Week 9 - Spinal Cord Injury Assessment & Meds Flashcards
define paraplegia
- impaired sensory & motor function in the legs
define tetraplegia
- impaired sensory & motor function in all 4 limbs
what is a complete spinal cord injury
- complete transection
what is an incomplete spinal cord injury
- incomplete transection
- results in tract & grey matter specific loss of function
the higher the SCI, the _____
more dysfunction
what is the significance of a high cervical spine injury
- cervical injury above C5 = total loss of resp muscle function
= pt requires mechanical ventilation
what do injuries below C5 cause
- 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)
what do injuries at thoracic levels cause
- impact the abdominal muscles needed for coughing
how does the impact of cervical & thoracic SCI on respiration impact nursing assessment & care
- complete a resp assessment
- pt at risk of hypoxia, pneumonia, atlectasis
what is the link between the cardio system and SCI
- injuries above T6 decrease the SNS response
= vasodilation
= bradycardia
= hypotension
what effect can vasodilation have
- reduced venous return of blood to the heart
= blood poling in legs
what is a primary SCI
- refers to the damaging force or medical condition
- caused by the initial traumatic event
what does the primary injury cause (5)
- severed axons
- hemorrhage
- ischemia
- necrotic cell death
- release of pro-inflamm factors
what is a secondary SCI
- 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
what are examples of secondary injury
- hemorrhage
- ischemia
- thrombosis
- edema
- vasospasm
see seminar notes for progression of SCI damage
….
what does spinal assessment include (3)
- motor exam
- sensory exam
- position sense
what does a spinal assessment require
- a safety pin
what should you assess during the sensory exam of a spinal assessment (2)
- pain sensation = pin prick
- light touch sensation = dull end
describe how to complete a sensory exam for spinal assessment
- 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
what is position sense
- 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
what should you assess during the motor exam of a spinal assessmeny
- muscle strength & tone
- all major muscle groups
- flexion & extension
- give each muscle group a score of 0-5
when do we not complete parts of a motor exam
- for complete SCI, do not assess for any muscle group below the injury
what does a scor of 0 meaning during a motor exam
- no muscle contraction detected
what does a score of 1 mean uring a motor exam
- a trace contraction is noted in the muscle by palpating the muscle while the pt attempts to contract it
what does a score of 2 mean during a motor exam
- pt can actively move the muscle when gravity is eliminated
what does a score of 3 mean during a motor exam
- pt can move the muscle against gravity, but not against resistance from the examiner
what does a score of 4 mean during a motor exam
- pt an move the muscle group against some resistance
what does a score of 5 mean during a motor exam
- pt moves the muscle group & overcomes the resistance of the examiner
- normal muscle strength
how should you hold the toe during position sense
- on the side to prevent an invalid test
what is the link between SCI & stress ulcers
- incidence of gastric ulcers increases in the first 6-14 days after SCI
- high stress from trauma
what med can we give to help prevent stress ulcers in SCI
- corticosteroids to reduce edema & inflmmation
what is the link between SCI & temp control
- interruption of SNS prevent peripheral temp sensations from reaching the hypothalamus
- sweating & shivering reduced below site of injury
- temp regulation is impacted
what is poikilothermism; how can this vary
- inability to regulate temo
- higher than injury = worsened degree of disregulation
what are post SCI concerns
- see notes, most are common sense
what is autonomic dysreflexia
- massive, uncompensated SNS rxn
with what inury does autonomic dysreflexia occur
- T6 or high
what does autonomic dysreflexia indicate
- over-activity of the autonomic nervous system
what causes autonomic dysreflexia
- 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
what are signs of autonomic dysreflexia (6)
- hypertension
- bradycardia
- HA
- diaphoresis
- blurred vision
- anxiety
what are common causes of dysreflexia
- bladder distension
- bowel distension
- stimulation of skin (pressure ulcer)
- stimulation of pain receptors
