UNIT 5 - SPINAL CORD INJURY Flashcards
what vertebrae are involved with someone that is a quadraplegia?
cervical through T1
what vertebrae are involved with somene that is a paraplegic?
T2 and below
which vertebrae suggests the sensation on top of the foot and calf?
L3, 4, and 5
which vertebrae suggest the sensation of the umbilicus?
T 10
which vertebrae suggests the sensation of the nipple line?
T4
which vertebrae suggest the sensation of finger sensation?
C7 and C8
which vertebrae suggest the sensation of the collar bone?
C 3 or C4
what is the point of the asia chart?
to help plan goals and make realistic rehabilitation plans
what type of mobility or assistance does one have with a C1-C4 spinal injury have ?
power wheelchair, use sip and puff or straw to operate. sling lift. these patients are completely dependent and will need help with ADLs
what type of mobility or assistance does one have with a C5-C6 spinal injury have?
use of biceps and wrist extension. power wheelchair with joystick, need help with ADLs and transfers
what type of mobility or assistance does one have with a C7-C8 spinal injury have?
now have triceps. light weight manual wheelchair. self transfer with a side board. self intermittent catheter and assistance with bowel care.
what type of mobility or assistance does one have with a T1-T9 spinal injury have?
may load wheelchair into car. independent.
what type of mobility or assistance does one have with a T10-T12 spinal cord injury?
manual wheelchair, long leg brace but balance issues. need canes or crutches to hold them up. they could potentially get fatigued.
what is important to keep in mind with Gardner Wells Tongs?
the tongs are screwed in the skull through the dura mater. must be careful of infection.
The ____ vest is preferred over bed based traction (Gardner Wells Tongs)
halo
____ keep vertebrae in line so don’t move weight or pick them up.
weights
what is used to stabilize and immobilize the spine?
- collars
- braces
- surgery
- Gardner-Wells Tongs
- C spine reduction and stabilization
when is emergency surgery performed in regards to a spinal cord injury?
spinal cord compression
- bone fragments
- hematomas
- penetrating objects
what are the goals of surgery?
- manipulation to correct dislocation
- decompression laminectomy to prevent ascending edema
- spinal fusion
- wiring or rods to hold vertebrae together
what is the fixed traction used to realign the vertebrae, facilitate bone healing and prevent further injury?
- worn for 8-12 weeks
- wrench used to remove vest when CPR is needed
- no driving b/c the patient can’t look over their shoulder
halo vest
what care needs to be done for the halo vest?
- one q tip per one pin placement. ensure that the pins are not loose. that would allow for the halo to migrate.
- neosporin, (1/2 strength peroxide in a one to one ratio with normal saline) and zeroform
- NEVER USE ALCHOHOl
- clothes are usually worn over it
pin site care.
what surgical intervention is used for a thoracic or lumbar spinal injury? REASONS: - alignment - stability - earlier rehab
- spinal fusion
- using wiring
- steel or metal rods (anterior/posterior)
- stabilizing the spine
- internal fixation (rods along spine)
what is the nurses focus when caring for someone with spinal rods?
- log rolling
- continuous assessment of motor, sensation, and mobility
- pain control
- tissue integrity
** if there are any motor changes notify the physician asap!
what is used after thoracic surgery?
thoracic lumbar sacral orthosis.
- this needs to be put on before getting out of bed.
what are some of the side effects of stopping baclofen (muscle relaxant) abrupty?
seizures
what anxiolytic and sedative is used to treat muscle spasms in those with a spinal cord injury?
diazepam
what muscle relaxants are used in spinal injury plan of care?
- tizanidine
- dantrolene
- baclofen
what does piokilothermia mean?
take on the temperature of the environment
piokilothermia occurs in those especially with a spinal cord injury at T6 and _____. this is due to loss of dilation and constriction of blood vessels below level of injury. They also have the inability to shiver.
above
what are some concerns with spinal cord injury in regards to hyperthermia?
- loss of sympathetic control of sweat glands below level of injury
- can not sweat when temperature increases
- many not see temperature elevation with infection (be mindful of environment)
incontinence and sudden voiding. when there is urine the bladder gets excited and causes sudden voiding however it does not empty completely.
spastic bladder
when there is an upper spinal injury (cervical and high thoracic injury) there is a _____ bowel and bladder. The reflex arc is intact. When there is urine the bladders get excited and causes sudden voiding but doesn’t empty completely. Trigger techniques are needed. However when there is a lower spinal injury (lower thoracic and sacral) there is a ______ bowel and bladder, and the reflex arc is affected. When this occurs additional stimulation is needed to initiate voiding. The bladder does not contract, and can overfill. Valsalva maneuver is used but be cautious b/c it can lower BP. The Crede Maneuver is also used and this is simply pushing on the bladder.
spastic ; flaccid
what is done to aid with elimination in spinal cord injuries?
- consistent toileting routines
- should be every 2 hours during the day and every 3-4 hours at night. catherterization.
what is the patient at risk for when the bladder overfills?
- infection
- decreased urinary function
- kidney stones
which care should be done first ? bowel or bladder?
bladder
____ decreases ecoli in urethra.
yogurt
what kind of juice decreases bacterial growth?
cranberry
what type of catherization helps improve self care and independence?
clean intermittent cath
- want > 150 mL but <500 mL
- <80 mL should be retained
- cath 4-6 times per day
- most have chronic bacteriuria
- if >500 mL then cath more often
what is the mitrofanoff surgery?
takes the appendix and uses as fistula and make a passageway from umbilicus to the bladder
_____ disimpaction is needed when the bowels are flaccid.
manual
______ are given 30 minutes after meals, in an upright position to stimulate peristalsis in those with spastic bowel. given at the same time everyday to train bowel.
suppositories (bisacoyl)
what should one consider with someone with a neurogenic bowel?
- bowel training
- high fluid and high fiber
- stool softener ( docusate) increase water in the gut
- suppositiories (bisacodyl)
- digital rectal stimulation
- enemas
reflex erection.
- most men can: reflex or with stimulation
- overall reasonable possibility of fathering children
- they can ejaculate but the amount/quality of the the sperm may be different
sexual dysfunction in men
less clear effects
- usually remains fertile
- complications: UTI , AD, uterine contractions not felt
- unable to reach orgasm
- ovulation could stop
sexual dysfunction in women
The role of recovery is related to what?
to adjustment more than acceptance
what drug is no longer recommended for SCI?
methylprednisolone
what drugs are used for hypotension?
- dextran (plasma expander)
- norepinephrine
- atropine (bradycardia)
what drugs are used for spastic muscles?
- tizanidine
- baclofen po and intrathecal pump
- diazepam
what drug is used for neurogenic bladder ?
oxybutynin
how is autonomic dysreflexia caused?
- irritation of the bladder wall, UTI and full bladder
- constipation/fecal impaction
- pressure sores/ulcers
- ingrown toe nails
- tight fitting clothing (belts, shoes, tight shoes)
- burns
- bone fractures
- sex
what is used to prevent autonomic dysreflexia?
- cath
- good use of bowel protocols
what the symptoms of AD?
vasodilation above T6: - flushed face - increased BP - headache - distended neck veins - decreased heart rate - increased sweating vasoconstrction below T6: - pale - cool - no sweating
