Week 8 Oxygenation Perfusion SCI

Question 1

Hyperflexion SCI

Answer 1

head is suddenly and forcefully accelerated forward, causing extreme flexion of the neck.
often occurs in car accidents
Head tilts forward

Question 2

Hyperextension SCI

Answer 2

head is suddenly accelerated and then decelerated.

Head tilts back

Question 3

Axial loading SCI

Answer 3

Diving accidents, falls on the buttocks, or a jump in which a person lands on the feet

Question 4

Examples of secondary SCI

Answer 4

Hemorrhage, Ischemia, Hypovolemia and Neurogenic shock (a medical emergency)

Question 5

Priorities in initial assessment of SCI

Answer 5

ABC
High resp risk
Hemorrhage
LOC (possible TBI)
Motor and sensory status for baseline

Question 6

Spinal shock

Answer 6

occurs immedieatly after injury and lasts 48 hours to weeks

Loss of motor, sensory, reflex, and autonomic function

Question 7

Cardiovascular changes caused by loss of sympathetic input in SCI

Answer 7

Bradycardia, hypotension and hypothermia may lead to dysrhythmias

Question 8

At what systolic level does hypotension need tx and why

Answer 8

below 90 mmHg because there may be a lack of perfusion to the spinal cord

Question 9

Common respiratory complications after SCI

Answer 9

atelectasis, pulmonary emboli and pneumonia

Question 10

Paralytic ileus

Answer 10

GI complication of SCI

Develops within 72 hours due to decreased peristalsis is spinal shock

Question 11

Abdominal bleeding in SCI

Answer 11

Hemorrhage may occur from trauma or stress ulcers from steroid use

Question 12

Result of LMN lesions

Answer 12

flaccid muscle paralysis leading to muscle wasting

Question 13

Result of UMN lesions

Answer 13

muscle spasticity which can lead to contractures

Question 14

Hypertrophic ossification

Answer 14

complication of immobility

bony overgrowth into muscle

Question 15

Urinalysis after SCI

Answer 15

testing for hematuria after trauma

Question 16

Respiratory tests after SCI

Answer 16

End tidal CO2 or ABG to monitor resp status

CO2 and respiratory acidosis = respiratory failure

Question 17

Blood tests after SCI

Answer 17

Check for low hemoglobin, leukocytosis, lymphocytopenia, and thrombocytopenia indicating lack of autonomic innervation to the hematopoietic (blood-cell producing) system.

Question 18

Imaging assessment after SCI

Answer 18

CT or MRI to determine damage to spinal cord and presence of blood
Full x-rays should also be done

Question 19

6 priority problems for SCI patients

Answer 19

1. difficulty breathing (UMN injury)
2. Neurogenic shock (mostly T6 and above)
3. Further SCI r/t swelling/fractures
4. Impaired mobility/ self care
5. bowel/bladder dysfunction
6. Maladjustment

Question 20

Interventions to prevent neurogenic shock

Answer 20

adequate hydration through PO and IV fluid

Question 21

Who is at risk for neurogenic shock?

Answer 21

SCI above T6 within 24 hours of injury

Question 22

Flaccid bladder

Answer 22

LMN injury

may achieve continence using valsalva maneuver

Question 23

Key features of autonomic dysreflexia

Answer 23

Sudden severe, throbbing HA
Severe, rapid HTN
Bradycardia
Flushing above lesion (face and chest)
Pale extremities below lesion
Nasal stuffiness
Sweating
Nausea
Blurred vision
Piloerection
Feeling of apprehension

Question 24

Immediate interventions for autonomic dysreflexia

Answer 24

#1 Sit Pt up
loosen clothing
Asses/ treat cause (urinary, bowel, temp)
Monitor BP
Give nitrates