Unit 7 Chapter 40 Spinal Cord Injury

Question 1

Causes of Spinal Cord Injury

Answer 1

• Trauma
• Violence
• Falls
• Tumors
• Cervical Spondylosis
• Herniated intervertebral disk issues(compression)

Question 2

What is an Incomplete spinal cord injury

Answer 2

Injuries that allow some function or movement below the level of the injury are described as an incomplete SCI.

Able to convey some messages to or
from the brain

-more common

Question 3

What is complete spinal cord injury?

Answer 3

A complete SCI is one in which the spinal cord has been damaged in a way that eliminates all innervation(nerve function) below the level of the injury

Question 4

Complications of SCI

Answer 4

Loss of or decreased mobility, sensory perception, and bowel and bladder control often result from an SCI.

Question 5

Your patient has sustained a thoracic spinal injury in T5, Where would you assess complications?
A. C1
B. C2
C.T3
D.T6

Answer 5

D.T6

ALWAYS ASSESS THE SITE BELOW THE INJURY

Below the level of injury functions lost are: Voluntary movement Sensation of pain, temperature, pressure & proprioception Bowel & bladder function Spinal & autonomic reflexes

Question 6

Would your patient with a C1 spinal cord injury require mechanical ventilation?
A. No
B. Yes

Answer 6

B. Yes

Question 7

How many vertebraes are in the spine (cervical+thoracic+lumbar)
A. 7
B. 15
C. 20
D. 24

Answer 7

D. 24

Question 8

How many vertebraes are in the cervical collum

Answer 8

7

Question 9

How many vertebraes are in the thoracic collum

Answer 9

12

Question 10

How many vertebrates are in the lumbar collum

Answer 10

5

Question 11

What is Quadriplegia

Answer 11

Quadriplegia – also called tetraplegia
* Paralysis of all 4 extremities
* Quadriparesis is weakness affecting all 4 limbs

Question 12

What is Paraplegia

Answer 12

Paraplegia * Paralysis involving only the lower extremities * Paraparesis is weakness of lower extremities

Question 13

If the cervical collum is damaged, What assessment should you initiate first?

Cardiovascular assessment or Respiratory investment?

Answer 13

RESPIRATORY ASSESSMENT

CERVICAL COLLUM DAMAGE IS A MEDICAL EMERGENCY

The higher the damage the patient will not be able to raise shoulders or shake their head, swallow.

Question 14

ABC’S

Answer 14

The initial and priority assessment focuses on the patient’s ABCs ( a irway, b reathing, and circulation). After an airway is established, assess the patient’s breathing pa ern. The patient with a cervical SCI is at high risk for respiratory compromise because the cervical spinal nerves (C3-5) innervate the phrenic nerve controlling the diaphragm.

Question 15

Spinal Injuries above C4 , Patients become?
A. Tetraplegic
B. Paraplegic

Answer 15

A. Tetraplegic

Injury above C4 causes tetraplegia and may be fatal because pt. cannot breathe independently

NO MOVEMENT OF HANDS OR LEGS , WILL MOST LIKELY CANNOT BREATHE ON THEIR OWN AND WILL NEED A MECHANICAL VENTILATOR

Question 16

Injury to C7–pt. usually…

Answer 16

Injury to C7 usually can lift shoulders, elbows, wrists and has some hand function

Question 17

Will patient with a C4 and above spinal injury need intubation with a mechanical ventilar?
A. No
B. Yes

Answer 17

B. Yes

Question 18

Nursing Intervention for mechanical ventilator?

Answer 18

-GI prophylaxis
-monitor for high and low-pressure alarms
-Immediately provide nutrition through TPN
-Get Post intubation ABG’s

Question 19

Medical tx

Answer 19

• steroid to decrease inflammation
  -pantoprazole to prevent stress ulcers

Question 20

Nursing Care for SCI?

Answer 20

-stabilize patient
-move as one unit especially clients with Halo devices

Question 21

What occurs immediately after spinal injury?
A. spinal shock
C. neurogenic shock

Answer 21

A. spinal shock

Question 22

What is Spinal Shock

Answer 22

*Shock associated with acute injury to the spinal cord.
* Occurs immediately of spinal injury.
* Immediate loss of sympathetic cord function below the point of injury.
EVERYTHING SLOWS DOWN

Can last days to 1-6 weeks or may continue 3 months

Question 23

S/s of Spinal Shock

Answer 23

Characteristics:
* Paralysis
* Hypotension
* Bradycardia
* Hypothermia
* Respiratory Failure—if cervical or upper thoracic
* Bladder/bowel distention
* No perspiration below level of injury—*Temperature impairment

• Spinal shock often last less then 48 hrs. but may continue for several weeks until body adjusts.
• MRI or CT to determine level of injury. Cord edema peaks 2-3 days & subsides usually within 7 days of injury.

Question 24

Sympathtic function(speed)

Answer 24

Sympathetic
*fight or flight response.
*Involved in maintaining homeostasis and also,
*The sympathetic system prepares the body for any potential danger.
*Increases heartbeat, muscles tense up. *The pupil dilates to let in more light.
*Saliva secretion is inhibited.

Question 25

Parasympathetic function (poor)

Answer 25

Parasympathetic *permits the rest and digest response. *The parasympathetic system aims to bring the body to a state of calm. Has comparatively longer neuron pathways, hence a slower response time. *Reduces heartbeat, muscles relaxes. * Saliva secretion increases, and digestion increases. No such functions exist in “fight or flight” situations. *rest and digest

Question 26

Complications of Spinal shock

Answer 26

Effect causes temporary (transient) depression of all reflexes = - paralysis (flaccid) - loss of sensation - loss of autonomic function - loss of B & B control (Sometimes priapism)

Question 27

What would your patient report when spinal shock is coming to an end neurogenic shock is starting? A. low heart rate B. hypothermia C. muscle weakness D. hyperreflexia

Answer 27

D. hyperreflexia Spasticity or hyperreflexia signals end of this shock

Question 28

drug class of choice to decrease inflammation in the spine?

Answer 28

corticosteroids EMS treatment starts with ( A/c-spine BC’s) and steroid drugs to reduce inflammation and help to prevent further damage to cellular membranes that can cause nerve death.

Question 29

When does neurogenic shock occur

Answer 29

after injury has occured

Question 30

Medical Managament

Answer 30

Decrease inflammation - Corticosteroids * Prevent Hypotension – Dextran * Treat Hypotension if not prevented - Dopamine * Prevent Bradycardia - Atropine sulfate * Reduce Pain – Opioids * Reduce Spasms – Skeletal muscle relaxant *stool softner

Question 31

Injury T6 or above are at risk for Autonomic Dysreflexia? A. No B. Yes

Answer 31

B. Yes

Question 32

What is autonomic dysreflexia

Answer 32

This condition can occur suddenly (at any time) after spinal shock subsides. It is an exaggerated sympathetic response to spinal injury above T6. The patient’s body cannot counteract the sympathetic response. -caused by any pressure on spine **RAPID EMERGENCY**

Question 33

s/s of Autonomic Dysreflexia

Answer 33

**Severe hypertension** * Bradycardia *headache * If injury in cervical area—respiratory failure and death (diaphragm paralyzed) * Numbness/paralysis * If cord completely severed, permanent paralysis Sudden, significant rise in systolic and diastolic blood pressure, accompanied by bradycardia * Profuse sweating above the level of lesion—especially in the face, neck, and shoulders; rarely occurs below the level of the lesion because of sympathetic cholinergic activity * Goose bumps above or possibly below the level of the lesion * **Flushing of the skin above the level of the lesion—especially in the face, neck, and shoulders** * Blurred vision * Spots in the patient’s visual field * Nasal congestion * **Onset of severe, throbbing headache** * Flushing about the level of the lesion with pale skin below the level of the lesion * Feeling of apprehension

Question 34

Why is managing BP imprtant

Answer 34

to prevent Autonomic dysrexia

Question 35

Nursing intervention for Autonomic dysreflexia

Answer 35

**SIT PATIENT UP** **INCREASE HOB** **FREQUENT PRESSSURE RELEIVE** **STAY FAITHFUL TO BOWEL REGIMEN** **EAT A WELL BALANCED DIET **STAY CONSISTENTT WITH DIET**

Question 36

Patient teaching for autonomic dysreflexia GU AND GI

Answer 36

- you need to straight cath yourself multiple times a day -you need a stool softner DAILY TO PREVENT SPINAL PRESSURE

Question 37

PATIENT TEACHING

Answer 37

Frequent pressure relief in bed/chair Avoid sun burn/scalds (avoid overexposure, use of #15 sunscreen, watch water temperatures) Faithful adherence to bowel program Keep catheters clean and remain faithful to catheterization schedule Well balanced diet and adequate fluid intake Compliance with medications

Question 38

Emergency Care Autonomic Dysreflexia

Answer 38

**Emergency Care Autonomic Dysreflexia**  **Immediate elevate head of bed to a high Fowler’s which lowers BP through blood pooling in lower extremities**  Check sheets for wrinkles  Check for urinary or gastrointestinal retention/impaction lower BP?) Notification  **Call RRT and MD but stay with patient** Look for cause of increased pressure. May need to medicate to lower BP (which meds lower BP , Beta blockers)

Question 39

What is the first nursing intervention for automatic Dysrexia

Answer 39

**SIT PATIENT UP**

Question 40

Family teaching and goal of rehan

Answer 40

Massive task to teach about neuro status, reflexes, activity, equipment, therapies, surgeries, etc. * Will need to relearn self care – usually transferred to a rehab hospital for extended stay after acute hospital care * Goal of spinal cord rehab. is to prevent further loss of function in these patients

Question 41

Key highlights of spinal cord injury

Answer 41

**High cervical spine injury (C1 to C5) quadriplegia** * **Thoracic injury (T1 to T12) + paraplegia (lower extremities)** * **Injuries higher then C4 is paralysis of respiratory muscles=need mechanical vent** * **Remember: Do not move a person with a spinal injury unless their head, neck, spine has been properly supported and immobilized.** * Damage to the spinal column could also progress to spinal cord causing: * Immediate complications—Respiratory distress, spinal shock * Long-term complications—Autonomic dysreflexia and the disorders of immobility

Question 42

Patients with sustained SCI suffer from role changes, it is important to empathize with client and offer therapeutic communication, What is an example of therapeutic communication?

Answer 42

- how do you feel about this -i can only imagine -what concerns you the most -i am free to talk when you are ready -what do you know about the injury -what is bothering you