Unit 2: Assessment + Interventions for Spinal Cord Injuries Flashcards
Patient teaching to prevent Spinal Cord Injuries (SCI)
- Avoid taking risks (HAHA yeah right)
- Use protective measures (helmets, pads)
- Wear a seatbelt
- Avoid impaired driving
- Avoid diving in shallow water (need ~9 feet)
Patient History r/t an acute SCI aims to identify how it occurred and the probable mechanism of injury. Questions include:
- Location and position immediately after injury
- Sxs immediately after injury
- Changes that have occurred subsequently
- Type of immobilization devices used
- Problems that occurred during stabilization and transport
- Tx given at the scene of injury or ED
- Medical Hx including osteoporosis or arthritis of spine, congenital deformities, cancer, and previous injuries or surgeries of the neck or back.
- Hx of respiratory problems (esp. if cervical SCI)
Diagnosis of an SCI (4)
- Dermatomes
- X-ray
- Spinal CT
- MRI
What two Diagnostic tests can determine the degree and extent of spinal cord damage?
CT and MRI
What type of SCI is at the highest risk for respiratory compromise? What about CV compromise?
Cervical SCI (C3-C5) → “C3/C4 = breathe no more”
SCI Above T6
3 Main assessments following an SCI
- ABCs
- Neuro (LOC, Glasgow Coma Scale)
- MS + Sensory (Myotomes/Dermatomes, DTRs)
The Priority assessment following an SCI
ABCs! → Respiratory status is first priority
1. Establish airway
2. Assess breathing (RR/pattern/effort)
3. Assess BP + peripheral perfusion (pulses, cap. refill, color, temp) + indications of hemorrhage
Why are we assessing Dermatomes/Myotomes?
To determine the level of injury for motor and sensory function and establish a baseline
Assessments to perform HOURLY following an acute SCI and findings that require immediate call to Rapid Response
- SpO2 (<95%)
- Sxs of Aspiration (Stridor, garbled speech, inability to clear airway)
- Symptomatic Bradycardia (LOC, decreased U/O)
- Hypotension (SBP <90 or MAP <65 mm Hg)
If the pt develops a decrease in sensory perception &/or a new loss of motor function/mobility from baseline, what should you do?
Notify provider!
Considered an EMERGENCY!
How often should we, in collaboration with RT, perform a complete respiratory assessment for a pt with a cervical SCI? What should this include?
q 8-12 hrs; breath sounds q 2-4 hrs for first few days
Breathing (RR/pattern/effort), SpO2, arterial O2 saturation
Able to breathe independently? Shallow? Able to cough?
Keeping in mind the major causes of death r/t an SCI, an SpO2 of <92% + adventitious breaths sounds may indicate a complication such as
Pneumonia or Atelectasis!
CV Assessment r/t an SCI
- HR (bradycardia)
- ECG (dysrhythmias)
- BP (hypotension/orthostatic hypotension)
- Temp (hypothermia)
A systolic BP of <__ mmHg requires immediate Tx because of lack of perfusion to the spinal cord could worsen the pt’s condition due to _____ to the SCI.
A systolic BP of <90 mmHg
Hypoxia
Interventions for Bradycardia <50-60 bpm
Atropine, Pacing
Interventions for Hypotension
IV Vasopressors (Dopamine, etc.)
_________ _____ is a complication of spinal trauma and causes a sudden loss of communication within the SNS which maintains normal muscle tone in blood vessel walls. Causes peripheral vasodilation leading to venous pooling + dependent edema in the extremities, a drop in cardiac output, bradycardia, and life-threatening hypotension.
Neurogenic Shock
Neurogenic Shock Interventions
Treated based on Sxs
1. IV fluids for hypotension
2. IV Vasopressors for hypotension
3. BP Meds for bradycardia
Respiratory Interventions
- Maintain SpO2 >95%
- Pulmonary hygiene (secretions, suctioning, IS)
- Quad cough
- Respiratory support (BiPAP, Trach, ventilator)
GI/GU Assessment r/t an SCI
- Assess for Internal bleeding (trauma, ulcer, stress)
- Bowel sounds (Paralytic ileus w/in 72 hrs)
- Bladder distention (U/O)
What assessment findings would we see if the pt developed Autonomic Dysreflexia?
S/S of SNS stimulation!
1. Sudden HTN
2. Bradycardia (reflexive)
3. Severe HA (from HTN)
4. Nasal congestion
5. Profuse diaphoresis + Flushing above injury
6. Pale, cold skin + Goosebumps below injury
7. Fever
Patients at the greatest risk for developing Autonomic Dysreflexia are those with altered
Sensory perception!
What’s the biggest risk/complication r/t Autonomic Dysreflexia we should monitor for?
Hemorrhagic stroke due to severely elevated BP
Prevention of Autonomic Dysreflexia
- No extreme room temps
- No tight fitting
- Indwelling catheter
- Assess GI for fecal impaction
- Meds
- Stool softeners
- BP meds (Clonidine)
Immediate Interventions for Autonomic Dysreflexia
- Raise HOB and sit pt UP
- Call Rapid Response
- Determine the cause (urinary retention, UTI, kidney stones, fecal impaction, pressure injury)
- Monitor BP q 10-15 min
- Administer Meds to lower BP
- Nifedipine or Nitroglycerin
Spinal Precautions:
What is “BLT”
B = bending—Avoid bending spine
L = lifting—Don’t lift more than 5-10 lbs
T = twisting—Don’t twist neck or back
Spinal cord Precautions
- Support head
- Firm surface/mattress (no specialty air mattress)
- Log Roll
- Teach “BLT”
- Follow MD orders
Spinal cord Precautions
What type of MD orders may we see?
- Bedrest
- HOB orders
- Sit limits (time spent sitting, etc.)
- Cervical Collar
- TLSO Brace/Clamshell
Medications for SCI
- Muscle relaxers (Tizanidine, Cyclobenzaprine, intrathecal baclofen)
- Steroids
- Pain Mx (gabapentin, lyrica, NSAIDs)
- BP Mx
- Stool softeners
Non-Surgical Tx of SCI
- Spinal cord stabilization (cervical collar, halo fixator, skeletal traction, log roll)
- Aggressive rehab
