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NUR4630 > Week 7: Spinal Cord Trauma > Flashcards

Week 7: Spinal Cord Trauma Flashcards

1
Q

How to know if pt is coroners case

A
  • less than 24 hours

- pt who just came out of surgery

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2
Q

Ideal time frame for doing post mortem care

A

-1 hour

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3
Q

Spinal cord begins and ends?

A

Spinal cord begins at the foramen magnum in the cranium and ends at the L1-L2 vertebra level

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4
Q

Spinal nerves continue until?

A

continue to the last sacral vertebra

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5
Q

Grey matter

A

voluntary and autonomic motor neurons

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6
Q

white matter

A

ascending and descending motor fibers

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7
Q

Posterios column dorsal

A

touch, proprioception and vibration sense

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8
Q

lateral spinothalamic tract

A

pain, temp sensation

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9
Q

lateral pyramidal

A

voluntary movement

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10
Q
  • originate in cerebral cortex
  • project downward
  • result in skeletal muscle movement
  • injury: spastic paralysis
A

upper motor neurons

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11
Q
  • originates at each vertebral level
  • project to specific parts of the body
  • results in movement/sensation
  • injury=flaccid paralysis
A

lower motor neurons

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12
Q

-skin innervated by sensory spinal nerves

A

Dermatones

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13
Q

Reflex arc

A

involuntary response to a stimulus without direct input from the brain

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14
Q

myotome

A

muscle group innervated by motor neurons

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15
Q

sympathetic response

A
  • fight or flight
  • everything centralized into core system of the body
  • tachycardia
  • dilated bronchi and pupils
  • middle portion of spinal column
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16
Q

parasympathetic

A
  • constriction of the pupils
  • constriction of lungs
  • hr slows down
  • both at the top and bottom (brainstem and s2-4)
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17
Q

etioloy of traumatic SCI

A
  • MVA (motor vehicle accident)most common cause
  • falls, violence, sport injury
  • SCI typically occurs from indirect injury from vertebral bones compressing cord
  • SCI frequently occur with head injuries
  • Cord injury may be caused by direct trauma from knives, bullets, etc
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18
Q

primary & secondary spinal cord injury

A
  • right when the injury happens, immediate injury to spinal cord
  • secondary is physiological response to the trauma: ischemia, hypoxia, hemorrhaging, edema
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19
Q
  • due to loss of vasomotor tone
  • SNS loss results in arasympathetic dominance with vasomotor failure
  • loss of SNS innervation causes peripheral pooling and decreased cardiac output
  • hypotention and bradycardia
  • orthostatic hypotension and poor temperature control (poikilothermic)
A

neurogenic shock

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20
Q
  • decreased reflexes and loss of sensation below the level of injury
  • motor loss: flaccid paralysis below level injury
  • sensory loss: touch, pressure, temperature pain, and proprioception perception below injury
  • lasts days to months
A

spinal shock

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21
Q

how do you know spinal shock resolving

A

Clonus: one of the first signs

  • hyperflexia of foot
  • test by flexing leg at knee and quickly dorsiflex the foot
  • rhythmic oscillations of foot agains hand
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22
Q

classification of SCI

A

mechanism of injury
skeletal neurologic level
completeness (degree) of injury
Mechanism of injury: felxion, hyperextension, compression, felxion/rotation

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23
Q

flexion (hyperflexion)

A
  • most common because of natural protection position

- generally cause neck to be unstable because of stretching of the ligaments

24
Q

hyperextention

A

caused by chin hitting a surface area, such as dashboard or bathtub
-usually causes central cord syndrome symptoms

25
Q

compression

A
  • caused by force from above, as hit on head
  • or from below as landing on butt
  • usually affects the lumbar region
26
Q

flexion/rotation

A
  • most unstable
  • results in tearing of ligamentous structures that normally stabilize the spine
  • usually results in serious neurologic deficits
27
Q

skeletal level vs neurologic level

A

skeletal level: vertebral level where the most damage to the bones

neurologic level: the lowest segment of the spinal cord with normal sensory and motor function on both sides of the body

28
Q

after spinal shock:

  • motor deficits:spastic paralysis below level of injury
  • sensory: loss of all sensation perception
  • autonomic deficits: vasomotor failure and spastic bladder
A

complete (transection) degree of SCI injury

29
Q
  • injury to the center of the cordd by edema and hemorrhage
  • motor weakness and sensory loss in all extremities
  • upper extremities affected more
A

incomplete degree of SCI, central cord syndrome

30
Q
  • hemisection of cord
  • ipsilateral paralysis
  • ipsilateral superficial sensation, vibration and proprioception loss
  • contralateral loss of pain and temp perception
A

incomplete classification of SCI, brown-sequard syndrome

31
Q
  • injury to anterior cord
  • loss of voluntary motor, pain, and temp perception below injury
  • retains posterior column funtion (sensations of touch, position, vibration)
A

incomplete classification of SCI, anterior cord syndrome

32
Q
  • least frequent syndrome
  • injury to the posterior (dorsal) columns
  • loss of proprioception
  • pain, temp, sensation, and motor function below the level of the lesion remain intact
A

incomplete SCI, posterior cord syndrome

33
Q
  • clonus medullaris: injury to the sacral cord (conus) and lumbar nerve roots
  • cauda equina: injury to the lumbosacral nerve roots
  • result: are flexic (flaccid) bladder and bowel, flaccid lower limbs
A

incomplete SCIs

34
Q

upper motor deficits result in?

A

spastic paralysis

35
Q

lower motor deficits result in?

A

flaccid paralysis and muscle atrophy

36
Q

paresis

A

weakness

37
Q

plegia

A

paralysis

38
Q

c1-c3 are?

A

usually fatal

  • ventilator dependent
  • no bowel/bladder control
  • electric wheelchair with chin/mouth
39
Q

loss of phrenic innervation causes?

A

dependent on ventilator

40
Q

C6 injury

A

weak grasp

  • has shoulder/biceps to transfer/push wheelchair
  • considered level of independence
41
Q

T1-6

A
  • full use of upper extremity
  • transfer
  • drive car with hand controls and do ADL’s
  • no bowel/bladder control
42
Q

immediate care of spinal injury at scene

A

-transport with c-collar
-assess abc’s
iv for life line
ng to suction
foley

43
Q

solumedrol

A
  • pt started within 4, treated for 24 hours of solumedrol
  • within 8 hours, treated for 48 hours
  • to decrease edema around spinal cord
44
Q

medications for SCI

A
  • vasopressors to maintain perfusion
  • histamine H2 blockers to prevent stress ulcers
  • anticoagulants
  • stool softeners
  • antispasmodics
45
Q

gardner-wells tongs

A

on weights, versus halo which is put onto the patient with a brace

46
Q

physical exam of spinal injury pt.

A
  • LOC and pupils, may have indirect SCI from head injury
  • respiratory status-phrenic nerve (diaphragm) and intercostals, lung sounds
  • vital signs
  • motor
  • sensory
  • bowel and bladder function
47
Q

c6, t4, t10

A

c6: thumb
t4: nipple
t10: naval

48
Q

Nursing problems/interventions

A
  1. impaired mobility
  2. impaired gas exchange
  3. impaired skin integrity
  4. constipation
  5. impaired urinary elimination
  6. risk for autonomic dysreflexia
  7. ineffective coping
49
Q

ROM is done?

A

every 2 hours

50
Q

how to deal with constipation in SCI

A
  • bowels rely on more bulk than nerve
  • stimulate bowels at the same time each day. Best after a meal when normal peristalsis occurs
  • individual may progress from Dulcolax suppository to glycerin then to gloved finger for digital stimulation
  • assess bowel sounds prior to giving food for the first time-paralytic ileus!
51
Q

goal for residual in bladder scan?

A

residual <100ml/20% of the bladder capacity

52
Q

urecholine

A

stimulates bladder contraction

53
Q

risk for autonomic dysreflexia description

A
  • SCI above T6
  • Results in loss of normal compensatory mechanisms when sympathetic nervous system is stimulated
  • Life threatening-if goes unchecked BP an result in cerebral hemorrhage
  • Vasodilation symptoms above SCI
  • Vasoconstriction symptoms below SCI
  • the cause of SNS stimulation
54
Q

What one lab would you check with regards to skin integrity

A

-pre-albumin

55
Q

autonomic dysreflexia nursing interventions

A
  • elevate HOB-causes orthostatic hypotention
  • indentify cause/alleviate if full bladder/cath, if skin/ remove pressure, if full bowel/ empty, etc
  • remove support hose/abdominal binder
  • monitor BP- can get >300 S
  • Give PRN medication to lower BP
  • If above not effective-call physician
56
Q

What is the max amount of urine you can safely empty out the bladder at one time?

A

800mL

57
Q

ineffective coping/sexuality nursing interventions

A
  • assess readiness/knowledge/their ability
  • use proper terminology
  • suggestions: empty bladder before sex, withhold fluids and antispasmodics, certain positions may increase spasms, explore new erogenous zones, penile implants
  • refer to specially trained counselor

NUR4630 (34 decks)

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