T9: Spinal Cord Injury Flashcards
Spinal cord injury (SCI)
damage to spinal cord as result of trauma; spinal cord can be bruised or completely severed
Spinal shock may occur following acute SCI and is characterized by
-↓ Reflexes
- Loss of sensation
- Absent thermoregulation
- Flaccid paralysis below level of injury
HINT HINT WHAT IS THE DIFFERENCE BETWEEN SPINAL SHOCK AND NEUROGENIC SHOCK
spinal gets better and they can come out of it
*Neurogenic shock, in contrast to spinal shock, results from loss of vasomotor tone due to injury and is characterized by hypotension and bradycardia.
neurogenic shock is characterized by
-Hypotension
-Bradycardia
HINT HINT neurogenoc shock is caused/associated with…
cervical or high thoracic injury (T6 OR HIGHER!!!)
Flexion injury of the cervical spine ruptures
the posterior ligaments.
Hyperextension injury of the cervical spine ruptures
the anterior ligaments.
Compression fractures crush..
the vertebrae and force bony fragments into the spinal canal.
Flexion-rotation injury of the cervical spine often results in
tearing of ligamentous structures that normally stabilize the spine.
how do we move patients with spinal cord injury
log roll SLOWLY with multiple nurses
intervention for flexion injury
-c spine collar and it will take time to heal
-may be in HALO traction to allow ligaments to heal
-Pin site care, immobility, assess to see if swelling is going down
medication for SCI
steroids to decrease inflammation ) MANNITOL , DECADRON, NSAIDS
what can we do for a spinal compression fracture
fuse spine at that level
C4 Injury results in
tetraplegia, complete paralysis below neck
C6 injury results in
partial paralysis of hands and arms as well as lower body
HINT HINT T6 injury results in
paraplegia, paralysis below the chest
L1 injury
paraplegia, results in paralysis below the waist
with tetrapelegia the person may..
not be able to breathe or have urine and bowl movements on their own
Complete cord involvement
Total loss of sensory and motor function below level of injury
Incomplete cord involvement
*results in a mixed loss of voluntary motor activity and sensation and leaves some tracts intact.
*The degree of sensory and motor loss depends on the level of the injury and the specific damaged nerve tracts.
Anterior Cord Syndrome
caused by flexion injuries
- occurs when 2/3 of the anterior cord is lost
- motor function, pain, and temperature sensation lost bilaterally below the lesion (flaccidity below the lesion)
Brown-Séquard Syndrome
causes by penetrating injury and involves hemi-transection of the cord, involves only one side of the cord. Symptoms include complete cord damage and loss of function on the affected side, with loss of pain and temperature sensation on the other side.
Central Cord Syndrome
*Caused from damage to the central spinal cord.
*Occurs most commonly in the cervical cord region.
*More common in older adults.
*Motor weakness and sensory loss are present in upper extremities.
*Dysesthetic burning pain is felt in upper extremities.
clinical manifestations of SCI
*generally related to the direct result of trauma that causes cord compression, ischemia, edema, and possible cord transection.
*related to the level and degree of injury.
Cervical injuries above the level of C4 present..
Total loss of respiratory muscle function (need to be on vent)
Injury or fracture below the level of C4 results
*diaphragmatic breathing if the phrenic nerve is functioning, resulting in respiratory insufficiency
Cervical and thoracic injuries cause paralysis of
abdominal and intercostal muscles resulting in ineffective cough and risk for aspiration, atelectasis, pneumonia
cervical and thoracic injuries present risk for
neurogenic pulmonary edema
Clinical Manifestations Cardiovascular System
Injury above T6 leads to dysfunction of sympathetic nervous system
-Leads to neurogenic shock
-Bradycardia
-Peripheral vasodilation
-Hypotension
Clinical Manifestations Urinary System
Neurogenic bladder
neurogenic bladder
*Bladder dysfunction related to abnormal or absent bladder innervation
* No reflex detrusor contractions (flaccid, hypotonic)
* Hyperactive reflex detrusor contractions (spastic)
* Lack of coordination between detrusor contraction and urethral relaxation (dyssynergia)
acute phase of neurogenic bladder
-Urinary retention
-Bladder atonic, overdistended, fails to empty
-Indwelling catheter
post acute phase of neurogenic bladder
-Bladder may become hyperirritable
-Loss of inhibition from brain
-Reflex emptying and failure to store urine
Clinical Manifestations Gastrointestinal System
-Decreased GI motor activity
-Gastric distention
-Development of paralytic ileus
-Gastric emptying may be delayed
-Excessive release of HCl may cause stress ulcers
-Dysphagia may be present
HINT HINT Cauda Equina Syndrome results from
damage to cauda equine (lumbar and sacral nerve roots) and is a MEDICAL EMERGENCY
Cauda equina syndrome symptoms
-Asymmetrical distal weakness
-Flaccid paralysis of lower extremities
-Complete loss of sensation in saddle area
-Areflexic (flaccid) bladder and bowel
-Severe, radicular, asymmetric pain
Poikilothermism
the adjustment of the body temperature to the room temperature.
-Interruption of SNS
-↓Ability to sweat or shiver below the level of injury
Poikilothermism interventions
keep room temperature at a good level, they will take on this temp, tylenol wont help!!
Clinical Manifestations Peripheral Vascular Problems
-Venous thromboembolism (VTE)
-Pulmonary embolism
* Nociceptive Pain
* Neuropathic Pain
Nociceptive Pain
*Musculoskeletal pain dull or aching, worsens with movement
Neuropathic Pain
*Located at or below level of injury
* Hot, burning, tingling, pins and needles, cold, shooting
* May be extremely sensitive to stimuli
Diagnostic Studies
-CT scan
-Cervical x-rays
-MRI
-Comprehensive neurologic examination
-CT angiogram
immediate post-injury goals include
-Patent airway
-Adequate ventilation/breathing
-Adequate circulating blood volume
-Prevent extension of spinal cord damage
immobilization methods
-Rigid cervical collar
-Backboard with straps
when do you not use spinal immobilization
with penetrating trauma
Interprofessional Care Drug Therapy
-Low-molecular-weight heparin (Prevent VTE)
-Vasopressor agents
(Maintain mean arterial pressure >85-90 mm Hg)
-Altered drug metabolism → worse with complete Cervical versus lower and partial
Fluid and Nutritional Maintenance
-Paralytic ileus may occur, requiring NG tube
-Monitor fluid and electrolytes
-Nutrition should be started within 72 hours
nutrition for spinal cord injury
-High-protein, high-calorie diet
-Possible parenteral nutrition
within 72 hours
Neurogenic bladder management
-Indwelling urinary catheter
-Strict aseptic technique
-↑Fluid intake
-INTERMITTENT CATH PROGRAM
intermittent cath program monitor for
-Every 4-6 times daily
-Monitor for signs and symptoms of urinary tract infections
Temperature Control
-No vasoconstriction, piloerection, or heat loss through perspiration below level of injury
-Temperature control is external
-Monitor environment and body temperature
-Do not use excessive covers or unduly expose patient
Autonomic Dysreflexia
*a massive uncompensated cardiovascular reaction mediated by the sympathetic nervous system. (T6 or above) causing activation of autonoic NS
Autonomic Dysreflexia clinical manifestatioins
-Hypertension (up to 300 mm Hg systolic)
-Throbbing headache
-Marked diaphoresis above level of injury
-Bradycardia (30 to 40 beats/minute)
Autonomic Dysreflexia interventions
(potentially life threatening emergency!)
-Elevate head, sit upright—lowers ICP to counter HTN
-Notify HCP
-Assess for and remove cause
-Immediate catheterization
-Remove stool impaction if cause
-Remove constrictive clothing/tight shoes
-Monitor and treat BP
