week 10 : mobility Flashcards
issue of mobility what could be the reason/cause ?
genetic ( inherited ) e.g duchenne muscular dystrophy
demyelination of nerve fibers
degeneration of neurons in brain
true or false. issue of mobility: one of them being is degeneration of motor neurons and injury to the bone
true
injury to spinal cord ( vertebra or edema pushing on cord ) is also seen as an issue of mobility
yes this is true
what else can bring an issue of mobility ?
impact on the pt ( mind and body ) and family
issue of mobility : impact on nursing care
true
issue of mobility : medications - treat the disease and treat problems caused by decreased mobility , is this true or false.
true
what other genetic disease can be a reason for issue in mobility ?
change of muscular dystrophy , ms , parkinson disease
what injury can be a reason/cause
spinal cord injury
higher level injury - higher impact
als and gillian burre
what is the impact on the patient ? ( mobility )
mind - fatigue, self identity, depression , independence, awareness of how they will die
recall that body is the one impacted if there is an issue with the mobiliity , what undergoes this ?
cns depression ( significant pain )
— neuropathic pain, and complex
explain how cvs system could have an impact on the patient
blood clots and pressure ulcers
what undergoes resp since this would be affected
atelectasis and pneumonia patietn can lose ability to clear their resp secretions
what undergoes GI as this would be a problem
GI ability to swallow and get good nutrition
GU problem with incontinence /can also have UTIS , is this true ?
yes this is true when it comes to mobility
how would pyschosocial be affected?
lose their sense of self and identity they have is different ( alot of significant anger ) because they lose their personal independence
impact on nursing care
resp system ( can pt clear secretions ) ?
if u have a pt who cna cough well their lungs is okay but if ot what possibilities are we looking at ?
atelectasis and secretions
impact on nursing care : body/limb alignment
what is happening
pain, muscle spasm, and perfusion
turning/repositioning – looking at the skin , how frequent are we turning ?
2 to 3 hours ( look at the pressure ulcers )
it is important to assesment the body and mind why ?
no big pressure underneath hand
thinking pressure points and what the skin looks like - help plan their future
moblity : what else are they in risk for that we should look out for ?
risk of falls ( and working hard is managing pain ) always looking for complications
what type of meds are we going to give them
prevent potential complications ( e.g dvts )
treat pain ( noiceptive, neurogenic )
treat muscle spasm
maintain general health ( breathing , nutrtion, prevent infeciton )
lets also give them the best mattress
equipment and skulls needed and used
wheelchairs, braces, canes, aspen collar
splints, pillows, roho cushions prosthetics
lifts, turning sheets/sliders , transfer board
true or false. staff to assist with mlt
teds/scds, binders, assistive devices ( feeding, writing, bathing )
communciation boars are something we utizlied as equipment and skills needed and used
true
spirometer, feeding tubes, urianry catehrs are also used.
true
what type of medications are we going to utilized ?
slow disease progression ( nerve impulses )
prevents clots
manage pain
decrease muscle spasms
antidepressants
true or false. it is important that a pt takes a med that decrese fatigue and prevent constipation and gu issues such as bladder
true
meds that prevent a lot of probelms
antidepression is big and decreasing fatigue ( make more energy ). is this true or false.
true
interprofessional
who are we working with ?
rt
social worker
rehabilitation units and ltc
sppech language therapist/patholigst
- communicating /swallowing/eating -0 swallowing assemsnet
recall that : rt
social worker
rehabilitation units and ltc
sppech language therapist/patholigst
- communicating /swallowing/eating -0 swallowing assemsnet
are interprofessional we are going to be working with , who else ?
PT
- rom , prevent contractures
-steghtening muscles
-chest physio/pulmonary toileting
OT
- wheelchairs/canes/walkers
-splints
-special cushions (roho ) to relieve pressure
-teach pt how to manage
mobility-diseases
nursing care - the pt is thinking what ?
what is the cause of this disease
curable ? any treatment?
what are the symptoms ?
how can the symptoms be managed?
will this be likely cause my death ?
how bad will it get
duchenne muscular dystrophy ( pediatris )
cannot be caught ( basically means the muscle is weakening )
this is genetic
chronic progressive and incapacitating disease
respirtory problems for duchenne msucular dystrophy
ecause their chest muscles get progressively weaker
there might be another kid that has a cough, this kid might get sick and continue on ( cannot fight it off )n
cardiac dysfunction for duchenne muscular dystrophy
cardaic rhythym abdnomalities ( encho and ekgs once a year to keep an eye on them )
obesity ( the child is not able to lose calroues. not active ) for duchenne msucular dystrophy
this is true
social isolation and pt and fmaily coping discussion s- possible transheotomy , ltc, end of life directives for duchenne muscular dystrophy
this is true
these patients die in their 20s and 30s ( shorten life despentencies )
everything gets worst
mobility gets impaired
they also get contractures
( they are a problem ) the goal is to maintain optimal functioning and prevent contractures
in terms of duchenne muscular dystrophy is this true or false
this is true
penumonia/ clearing penumonia and all of that could be seen within duchenne mucucla rdistrophy
this is true
look at slif 4 for the child walking for the musuclar dystorphy for duchenne
okym
ms describe it
chronic progerssibe remission.exacerbation
what is ms
autoimmune disorders of cns and demyelination of enrve fibers ( brain sinal cord and optic nerve )
what are the s and s for ms
motor, sensory, fatigue, pain , pt manage independence rest adn self care
dx and minotr for ms
hx, s and s
evoked repsonse testing
true or false canada has the hgihest rating for ms
true
not going to the bathroom normally
myelin is basically attack and tried to regenerate
what we see is chronic inflmmation and scaring
this is desciring ms
no discovery yet that fizes this diseases ( the cuase is unknown ) but researches have been dne in mb becauee its so high
yes this is ms
yes it is
what is ms - oerall goal and care
funtioning, independance, in daily living, mamage fatigue, mental health , adjust, reduce factors that lead to exacerbations
what is retaline for in ms
give ore energy dont ahve a ath later on teh day after a goodnight sleep lots of differnt things to do
dvt penumonia pressure ulcer atelectasis patingteaching is help these people help overal healthy life for ms
yes this si true
- Triggers/exacerbations
- Hospitalization
- Pt teaching
are needed for ms overall goal and care
yes this si tru
what is importnt for ms potarntially
learn how to straight cath themselves ( invcontinent out and about is decrease )
bladder will retain urine and habe reflex emptying , they do not have control over it
yes this is true for ms patients
bowel issues and such would what in ms overall goal an care
lactulose or peg
IF THESE PEOPLE ARE HOSPITLIZED ( DIAGNOSTIC WORKUP ) ACUTE EXACERBATIONS ( on bed rest ) fam and friedns need help
ms yes this sit rue
reduce stress/fatigue/ rest throughout the day/. extreme temperatures
very hot temp is very difficult for pts
also extreme cols
anu type of infections ( stomach flue
yes this sis true or ms ( autoimmune )
define if these are signs of duchenne muscular dystrophy ( not walking properly )
shoulders and arms are held back awkwardly
sway back
weak butt muscles ( hip straightens )
add 3 more
yes
knees may bend back to take weight
thick lower leg muscles ( the muscle is mostly fat, and not strong )
tight heel cord ( contracture ) child may walk toes
why does the belly stick out during duchenne muscula dystrophy
belly sticks out due to weak belly muscles ( child is poor at situps )
thin weak tights ( especially front part for duchenne muscle dystrophy )
yes this is true
what is the balance like for ducehnne muscle dystrophy?
poor balance : falls often , awakward clumsy if walking
weak muscles in front of leg cause foot drop, and tip toe contractures : this is true amongst duchenne muscular dystrophy
true
medications for ms
what is our goal here ?
hint** what is steroid used for ?
goal is decrease progression of disease and control symptoms
treatment acute exacerbations ( edema, inflammation at site of demyelination )
define if these medications are being utilize for MS
- Medications
– corticosteroid (methylprednisolone, prednisone)
– immunomodulator (Betaseron, Avonex)
yes this is true
recall if these meds are used for ms : * Medications :
– corticosteroid (methylprednisolone, prednisone)
– immunomodulator (Betaseron, Avonex)
– immunosuppressant (Methotrexate, Imuran, Mitoxantrone)
– anticholinergic (Ditropan) – help with bladder symptoms (tone)
– fight fatigue (Ritalin)
– antispasmodic (Baclofen)
what is ritalin for ?
we use this in ms
helping to fight fatigue ( to give more energy ) pill taken 3 times a day ( decreae muscle spasm ) getting to know their own body and how theyre body reacts ( side effects )
what is three biggest indicator of parkinson disease ?
tremors
rigidity
bradykinesia
what is parkinson disease disease process?
chronic, progressive, degenerative disease of cns
affects movement : slow to move, rigidity and tremors
what are the s & s : for parkinson disease
tremors, rigidity, slow to start moving also depression, fatigue, pain, constipation
dx & monitor : Hx and s and s
no dx test
for parkinson disease are those descriptions accurate
yes it is accurate
instead of diagnostics what are we checking for parkinsons pts ?
theres no specific diagnostic test
head to toe ( check reflexes, get checked with fam and put it together )
true or false. patients have swallowing problems because of what ?
because of the muscle weakness meds that are helpful for this disease ( dopamine receptors and transmitting neurons )
recall that remors of the hands even at rest
persistent tremors
are seen with parkinsons
what else ?
shuffling gait
unbalanced & small in steps, curved in characteristic way
if meds are late for parkinson pt what happens ?
if these meds are late — it affects their mobility
what is our goal in terms of meds for parkinsons
correct imbalance of neurotransmitters within the cns
ng care for parkinson
manage issues for mobility, communication, nutrition ( swallowing ) adapt activities
what are the different type of meds we are giving parkinson pts
dopaminergic ( L- dopa, sinemet )
beta adrenergic blocke ( inderal ) - manage tremors
*titrate dose to effect, combination of meds
*symptoms will progress, worsen
parkinson disease - overall goal and care
can have a risk of what ?
risk of falls
we want them to exercise, ( really decrease their muscle atrophy )
decrease contractures also getting exercise plan with physio therapist
what are different things we are utilizing for parkinson’s disease as an overall goal and care
physical exercise
diet
physio
sleep issues
dep and anxiety
physical exercise
diet
physio
define these in terms of PD
have trouble ingesting foods, swallowing or coughing
swllowing assesments may need , maybe diced tomake it easier to chew and swallow
safety alert for falls ( they need to adapt )
sleep issues
dep and anxiety
cognitive function change
define for PD
satin shees, and satin pajamas ( have huge impact on turning and sliding )
dep and anxiety- makes so many changes for them
cognitive function change - notice settle change in their cognitive ( even progress to full dementia )
Severe mobility issues (airway, ventilation)
what is ALS
amyotrophic lateral sclerosis
what is the descrption of ALS
progressive paralysis, mind is intanct
- no treatment , no cure, supportive care
what does als patient need eventually ?
tracheostomy and ventilator
what does medically assisted suicide mean ?
they know whats going to happen ( hard disease ) and take care of ,
upset and knows whats going to happen
what is Guillain barre syndrome
symmetrical ascending paralysis, demyelination of peripheral nerves , +++ pain peaks at week 3
what is the rate of recovery for gbs
85 percent
what is the treatment for gbs
plasmapheresis and ivig
what is ivig for gbs
intravenous immunoglobulin
infusion get from blood taken
the amount of pain for some people
for als no pain ) but for als ( pain ) tingiling , boarding lighting bols
disese peaks aorund 3 weeks meaning bad its gonna get
trueor false.
true
for gbs what happens when u have the stomach flue ?
ba stomach flue ( whole immune system goes cracy and theyhave this prolem now ) ‘alot of the time they have them sick before a resp gi problem ( not sick enough to go tot he hospital ) but then they develop this
cause and symptoms of gbs
obstruction of myelin, known as demyelination
what are the symptoms?
paralysis, including loss of breath
loss of reflexes
muscle weakness
recall that paralysis, including loss of breath
loss of reflexes
muscle weakness
are all symptoms of gbs what else?
prickly, tingling sensations in the arms and legs ( paresthesia )
mobility - injury/trauma
what type of diagnostics test are we running ?
xray, ct scan, mri
what is th neurovascular asssment are we doing for mobility - injury/trauma
color, temp, cap refull, distal pulses, edema, sensation , motor function , pain
what is the number one priority in neurovascular assesment
the number one priority is color
what do we want to prevent in mobility- injury/trauma
prevent resp complications ( db and coughing ) , spirometry, turning, ROM exercsies
what is ROM exercsies?
range of motion exercises
aside from resp complications : what else do we want to prevent ? ( for injury/trauma )
we want to prevent pressure ulcers
if they havea cast on, we need to think where is the cast hitting them
pain should improve overtime ( as the bone is healing ) if pain is not improving ( they are a complication ) is this true or false.
this is true
what is critical in our neurovascular assessment
distal pulses, edema, sensatin, motor function
what are the meds that patient is on when they have moblity issues such as injury or trauma
manage pain( baclofen, nsaids, narcotics, t3s )
phantom limb pain with amputation
prevent system complications for immobility
- cosntipation ( stool softeners ) , clots ( heparin, enoxaparin )
if someone had a rib fractures, would we encourage deep breathing and coughing ?
bruh no, this is extremely painful and it is not advisable
given this scenario , look at the mar before
fentanyl only 3 times now 4 times and pain is still there
what do u think could be happening
something is cooking up cant lie ( look further )
( pain is getting worst )
what is the general care for bone injuries
what undergoes alignment
midline, neutral position
wehat is traction in terms of geenral care for bone injuries
pulling force to keep alignment ( promtoes bone healing, dec muscle spasm , prevent furhter soft tissue and vessel injury )
true or false. it is major to assess neurovascular status for our general care for bone injureis
yest his is true
what else are we asesing for in terms of our genral care for bone injrueis
surgical site, hematoma
assess for complications such as …
for general care for bone injuries
infeciton, venous thromboemvolism, ( dvt, pe ) infection ( wound for skin or abscess )
recall that these are complications that could occur within bone injres what else could occur ?
recall : infection, venous thromboembolism (DVT, PE), infection (wound
fr skin or abscess
osteomyelitis/hardware inserted
acute compartment syndrome, fat embolism ( something that can kill the pt )
managing pain is also crucial for our general care for bone injuries is this true or false?
bonus : what type of pain are we going to encounter for these patients?
muscle spasm, bone pain, soft tissue injury
fracture can be open or closed. what does this mean
literally open ( see the bone )
close ( cannot see anything but ) but imagine what is going to do with the vessels and cause issues inside
what is the biggest risk for open fracture
high risk of infection and they should have tetanus immunization ( again increase of infection )
what is the RICE acronym
rest
ice
compresison
elevation
what are we going to assess for fractures and what else after tha
assess vascular status/perfusion
additional tissue/vessel damage
with fractures bone reducion is one of the option , what does this mean ?
bone reduction but closed method ( pulling or open method surgery ) called fixation , aignement , possibltiy traction, immobilize, time to heal
for fractures could we utilize splints and orthopedic boots/shoes , cast
yes we can !
what is the serious consequence that could happen with fractures
vertebrae ( SCI - spinal cord injury ) , pelvic, hip
what are we giving the pts before bone reduction
give pain killers or ketamine or block ( try to pull force and try to pull it back to place )
external fixation
what is happening ehre
pin site care
vascular assessment
alignment
pain should decrease with time
what is the question we are asking the patients : for external fixation
is it warm, any pain in his toes ?
( white thing — thick sponge , soak in covid dome and wrap it around bascially the scew from the hardware into the leg bone )
how is cast like in external fixation
plastic fiber glass
vascular assesment - pain assesment and management complciations ( watch out for it )
and general care
what if it swells even more, thinking abt any type, of problems or complications that could happen here : what is this describing
external fixation
plaster cast go on wet and a then dry give off heat is this true in terms of external fixation
yes this is true
ORIF - open reduction internal fixation : what is this
to stabilize a long bone fracture, a plate and screws outside the bone or a rod inside the bone may be used
in terms of infection and weight bear for open reduction internal fixation what undergoes it
reduced it - put everything on alignment , internal fixation - inside there they put in hardware
leave hardware in or something things have heal up ( take it out ) depends on the situation
true or false in terms of open reduction internal fixation
true
true or false.u put in a rod or a plate with screw for open reduction internal fixation
true
traction - skin or skeletal
done operation and xray the operation in the or still not quite an alignment
true or false.
true
what is skin traction ?
short term treatment also uses light weight ( grabbing the skin ) as far weights 2-3 to 4.5 kg ( this is temporary )
like a skin tenser, bandages, and then pulling in to the skin
this undergoes what
skin traction
what is a skeletal traction
this is where something is drilled into the patients bone , meaning the skeleton
bone right at the skeleton short term treatment
what is a skeletal traction
the weight is heavier and reuse for a longer amount of time ( needs more pull to get it aligned )
nurses don’t decrease or increase the weight ( don’t touch the wound )
call ortho tech to do it
true
weight to hang freely - not rest on the floor
bucks traction
u cannot have this weight on the ground , nurses do not have to set this up
bone fractures NCP
where does this undergo to
splinting, traction alignment , analgesia, pressure points
through neurovascular status
what undergoes this for bone fractures
skin color and temp , moveent, sensation, pulsses , cap refill, pain
bone fractures NCP : analgesia
what undergoes this
pain shoulde decrease
bone fractures ncp
manage edema ( ice, elevate ) this is true in terms of bone fractures.
true
teach pt about care, clarify activity level ( increasing mobility )
they cannot wear bear on that leg ( hip that is fracture, clear the orders )
proper nutrition is important
increase fibre intake and increase fluid intake 2- 3 liters
complications of #
assessment and intervention treatment :
skin
blood clots
fat embolism syndrome
infection ( open fractures )
this is true
acute compartment syndrome what is a possible complication with this
possible fasciotomy
pressure ulcer, wet/macerated skin : go more in depth about this
high risk of breaking down , guy in the collar worries about under his chin and neck
shoulder ( these are patients on gogles ) we always do 2 nurses ( one person sits head of the bed and the other person takes off collar and wet wash cloth )
deep vein thrombosis : give details about this
mainly blood clot ( big thing here is prevention )
heparin or dalteparin
true or false. sometimes they do not work ( gets blood clot ) the whole plan changes
heparin subcut ( give bolus iv heparin ) based continues of heparin no longer subcut
true. heparin works fast and gets out of ur skin fast, coumadin takes a while
what would u like to increase when it comes to DEEP vein thrombosis
increase mobility as much as possible
we want to turn these patients every 2 to 3 hours
make sure we are doing range of motion exercises where they are working with physio
what is fat embolism syndrome: go more in depth
two long bones
10% of these people die
fat globules from the bone fracture- breaks off and float through your body
what is the sign and symptoms of fat emoblism syndrome
significant hypoxia, tatchycardia, tachypnea , and dyspnea
what is this describing : confuse or pass out ( mental status ) sometimes they can get restless
respiratory rate will go up and try to get more oxygen in and pending
sense of pending due is they think something terrible has happened ( sats will go down )
fat embolism syndrome
what is typically the signs and symptoms of fat embolism syndrome
signs and symptoms is poor oxygenation , and what is usually seen first is the patients mentation
intubated not on ventilator
early infection generally occurs for how long ?
less than 2 weeks after surgery S & S : increasing local pain, redness, swelling, wound drainage, disturbed wound healing, fever
what is typically the infecting organisms for infections
typically, infecting organisms are highly virulent ( staphylococcus aureus , gram negative bacilli, clostridial infections ( gas gangrene or tetanus )
acute compartment syndrome is what ?
huge build up of fluid outside (cast ) inside ( edema )
what is this describing : could have outside pressure or inside pressure
acute compartment syndrome
how do we release pressure when someone has acute compartment syndrome
cut cast
fasciotomy
need to regain perfusion
true or false. if its not a cast ( inside pressure ) therefore it is edema
bonus: what do they have to do ?
fasciotomy
how does the doctor make the incision for acute compartment syndrome
the doctor will get sterile stuff , scapel and make an incision all the way down there
u can see the body smile, the pressure is so big
what is fasciotomy ?
not simple to heal
perfusion is not getting to it
DO NOT ELEVATE the leg , it’ll make it worse
what should we not do : other than do not elevate their legs ( fasciotomy )
no cold compresses ( vasoconstrictor )
if it was just a tenser ( losen )
if its a cast ( call the doctors and ortho and get them to deal with it )
fasciotomy : true or false. this wound needs to heal from inside out, packing dressings, likely need a skin graft or some other method of slow/constant closure
true
black sterile sponge in the wound bed ( largest clear tape all over it ) and attach the tubing to it and make a hole sterile scissors and attach it to eh machine so it suctions fluids
: what does this undergo to?
fasciotomy
Hip
what undergoes the charactersitics
elderly ( significant of death, osteoporosis increases risk )
pain management/multimodal approach, geriatric dosing, regional nerve block
when it comes to hip
this is true
ng quality care for hip
timing of surgery, mobility, nutrition, foley fr uti, delirium
recall : that these timing of surgery, mobility, nutrition, foley fr uti, delirium undergoes ng quality care , what else?
pneumonia, constipation, vte, pressure injury, discharge plan, bone health
hip : traction - alignment/turning
true
people with hip issues typically may need what ?
may need pinning or replacement a replacement is reffered to as prosthesis - risk for hip dislocation
activity orders for hip is what ?
char, ambulate, weight bear
use of abduction pillow to prevent hip dislocation after toal hip replacement , what are we doing
1) affected leg should not cross the center of the body
2) hip should not bend more than 90 degrees
3) affected leg should not turn inward
what do u have to think about when it comes to the pelvic
think abt internal organs ( bowel, bladder, urethra ) what we worry abt is bone fracture could actually damage organs
could cause irrigate the vessels
stops doing tis thing
pelvic is not life threatening ?
it is life threatening - high mortality rte
what can cause a serious intra abdominal injury
pelvic
- lacerate an organ ( urethra , bladder, colon )
-lacerate a vessel ( hemorrhage )
-paralytic ileus
pain medication, stool softeners are utilized in pelvic
yes this is true
Non-weight baring#(bedrest, painful; heal in 2
months – may need rehab/PT after)
for pelvic
true
Weight baring # - need OR (external fixation, ORIF or both: severity of injury/potential need for traction determines when pt can weight bare
is this true in terms of pelvic
yes this is true
surgery ( they get hardware put in ) depending on where it is broken
non weight bearing ( heals on its own ) need some things such as rehab and physio
true in terms of pelvic
in pelvic , they have these hardware that stay in there forever
this is true
spinal cord injury : is what ?
what are the diagnostics we are looking at
injury to a vertebrae that impacts the cord
dx: xray, mri
what is the level of injury of spinal cord injury
C,T, L , vertebrae
vertebra #
complete or incomplete ( more common )
bone like a vertebrae you will have problems ( and fractures or elg fractures ) your cord has sensory and motor neurons. Is this true or false.
this is true
if u have a vertebra #
what happens
never breathe on their own again ( spinal cord injury )
elbow crunches
level of injury is huge (tells us what the future will tell us for the patient )
level of injury could be complete or incomplete ( more common )
this is true
impact on the bod systems : loss of or decreased mobility, sensory perception and bowel and bladder control often result for an sci
this is true
the higher the injury the more the effect on the body
this is true ( spinal cord injury )
cross messages right through cord or incomplete
damage part of the cord ( usually right where the bone came off )
yes this is true
what happens if there is a c4 injury
c6 injury
c4- tetraplegia
c6- tetraplegia
what happens if there is a t6 injury
or L1 injury
t6- paraplegia
L1- paraplegia
where is cervical located close to ?
right by the neck
sacral : complete right through the cord cannot move it cannot feel it. true or false.
true
what is this describing : that area of spinal nerve is involve with
dermatomes
this is a good image of what an injury or part of the body infected on the level : what is this describing
dermatones
c6
t4
thumb
nipple line
level of injury will tell us what will be the impact on the patients functioning ?
tells us what that patient functioning will be and will be focusing on our care
( when we think abt the injury the primary injury right when the accident happens )
injury : what is the initial/primary injry
actual physical disruption of axons
what is secondary inury
ongoing, progressive damage that occurs after the
initial injury
the damage from the primary
make the injury itself a bit worse
what is this describing ?
secondary injury
what is the goal for injury ?
prevent further cord damage/extension of injury
____ or ____ because of that secondary injury
t4 or t3
what is the whole goal for injury
to prevent more poor damage
we do not want the secondary injury to happen ( we immobilize them ) and think abt collars
is this true or false.
this is true
how can we prevent further cord damage/extension of injury
immobilize and methylprednisolone
IV a big dose
( for 24 to 48 hours )
all that to prevent more swelling or secondary injury
true or false.
true
spinal shock
true or false. it does affect vital signs , not only spinal cord
false. it does not affect your vital signs
spinal shock
what happens in the body ?
that is not permanent
this is temporary - it depresses all the cord function
decrease reflexes, and we also have lose sensation
true or false. spinal shock also causes flaccid paralysis , below the level of injury , this is a bit of a shock
true
true or false. spinal cord injury are at risk for spinal shock happening but only 50 percent o them get it
true
spinal shock may mask what
post injury neurologic function
when we get this patient ( never gonna move their arms again ) but once this spinal shock wears off then they move there arms
what is the treatment for spinal shock ?
last from days to months
there is none
we dont have to wait to get to patient
is there an active rehab in spinal shock
no treatment or active rehab right away
resolves overtime
once it resolves
we might see that the functioning is actually better than we initially thought
complete sci assessment
( spinal cord injury )
effects depend on the level of injury
resp c1-3 ( these injuries are fatal , these people have apnea ( cannot breathe in ) they cannot cough
if these people do live, they will need 24 hour help for the rest of their life
if someone has c4 injury what happens
if someone is injured a bit lower c4 - may be able to breathe without a ventilator ( but they have a poor cough )
diaphragmatic breathing or hypoventilation ( they do not take big breaths )
what happens if someone has c5-t6 injury ( complete sci )
c5-t6 they have decrease resp reserve ( decrease resp reserve means u and i can get cold and feel crap and feel okay ) that cold can turn into horible pneumonia and can be fatal ( if they get sick )
muscle weakness - cannot talk very loud ( cannot get air to get through vocal chords )
maybe even a weak voice
below t6 , what is the injury
no problem with resp system
phrenic nerve
the cervical plexus ( make your diaphragm move )
CVS : above T6 complete sci assesment
absence of vaso motor tone - they also have postural hypotension
they also have lower heart rate, low blood pressure
( abdominal binder ) something that helps these people
complete sci assesment
GI : above T5
they cannot control bowel movement or sometimes cannot they need to go
no bowel sounds
people with gi problems above 75 what type of problem do they often have ?
have often have problems with paralytic ileus
also problems with abdominal distension,constipation, and fecla incontinence
complete sci assesment : GU T1-L2
they cannot control when they void
urinary this is retention
urine is flaccid , kidneys will make urine and sit there
gu. true or false doesnt get the urge to move away, there bladder can reflex empty
true
in the photo describe how the man is ( try to recall the picture )
tracheostomy
got an iv
pump probably tube feed pump
in the photo ( try recalling the photo )
why bother wearing sneakers ?
runners and when u are not walking runner helps keep their foot protected, and keep their heels flat
keep tendons from wanting to shorten
s
sci : effect on pt and ng care ncp
manage airway and improve breathing , resp chest physio ( pulmonary toileting )
SCI: Effect on Pt & Ng Care NCP
* Manage airway & improve breathing p881 Respiratory “chest physio” “pulmonary toileting”
what undergoes this
effort ( work of breathing )
abg ( po2 and c02 levels )
air entry ( atlectasis ) , asuculate breath sounds
adequate cough ( pneumonia )
cough assist
what undergoes cvs : sci : effect on pt and ng care ncp
rics neurogenic shock
adequate hydration, dec CO
DVT, PE
muscle spasm, neuropathic pain
DV, PE ( because they are immobile )
what type of intervention are we utilizing for muscle spasm and neurpathic pain
baclofen , sometimes necrotic
effort of breathing and how strong their heart is
cough assist is take a deep breaths and say cough and move in their upper abdomen to help them cough
yes
cough as hard as u can ( not hard at all )
cvs thinking risk for neurogenic shock
true
neurogenic shock : what is it ?
loss of sympathetic innervation
neurogenic shock
what does this do ?
vital signs
neuro genic shock happens because they have losee their sympathetic innevration
what type of vasodilation do neurogenic shock get ?
they get peripheral vasodilation
also get venous pooling
and decrease in cardiac output
who is at risk for neurogenic shock ?
low blood pressure and low heart rate these patients are warm and dry
they do not feel cold and calmy which they should since low bp and low he
people who are at risk is injured from t5-or above what is this describing ?
neurogenic shock
what are the s & S for neurogenic shock ?
low blood pressure and low heart rate
( treat this blood pressure )
true or false. neurogenic shock is always a problem ( life long )
this is true may have to put medarine meds that brings up blood pressure
what are the s and s resolution
systolic of 60-75 if we do nothing
it may not go up and this is trouble and can lead to hear attack ( keep an eye on this )
when is this goingaway ?
when vital signs become more normal
bowel and bladder retraing
GI neurogenic bowel
hypotomotility and management ( bowel routine ) –> bowel routine this is usual colace everyday , doing this suppersitory, every second day
bowel and baldder retraing , what do we have to make sure ?
getting enough nutriton and fibre
bowel and bladder retraing
GU neurogenic bladder
what undergoes it
urgency, frequnrecy, incontinence
management
decreasing the risk of UTIs
getting enough nutrition and fibre
for gu ( neuro genic bladder ) problem with what ?
urgency , frequency, incontinence
these people may need to ct staright of then is always better than stragiht cath than indwelling foley
GU ( neurogenic bladder ) . tru or false.
true
if patient cannot straight cath, they may given indwelling foley
true
nutrition/GI : bowel and bladder retraing
nutrional intake
metabolism
ulcer protection
first 6 months are hypermetabollic meaning they are not moving they are burning calories a lof of calories, make sure they have enough calories and proteina dn metbaplism is the high at the start because of what ?
muscle wasting
ulcer protecting — what type of medication are we doing ?
PPI h2 we want to make sure they are getting enough nutrition and not a bleeding ulcer
bowel and bladder retraing :what else?
thermoregulation ( poikilothermia )
skin inspection : skin care, comfort, mattress; roho cushion for wheelchair
these pts are a high level of injury ( be careful of body temp )
will take on the environment temperature
los the ability tor regulate it
true or false.
bowel and bladder retraing : sexuality , rehab process, emotional/mental health
sexuality
-sensation
-fertility
rehab process
- expectations regarding recovery ( related to level of injury )
emotional/mental health
-greif/loss, depression
-goal is pyschosocial adjustment
stabilization and alignment : harcd vercial collar
other than that what else
crutchfield tongs
- weight/bed angle
-turning/logroll
-washing skin and pin site care
stabilization and alignment : harcd vercial collar
other than that what else
recall : crutchfield tongs
- weight/bed angle
-turning/logroll
-washing skin and pin site care
what else ?
halo vest
- patient and family education
alters patient’s balance
-skin and pin site assessment and care
-washing skin under vest liner
- emergency wrench
is traction and stabilization short or long term
this is short term
what is the situation for the patient like during traction and stabilization
just to get them stable enough
patient is npo
turn him ( had to make sure )
foley and clean him and clean the bed again
turn a tiny bit ( shift to the weight is okay )
summary of sci management in acute care
give a run down of the meds
and surgery
meds :
methylprednisone
dopamine
atropine
surgery : ( stabilize, realign, spinal column )
- laminectomy, fusion
blood pressure up, for dopamine and get heart rate up with atropine is this true or false.
this is true
how does lainectomy work ?
dr will go in or prone ( faced down ) and make an incision, in that area clean out bone fragments, and clean up any blood and out in hardware
how is the patient going to recover furing laminectomy ?
back on the unit, and rule is discontinued to get the pt to move around and get up in the wheelchair
and then move on to rehab
what is non surgical intervention for sci management n acute care
spinal immobilization and stabilization
what do they wear in sci management in acute care
wear hard cervical collar , halo fixation device with jacket
recall : what do they wear in sci management in acute care
wear hard cervical collar , halo fixation device with jacket
then when physcially stable the focus move to what ?
physio ( stretching, stregtening, balance 0
braces/canes/wheelchair/mobility
rehab and hospital leaving unit on day passes
adl and mobility training
autonomic dysreflexia whcih sci pts are at risk ?why does it occur ?
injured at t6 , or above high level injury problem
why does this ocur ? because of a reflex neuro sympathetic response of vasoconstriction
autonomic dysreflexia
why does it occur ?
slower imbounded pulse
high blood pressure is one
heart rate could be in the 0s or 40s the patient feels terrible, bad headache, blurred vision, and even flushed above the level of injury
autonomic dysreflexia what is it ?
a massive uncompensated cvs reaction mediated by the sns
recall that : a massive uncompensated cvs reaction mediated by the sns
autonomic dysreflexia
sns response to stimuli > reflex vasococntriction below injury and vasodilation above injury
- the return of reflexes ( after spinal shock has resovled) means that hse pts may develop autonmic dysflexia
what are the s and s for autonomic dysreflexia
systlloc 180-200
slower imbounded pulse
( high blood rpessure is one )
heart rate could be in the 0s or 40s the patient feels terrible , bad headache , blured voison
and even flushed above the level of oiijiry
ng care and tc for autonomic dysrefelxia
vasodilator
- we want their blood pressure to be down
first thing we do is nursing care , et their head of bed head up
- figure out what is the cause and idea with that
fixed whatver cased this happen : autonomic dysreflexia , is this true or false
this is true
possible causes of autonomic dysreflexia ?
full bladder, things like a full bowel ( alot of stool in their rectum ) and even like shoes on too tight when was the last time u catherized ur self ? staight cath would solve the problem
true or false. it is important ot eh tach the pt an family
true what can happen person can have stroke or seizure if not contorlled of blood pressure
teach patient and fmailt identify signs and tratments tis can happen in t6 or above
amputation
what undergoes this ?
