Week 9 - Spinal Cord Injury Assessment & Meds

Question 1

define paraplegia

Answer 1

• impaired sensory & motor function in the legs

Question 2

define tetraplegia

Answer 2

• impaired sensory & motor function in all 4 limbs

Question 3

what is a complete spinal cord injury

Answer 3

• complete transection

Question 4

what is an incomplete spinal cord injury

Answer 4

• incomplete transection

- results in tract & grey matter specific loss of function

Question 5

the higher the SCI, the _____

Answer 5

more dysfunction

Question 6

what is the significance of a high cervical spine injury

Answer 6

• cervical injury above C5 = total loss of resp muscle function
  = pt requires mechanical ventilation

Question 7

what do injuries below C5 cause

Answer 7

• allow for diaphragmic breathing if the phrenic nerve is still functioning
• but will still see affects on ventilation due to damage to the accessory breathing muscles (intercostal, sternocleidomastoids)

Question 8

what do injuries at thoracic levels cause

Answer 8

• impact the abdominal muscles needed for coughing

Question 9

how does the impact of cervical & thoracic SCI on respiration impact nursing assessment & care

Answer 9

• complete a resp assessment

- pt at risk of hypoxia, pneumonia, atlectasis

Question 10

what is the link between the cardio system and SCI

Answer 10

• injuries above T6 decrease the SNS response
  = vasodilation
  = bradycardia
  = hypotension

Question 11

what effect can vasodilation have

Answer 11

• reduced venous return of blood to the heart

= blood poling in legs

Question 12

what is a primary SCI

Answer 12

• refers to the damaging force or medical condition

- caused by the initial traumatic event

Question 13

what does the primary injury cause (5)

Answer 13

• severed axons
• hemorrhage
• ischemia
• necrotic cell death
• release of pro-inflamm factors

Question 14

what is a secondary SCI

Answer 14

• starts within the first 48 h & continues at leats 6 mo.
• lesion expands and affects adjacent white & gray matter
• created by a series of functional & biological changes

Question 15

what are examples of secondary injury

Answer 15

• hemorrhage
• ischemia
• thrombosis
• edema
• vasospasm

Question 16

see seminar notes for progression of SCI damage

Answer 16

….

Question 17

what does spinal assessment include (3)

Answer 17

• motor exam
• sensory exam
• position sense

Question 18

what does a spinal assessment require

Answer 18

• a safety pin

Question 19

what should you assess during the sensory exam of a spinal assessment (2)

Answer 19

• pain sensation = pin prick

- light touch sensation = dull end

Question 20

describe how to complete a sensory exam for spinal assessment

Answer 20

• pt lay down supine with eyes closed
• instruct pt to say sharp or dull when they feel the object & where they felt it
• alternate between sharp & dull with at least 5 sec between
• move bilat down the body

Question 21

what is position sense

Answer 21

• tested by moving the fingers & toes up or down a few degrees
• pt has to have their eyes closed and say if you are moving it up or down

Question 22

what should you assess during the motor exam of a spinal assessmeny

Answer 22

• muscle strength & tone
• all major muscle groups
• flexion & extension
• give each muscle group a score of 0-5

Question 23

when do we not complete parts of a motor exam

Answer 23

• for complete SCI, do not assess for any muscle group below the injury

Question 24

what does a scor of 0 meaning during a motor exam

Answer 24

• no muscle contraction detected

Question 25

what does a score of 1 mean uring a motor exam

Answer 25

• a trace contraction is noted in the muscle by palpating the muscle while the pt attempts to contract it

Question 26

what does a score of 2 mean during a motor exam

Answer 26

• pt can actively move the muscle when gravity is eliminated

Question 27

what does a score of 3 mean during a motor exam

Answer 27

• pt can move the muscle against gravity, but not against resistance from the examiner

Question 28

what does a score of 4 mean during a motor exam

Answer 28

• pt an move the muscle group against some resistance

Question 29

what does a score of 5 mean during a motor exam

Answer 29

• pt moves the muscle group & overcomes the resistance of the examiner
• normal muscle strength

Question 30

how should you hold the toe during position sense

Answer 30

• on the side to prevent an invalid test

Question 31

what is the link between SCI & stress ulcers

Answer 31

• incidence of gastric ulcers increases in the first 6-14 days after SCI
• high stress from trauma

Question 32

what med can we give to help prevent stress ulcers in SCI

Answer 32

• corticosteroids to reduce edema & inflmmation

Question 33

what is the link between SCI & temp control

Answer 33

• interruption of SNS prevent peripheral temp sensations from reaching the hypothalamus
• sweating & shivering reduced below site of injury
• temp regulation is impacted

Question 34

what is poikilothermism; how can this vary

Answer 34

• inability to regulate temo

- higher than injury = worsened degree of disregulation

Question 35

what are post SCI concerns

Answer 35

• see notes, most are common sense

Question 36

what is autonomic dysreflexia

Answer 36

• massive, uncompensated SNS rxn

Question 37

with what inury does autonomic dysreflexia occur

Answer 37

• T6 or high

Question 38

what does autonomic dysreflexia indicate

Answer 38

• over-activity of the autonomic nervous system

Question 39

what causes autonomic dysreflexia

Answer 39

• a noxious stimulus below the injury lvl sense nerve impulses to the spinal cord
• they travel upward until blocked at the lvl of injury
• since cannot reach, brain does not respond as it normally would
  = activated reflex that increases activity of the SNS

Question 40

what are signs of autonomic dysreflexia (6)

Answer 40

• hypertension
• bradycardia
• HA
• diaphoresis
• blurred vision
• anxiety

Question 41

what are common causes of dysreflexia

Answer 41

• bladder distension
• bowel distension
• stimulation of skin (pressure ulcer)
• stimulation of pain receptors