Unit 7 Chapter 40 Spinal Cord Injury Flashcards
Causes of Spinal Cord Injury
- Trauma
- Violence
- Falls
- Tumors
- Cervical Spondylosis
- Herniated intervertebral disk issues(compression)
What is an Incomplete spinal cord injury
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
What is complete spinal cord injury?
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
Complications of SCI
Loss of or decreased mobility, sensory perception, and bowel and bladder control often result from an SCI.
Your patient has sustained a thoracic spinal injury in T5, Where would you assess complications?
A. C1
B. C2
C.T3
D.T6
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
Would your patient with a C1 spinal cord injury require mechanical ventilation?
A. No
B. Yes
B. Yes
How many vertebraes are in the spine (cervical+thoracic+lumbar)
A. 7
B. 15
C. 20
D. 24
D. 24
How many vertebraes are in the cervical collum
7
How many vertebraes are in the thoracic collum
12
How many vertebrates are in the lumbar collum
5
What is Quadriplegia
Quadriplegia – also called tetraplegia
* Paralysis of all 4 extremities
* Quadriparesis is weakness affecting all 4 limbs
What is Paraplegia
Paraplegia * Paralysis involving only the lower extremities * Paraparesis is weakness of lower extremities
If the cervical collum is damaged, What assessment should you initiate first?
Cardiovascular assessment or Respiratory investment?
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.
ABC’S
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.
Spinal Injuries above C4 , Patients become?
A. Tetraplegic
B. Paraplegic
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
Injury to C7–pt. usually…
Injury to C7 usually can lift shoulders, elbows, wrists and has some hand function
Will patient with a C4 and above spinal injury need intubation with a mechanical ventilar?
A. No
B. Yes
B. Yes
Nursing Intervention for mechanical ventilator?
-GI prophylaxis
-monitor for high and low-pressure alarms
-Immediately provide nutrition through TPN
-Get Post intubation ABG’s
Medical tx
- steroid to decrease inflammation
-pantoprazole to prevent stress ulcers
Nursing Care for SCI?
-stabilize patient
-move as one unit especially clients with Halo devices
What occurs immediately after spinal injury?
A. spinal shock
C. neurogenic shock
A. spinal shock
What is Spinal Shock
*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
S/s of Spinal Shock
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.
Sympathtic function(speed)
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.