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Spinal Cord Injury (EXAM 2)
Terms in this set (70)
Who are at highest risk for spinal cord injury?
Young adult males between ages 16 to 30
(because they are risk takers)
What is the number one cause for spinal cord injuries?
What is secondary injury?
Ongoing progressive damage that occurs after initial injury (can have cell death more than just where injury occurs)
What are the clinical manifestations of spinal shock?
- decreased reflexes
- loss of sensation
- flaccid paralysis below level of injury
How long does spinal shock?
It will wear off but takes 1-6 weeks
What are the clinical manifestations of neurogenic shock?
What happens during neurogenic shock?
Vasodilation causes drop in bp and hr
What are the classifications of spinal cord injury?
1) Mechanism of injury
(how injury occurred)
2) Level of injury
3) Degree of injury
( how complete the cord involvement is)
What are the mechanisms of injury?
(head is pushed forward and tears ligaments/fractures in back of vertebrae)
(primarily located in anterior)
(causes fragments of vertebrae)
What are the different levels of injuries?
- Skeletal level
(Injury is in the vertebral level where there is most damage to vertebral bones and ligaments)
- Neurologic level
(lowest segment of spinal cord with normal sensory and motor function on both side of the body)
What place of injury on the vertebrata is incompatible with life?
C1 and C2 because it controls breathing
What functional abilities do those with C3 spinal injuries have?
They should be able to function with a ventilator and may be able to live at home with help.
- No extremity movement and cannot operate electric wheel chair
(Need someone 24 hours a day so may end up in a facility)
What functional abilities do those with C4 spinal cord injuries have?
- May or may not need a vent
- 24 hour care is needed
- Cannot operate a wheel chair
What are the functional abilities of those with a C5 spinal cord injury?
- Able to have some shoulder shrug
- Gross arm movement
- decreased respiratory reserve so they are high risk for respiratory infection
- Able to operate electric wheel chair
- Need about 10 hours of care a day
What are the functional abilities of those with a C6 spinal cord injury?
- Gain thumb (can now feed self and brush teeth)
- Weak grasp
- Can transfer self
- 6 hours
- able to drive wheel chair
What are the functional abilities of those with C7/8 spinal cord injury?
- You gain fingers and hand movement
- fine movement control
- 0 to 6 hours of attended care
What are the different degrees of injury?
Complete or incomplete
What is complete cord involvement?
Total loss of sensory and motor function below level of injury
What is incomplete cord involvement?
Mixed loss of voluntary motor activity and sensation and leaves some tracts intact
What are the six syndromes associated with incomplete lesions?
1) central cord syndrome
2) anterior cord syndrome
3) Brown- seqaurd syndrome
4) Posterior cord syndrome
5) Cauda equina syndrome
6) Conus medullaris syndrome
What is the central cord syndrome?
In the central part of the spinal cord
- the UPPER extremities sensory and motor functions are more effected
What is anterior cord syndrome?
The anterior portion of cord is damaged
- Loss of motor function below level of injury and lose of sensation of PAIN and Temperature below level of injury but still have the sense of touch , position sense, and vibration
What is brown sequard syndrome?
An injury to the lateral part of the cord
- They lose motor movement below injury on same side
- Lose sense of vibration and sensation on same side
- Lose sensation of pain and temperature on OPPOSITE side
What is posterior cord syndrome?
An injury to the posterior spinal artery
- Loses sensation of their proprioception (Position sense)
- Everything else is maintained
What are the diagnostics for spinal cord injuries?
- CT scan
What are the initial goals with spinal cord injuries?
- sustain life
- prevent further cord damage
- limit secondary injury
What nonoperative stabilization is used for spinal cord injuries prior to surgery?
What nonoperative stabilization is used for post surgery for higher level spinal cord injury?
What are we watching for with the EMERGENCY surgical therapy of spinal cord injury?
- evidence of cord compression (worsening neuro assessment)
- progressive neuro deficit
- compound fracture
- bony fragments
- penetrating wounds of spinal cord or surrounding structure
What is the surgical therapy for spinal cord injury?
1) Decompression laminectomy
2) Insertion of stabilizing rods
How do you maintain immobilization?
- correct alignment
- turn body as a unit
- maintain traction
- maintain braces
What is the ASIA impairment scale?
Used to check for movement and sensation
- Do this at beginning, during, and after rehab
What are the clinical manifestations spinal cord injury?
- Related to level and degree of injury
- Systemic effects
What are the respiratory clinical manifestations for C4 or higher?
Loss of respiratory function
What are the respiratory clinical manifestations for below C4?
- Respiratory insufficiency if phrenic nerve affected
- Loss of muscle strength of intercostal and abdominal muscles
- Insufficient cough
What are the cardiovascular clinical manifestations for about T6?
- Peripheral vasodilation causing hypovolemia (due to blood capacity of dilated veins)
What is the overall cardiovascular clinical manifestations of spinal cord injury?
Risk for DVT
(pulmonary embolism is leading cause of death)
What are the GI clinical manifestations for about T5?
- paralytic ileus
- gastric distention
What are the overall GI clinical manifestations of spinal cord injury?
- Stress ulcers are common
- intrabdominal bleeding may occur
What are the metabolic and nutritional needs clinical manifestations of spinal cord injury?
- Potential difficulty swallowing with high cervical
- Loss of body weight is common (ACUTE)
- Increased nutritional needs (ACUTE)
- needed to prevent skin breakdown and
- Decreases rate of muscle atrophy
- Maintenance of appropiate BMI (CHRONIC)
What are the clinical manifestations of urinary elimination for spinal cord injury patients?
- urinary retention and over distention common (EARLY)
- Bladder may become hyper irritable (LATE)
- Reflex emptying (LATE)
What are the clinical manifestations of bowel elimination for spinal cord injury patients?
- reflex emptying
What are the clinical manifestations of integumentary systems for spinal cord injury patients?
- pressure ulcers can occur quickly
- monitor of breakdown
- reposition every 2 hours
- pressure relieving cushion
What are the clinical manifestations of musculoskeletal/neurological of spinal cord injury patients?
- muscle atrophy
- loss of sensations
- spastic reflexes
What are the clinical manifestations of the reproductive system for males with spinal cord injury?
- injury level and completeness of injury is needed to understand the male patient's function
- potential problems with erection and or ejaculation
What are the clinical manifestations of the reproductive system for females with spinal cord injury?
- woman of childbearing age remains fertile and has ability to become pregnant or to deliver normally through birth canal
What are the psychological clinical manifestations for those with spinal cord injuries?
- disrupted sleep
- Grief (may feel an overwhelming sense of loss)
- Coping (may believe they are worthless and burdens to their families)
What are the overall goals for spinal cord injury patients?
- maintaining an optimal level of neuro function
- have minimal to no compliance of immobility
- Learn skills, gain knowledge, and acquire behaviors to care for self
- Return to home and community
What should you consider with nursing implementation?
- patient teaching needs
What are the overall respiratory interventions for spinal cord injury patients?
- monitor for respiraotry distress, ABGs, saturation, breath sounds, and sputum
What are the respiratory interventions for acute phase of cervical injury?
- mechanical intervention
- Trach care and suctioning
- incentive spirometer
What are the respiratory interventions for chronic care?
- abdominal thrusts for coughing
- teaching for prevention of respiratory infections
- smoking cessation programs
What are the interventions for cardiovascular instability?
- monitor VS esp. bradycardia, EKG, signs of DVT
- Limit increased vagal stimnulation can result in cardiac arrest
- Compression gradient stockings
- Prophylactic anticoagulants
- Drug therapy may include vaso such as dop
- Fluid replacement
What are the GI system and metabolic needs for spinal cord injury?
- NG tube may be inserted
- monitor fluid and electrolyte, daily intake, daily weight
- monitor bowel function
- assess swallowing with high cervical injury
- oral food and liquids can be given once bowel sounds are present or flatulence is passed
- TPN and nutritional supplements may be needed
- dietary consult
What is the drug therapy for stress ulcers?
- histamine blockers
What signs for you monitor with stress ulcers?
- hypotension despite tx
- decreased hgb and hct
- abd. distention
- signs of bleeding
What is the bladder management for spinal cord injury patients?
- urine retained
- progress to intermittent cath program
- adequate fluid intake
- monitor for infection
- teach cath to family and pt
What is the bowel management for spinal cord injury patients?
- - timed defecation after meal
- rectal stimulant
- digital stimulation
- left side lying position until able to use BSC
What are the integumentary interventions for spinal cord injury patients?
- teach prevention of skin breakdown
- position q 2
- pressure relieving cushions in wheel chairs
- avoid thermal injury
How is temperature controlled below level of injury?
- no vasoconstriction
- no piloerection
- no heat loss through perspiration
(nurse must monitor environment and body temp)
Why might the return of reflexes complicate rehab?
- exaggerated responses
What are some antispasmodic drugs?
(assess patient for extreme drowsiness and ortho BP)
What is the nurse's role in grief work?
What are some characteristics of rehab and home care?
- organized around patient
- patient expected to be involved in therapies (to learn self care)
- offer encouragement
What injury may cause autonomic dysreflexia?
injury level T6 or higher
What is autonomic dysreflexia?
- occurs in response to visceral stimulation
- life threatening
What is the most common cause of autonomic dysreflexia?
- distended bladder or rectum
What are the clinical manifestations of autonomic dysreflexia?
- blurred vision
- thobbing headache (take BP)
- marked diaphoresis above lesion level
- piloerection (erection of body hair)
- flsuhing of skin above lesion
- spots in visual field
What are the nursing interventions for autonomic dysreflexia?
- elevate HOB at 45 degress pr sit patient upright
- notify Physician
- assess cause
What teaching should be done with autonomic dysreflexia?
- teach patient and family causes
- teach symptoms
- teach interventions
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