/F: Huntington’s Disease is hereditary.

79
Q

Definitions:

— is the inability to find words.

— is the inability to use words/objects correctly.

— is the inability to speak/understand

— is the loss of sensory comprehension.

A

Anomia

Apraxia

Aphasia

Agnosia

80
Q

Alzheimers:

What type of diet is helpful?

A

Dark colored fruits/veggies

Folate

Vit B12, C, and E

81
Q

Parkinsons:

What psychological factors are we assessing for?

A

depression

anxiety

insomnia

82
Q

Parkinsons:

What type of diet is helpful?

A

high protien, high calorie

***Monitor for ability to eat

***monitor fluid/food intake

83
Q

Parkinsons:

When should activities be scheduled?

A

later in day to give them time to get ready

***they are much slower than normal

84
Q

Parkinsons:

What autonomic signs would we see in the physical assessment?

A

Othostatic hypotension

Flushing

85
Q

Parkinsons:

What type of emotional condition are they likely in?

A

Labile

Depressed

Paranoid

86
Q

Which type of seizure may experience an aura?

A

Simple Partial

87
Q

Miosis (pinpoint constriction of pupil) is a s/s of — headaches.

88
Q

3 R’s of Migraines

A

Recognize symptoms

Respond and call health care provider

Relive pain and associated symptoms

Adult Health 1 - (Josh) (26 decks)

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