Test 3/Midterm Flashcards
SCI Hyperextension vs. hyperflexion
neck forced back vs. neck forced forward
Most unstable mechanism of SCI injury
Rotation due to torn ligaments
SCI Initial injury (axon disruption) examples
cord compression (bone displacement, interruption of blood supply, pulling/stretching cord) or penetrating injury (gunshot, stab wound)
SCI Secondary injury (ongoing, progressive damage) complications
hemorrhage, edema, free radical formation, calcium influx, ischemia
SCI Cervical injury priority
breathing
SCI Thoracic injury priorities
breathing and shock
SCI Complete injury
- worse prognosis
- loss of voluntary movement/sensation below the injury
- reflex activity below injury may return after spinal shock resolved
SCI Incomplete injury
- remember ABCs
- better prognosis
- varying degrees of motor/sensory loss below
- central/lateral/posterior injury
SCI Central cord syndrome
- forced hyperextension
- sensory/motor deficit upper>lower
- “can walk to the door but can’t open it”
SCI Anterior cord syndrome
- hyperflexion or spinal artery injury
- loss of motor, pain, temp, with mixed sensory loss
- touch, proprioception, vibration remain intact
SCI Brown-Sequard syndrome
- penetrating trauma
- same side as injury: loss of motor, touch, pressure, vibration, BUT pain/temp intact
- opposite side of injury: loss of pain/temp, BUT motor, touch, pressure, vibration intact
SCI Cauda equina/conus medullaris
- compression of lumbar/sacral area
- conus: T11-L1/cauda: L2-sacral
- Flacid (atonic) bowel/bladder
- impaired sexual function
- motor loss, but sensory unimpaired
- motor and B/B function best indicator of return of cord function
C4
top of shoulders, if above: high risk, ventilator dependent
C6
thumb
C7
middle/ring fingers
C8
little finger
T4
below nipple line
T10
below umbilicus
T12
loss in groin
L4
variable: big toe, buttocks, genitalia
S1
top of small toe, perineal/anal numbness
SCI Neurogenic shock mechanism and assessment findings
- SCI above T6
- loss of sympathetic tone results in massive vasodilation
- hypotension
- bradycardia
- poikilotermic
SCI Neurogenic shock management
- determine underlying cause
- support airway
- fluids (possibly, if no spinal shock)
- vasopressors (atropine)
- temp control
SCI Spinal “shock”
- d/t acute SCI
- absence of all voluntary/reflex activity/sensation below
- recovery: bradycardia/hypotension persist after resolution, return of anal wink/spasticity/bladder
SCI medication therapy
- methylprednisolone (SoluMedrol) 30mg/kg over 1 hour, then 5.4mg/kg/hr for 23 hours
- improves profusion, prevent cell membrane breakdown, improves energy metabolism, better odds of moving to a higher sensory/motor category
SCI Autonomic dysreflexia (hyper-reflexia)
- sudden onset of excessively high BP (250/150)
- T6 or above
- triggers: full bladder, infection, pain, skin damage
SCI Autonomic dysreflexia S/Sx
- hypertension/bradycardia
- Below (sympathetic): cool skin (vasoconstriction), goosebumps
- Above (parasympathetic): headache (#1 sign), flushed face/warm skin (vasodilation), nasal congestion
SCI Autonomic dysreflexia nusing assesment/priorities
- HTN/brady
- empty bladder/bowel (no digital stimulation)
- monitor BP q5min
- find and remove negative stimuli
- call MD after treatment/finding cause
SCI Spinal precautions
- log roll
- hard collar in place if ordered
- TLS orthotics on unless orders to remove
- tongs in alignment
SCI Breathing interventions
- do not perform after eating (may induce vomiting)
- quad cough
- glossopharyngeal breathing
SCI Mobility interventions
- reduce skin breakdown
- ROM, splinting
- prevent PE, use PAS stockings
SCI Flaccid bladder nursing interventions
- PVR <100mL indicates training is working
- encourage fluids to prevent stones/UTI
- do not allow >500mL in bladder
SCI Spastic bladder nursing interventions
- stroke inner thigh
- warm water over perineum
- anal stimulation (not cardiac patients)
- PVR<100mL
SCI Skin integrity nursing interventions
- check skin with every turn q2h
- maintain normal body temp
Meningitis take away point
knowing the specific cause will direct treatment
Meningitis exudate formation
Exudate formed with bacterial, NOT viral
Pneumococcus vs. meningococcus transmission
Pneumococcus: droplet (also viral)
Meningococcus: inhalation or direct contact
Positive signs of meningeal irritation
Kernig’s: pain in back when lifting hip/knee while supine
Brudzinski’s sign: severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed
Nuchal rigidity: an inability to flex the neck forward
Meningitis most common assessment findings
fever, headache, photophobia
Meningitis pt. with petechial hemorrhagic rash
very ill, advanced disease process
Meningitis lumbar puncture: bacterial vs. viral
bacterial: cloudy CSF, low or no glucose (bacteria using), increased pressure, protein, neutrophils
viral: clear or cloudy, protein/glucose normal, elevated lymphocytes
Meningitis hyponatremia
from SIADH
Lumbar problems: diagnostic gold standard
MRI
Lumbar problems: medical Tx
activity (limit bedrest)
also: PT, hot/cold packs (with order), medications
Lumbar problems: Teaching post-op
- wear brace TLSO device at all times while out of bed
- report changes in sensation
- maintain good body alignment (log roll, no twisting)
Seizures: Generalized 2 types
tonic-clonic (grand-mal) and absence (petit-mal)
Tonic-clonic seizures
aura, loss of consciousness, tonic then clonic movement, B/B incontinence, tongue biting, salivation, post-ictal phase: HA, sore, tired, amnesia
Absence seizures
interruption of consciousness, seen in peds, vacant staring, altered awareness or loss of environmental contact
Simple partial (focal) seizure
no loss of consciousness, single muscle group progressing to adjacent, autonomic, deja vu
Complex partial (focal) seizure
impaired LoC, simple to complex, unaware, bizarre behavior (lip smacking, automatic movement)
Febrile seizures
children with high temps, treat with tylenol, tepid bath, IV/rectal if valium necessary
Phenytoin/Dilantin intervention
oral care
EEG nursing considerations
before EEG: no caffeine, tranquilizers, sedatives, etc. Call to clarify anti-convulsants. Make sure pt. eats.
Status Epilecticus
medical emergency: prolonged seizures without regaining consciousness for 30 mins
Status Epilecticus management
oxygenation (may require intubation), start IV, protect from injury, administer drugs as ordered, control seizure activity with Ativan
Seizure family teaching
no driving 1 year, oral care, no baths, meds at same time each day, awareness of aura, lifestyle mods
