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XP-Spinal Cord Injury and 1 other
Terms in this set (84)
Spinal Cord Injury?
-damage to spinal cord that results in a loss of function such as mobility and/or feeling
-most injuries do not result in complete severing of spinal cord: it is intact; damage results in loss of functioning
-it is possible to break back or neck but not have spinal cord injury because the bones are only affected
who is at risk for SCI?
risk takers, drug users, males, 15-30
C8 and above
T1 and down
degree of spinal cord involvement
Complete: total loss of sensory and motor function below level of injury/lesion.
-if cervical cord is involved, paralysis of all 4 extremities occurs, resulting in tetraplegia/quadraplegia (paralysis of arms and legs)
-if thoracic or lumbar cord is damaged, result is paraplegia (paralysis and loss of sensation in legs)
Incomplete: results in mixed loss of motor and sensory (partial transection) and leaves some tracts intact; degree of sensory/motor loss varies depending on level of lesion; reflects specific nerve tracts damaged and those spared
can move deltoid
small fingers abductors
long toe extensors
ankle plantar flexors
what is a dermatone?
Area of skin innervated by the sensory axons within a particular segmental nerve root. They are important to determine level of injury
flexion injury (whiplash)
-damage to spinal cord
- forward dislocation
- ruptured POSTERIOR ligaments
hyperextension (hit chin on desk)
- ruptured ANTERIOR ligaments
compression (diving headfirst)
-compression of spinal cord
- fractured vertebrae
flexion-rotation injury (falling off horse)
-dislocation of vertebrae
injury, edema, ischemia, necrosis, destruction of cord
general SCI mgmt
rule out C-spine injury
meds - high dose steroids methylprednisone
administered early is best
before 8 hours post injury
administration = greater chance for neuro fxn stabilization
immobilization until stabilization
always always rule out c-spine injury! do not move patient!
acute complications of SCI
spinal (neurogenic) shock within 1st 24 hours, lasts a week
what is neurogenic shock?
loss of autonomic innervation of small vessels and the cardiovascular system
-impairment of descending sympathetic pathways in spinal cord which results in loss of vasomotor tone to the heart
causes: SCI, drugs, surgery, anesthesia
s/s of neurogenic shock
loss of muscle tone
lack of sweating beneath affected areas
- everything is shutting down!!
- tx: vasoactive meds, IV fluids, atropine (r/t bradycardia)
SUDDEN depression of reflexes below level of injury
- variable state
- shock makes it appear completely functionless, but it may not be completely destroyed
what is autonomic dysreflexia?
for injuries T6 and above
can appear late stage
usually caused by bladder fullness/dysfunction
raised BP, pounding HA, bradycardia, sweating above injury level
management: autonomic dysreflexia
at risk for STROKE! RAISED BP
have patient sit up (lowers BP)
check catheter for kinks or cath if bladder dysfunction
check for fecal impaction
examine skin for breakdown
nursing care for SCI patient
lung sounds and cough
monitor motor, sensory function and any changes
assess for spinal shock
monitor for bladder retention or ilieus
monitor for hyperthermia
nursing dx and planning for SCI pt
BREATHING #1 priority!
impaired physical mobility
impaired sensory perception
impaired urinary elimination
PROM 4x day
maintain proper alignment
turn only if spine is stable
monitor BP with position changes
use neck brace when prescribed
move gradually to erect position
Violent, momentarily displacement of spinal cord
Why is the extent of the injury not clear initially?
Spinal shock, causes flaccidity initially
1st degree injury
-Initial mechanical disruption of axons as a result of stretch or laceration
-Disruption of neurons at anatomical level of injury- initial swelling can cause higher degree of loss of function
2nd degree injury
-Ongoing, progressive damage that occurs after initial injury
-Neural damage beyond the initial (within minutes or hours after surgery d/t biochemical events that can last for hours or weeks)
Define a "complete" injury
-No motor or sensory of S4-5.
-No or few axons survive.
-Complete loss of sensory and motor below LOI
-Cord doesn't have to be completely transected
Define "incomplete" injury
Have sensory and/or motor of S4-5
T/F? Tetraplegia/Quadriplegia= all cervical injuries
Paraplegia can involve thoracic, lumbar or either?
Thoracic and lumbar injuries
81% of all SCI occur in MALES
What is a spinal cord concussion?
Transient neurological deficit, fully recovers w/o any apparent structural damage
LOS for SCI is increasing or decreasing?
Cause of death p-SCI?
Pneumonia, PE, systemic infection, kidney infection
40% of all SCI's are caused by?
MVA (this trend is decreasing)
28% of all SCI's are caused by?
Falls (trend is increasing)
15% of all SCI's are caused by?
violent acts, gun shot wounds
Recreation and sports injuries (8%) are decreasing. 70% of these cases are caused by what injury?
Diving in shallow water
What are some causes of non-traumatic SCI?
-Aortic Aneurysm (infarct on the cord)
-OA, spinal stenosis
This mechanism of injury is most common, and involves head hitting steering wheel, from blow to back of head, or head on collision
This MOI is associated with flxn injuries and is caused by vertical or axial blow to back of head (diving)
This injury is caused by a strong posterior force (rear-end collision, fall w/ head hitting object)
MOI described as P-A Force hits rotated vertebral column (passenger rotated towards driver when hit)
SCI's named by NEUROLOGICAL level of injury (NLI)
lowest single segment of normal sensory AND motor function
Where it happened (anatomically?)
If an individual has motor and/or sensory below NLI but doesn't have function at S4/5, then the AREAS of intact motor/sensory function below the NLI are?
Zones of partial preservation
What syndrome is associated with damage to the central portion of the SC, sparing peripheral
Central Cord Syndrome
Central Cord is almost always in CERVICAL spine and most commonly caused by EXTENSION injuries involving osteophytes poking into cord.
With Central Cord Syndrome motor weakness follows what pattern?
With Central Cord Syndrome, sensory loss follows what pattern?
-Pain, temperature>proprioception, vibration
-Pain, burning common in UE
-Bowel/bladder usually intact
Where is the damage with Anterior Cord Syndrome?
Anterior, anterolateral portions damaged
Anterior spinal artery damaged
Posterior columns preserved
What is lost below the LOI in Anterior Cord Syndrome?
-Sensory-pain and temperature
What is preserved below the LOI in Anterior Cord Syndrome?
Sensory-proprioception, light touch , deep pressure
Where is cord damage with Brown-Sequard Syndrome?
-To one side of the cord, or greater damage to one side (usually d/t penetrating injury, surgical procedure, burst fracture)
What is lost below LOI Ipsilaterally with Brown Sequard?
Sensory: light touch, deep pressure, proprioception
Motor:function with spasticity (+clonus +babinski)
What is lost below LOI contralaterally with Brown Sequard?
Sensory: Pain and temperature
Damage to sacral cord and lumbar nerve roots within the SC is known as?
Conus Medullaris Syndrome
Conus Medullaris Syndrome involved what motor and sensory loss?
Can be variable....
Most have flaccid paralysis in LE and areflexic bowel/bladder (S4/5 motor neurons)
-involvement usually bilateral and symmetric
-mixed UMN and LMN damage
Injury to bundle of nerve roots (L2-S5) that extend thru canal distal to conus medullaris is?
Cauda Equina Syndrome
Cauda Equina Syndrome is technically a LMN or UMN injury?
LMN (but can affect cord too UMN)
What are the motor/sensory deficits with Cauda Equina Syndrome?
-Most have flaccid paralysis of LE, areflexic B&B
What are Autonomic Nervous System Changes after SCI?
-Loss of thermoregulation below LOI (cant shiver/sweat)
-dress in layers, temp control
Autonomic Dysreflexia (AD). Why is it a medical emergency?
ANS regulates HR, BP< gland activity
Noxious stimulus activates SNS response, results in vasoconstriction and ↑ BP (splanchnic vasculature)
SCI pts dont have sympathetic compensation to vasodilate (injuries above T6 block signaling to lower cord)
Results in ↑ BP, possible hemorrhage, seizure, MI, death
-Sudden ↑ in Systolic and Diastolic BP (>20)
-Sudden throbbing or pounding headache
-sweating or flushing of face, neck shoulders
-goose bumps above level of lesion
-inc. anxiety w/o cause
-HR changes, arrhythmias, PVC's
-full or impacted bowel
-labor contractions, menses
-Tight constrictive clothing
-Pain/irritation below LOI
-Changes in temp
-Immediately bring patient to upright
-ID and remove noxious stimulus
-check clothing and catheter tubes, perform bowel program if impacted
-pharmacology if BP>150 mmHg
What is a musculoskeletal change that occurs post SCI (below LOI) that results in limited ROM, pain and impaired seating and posture?
Heterotrophic ossification (HO)
What is most common cause of death in both acute and chronic stages of SCI?
*lesions above C4=paralysis of mm of inspiration, req artificial vent
*Lesions C6-T12= lose of mm of expiration (abs, intercostals), forced cough and ability to expel secretions lost
Where are areas of concern for Pressure Ulcers?
Elbow, Inner knees, back of head, shoulder, lower back and pelvis, heels
What sexual function issues are associated with females
-Menstruation interrupted 3-6 mos
-Fertility/pregnancy not interrupted (high risk tho)
What sexual function issues are associated with males?
-Reflexogenic-response to external stimulation UMN lesions
-Psychogenic-response thru cognition/fantasy
-Higher lesions- can achieve reflexive erection, not ejaculation
-Lower lesion-tougher to achieve erection, able to ejaculate
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