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NU 407 end part of Neuro (for quiz 12/10)
Terms in this set (40)
What are some common cervical SCI complications?
- Resp failure d/t phrenic nerve & intercostal muscles innervation
- Mechanical ventilation bc of risk for VAP
One complication that can happen with any SCI is Spinal Shock. What is this?
Temporary suppression of reflexes below level of injury
- no sensation; paralysis; no thermoregulation
Spinal shock can start in ______ and last up to...
minutes; 4-6 weeks after SCI
Spinal Shock can mask the effect of....
*until spinal shock is resolved, cannot make Dx of complete vs incomplete SCI bc you cant tell the extent of injury
Neurogenic shock occurs with an SCI at what level?
T5 or above
What is Neurogenic shock?
Complication of SCI
- Unopposed parasympathetic response
- Loss of vasomotor tone (SNS) --> periph vasodilation/pooling & decreased BP, HR, & CO
Neurogenic Shock, a complication of SCI, results in a loss of vasomotor tone (SNS), which leads to what symptoms?
Decreased BP, HR, & CO
Neurogenic shock may continue for...
1 - 3 weeks
Autonomic Dysreflexia is another complication of SCI. This occurs with an SCI at what level?
T6 or above
What is Autonomic Dysreflexia? / what's it characterized by
- Uncompensated SNS response
- Caused by bladder/bowel distention
- Life-threatening! Will die if not treated
What are S&S of autonomic dysreflexia?
- Severe HTN
- Throbbing HA
- Decreased HR
- Diaphoresis above SCI
- Others: blurred vision, nasal congestion
What causes autonomic dysreflexia?
How can autonomic dysreflexia be prevented?
- Bladder program: if not emptying on own, in & out cath
- Bowel program: stool softeners, enema if needed; goal is BM every 2 days
With someone who's had an SCI, the goal is for them to have a BM at least every... why...?
every other day
- to prevent paralytic ileus and autonomic dysreflexia
If autonomic dysreflexia is not treated, what things can happen?
- Stroke, MI
- Retinal hemorrhage, cerebral hemorrhage
- Renal insufficiency
- Pulmonary edema
What is done to treat autonomic dysreflexia?
- Raise HOB
- Tx cause - bowel/bladder stimuli
- Rapid onset, short duration antihypertensive
One treatment for autonomic dysreflexia is a rapid onset, short duration antihypertneive, such as....
What are SCI complications r/t sacral inures?
- Neurogenic bladder
- Neurogenic bowel
What is neurogenic bladder characterized by?
Urinary retention or incontinence
How is neurogenic bladder treated?
- Anticholinergics: oxybutynin, tolterodine
- Alpha-adrenergic blockers: -zosin
- Antispasmodics: baclofen
- need to clean catheter every shift-prevent CAUTI
How do alpha-adrenergic blockers help with neurogenic bladder?
They relax the urethral sphincter to help with retention issues
Neurogenic bowel is characterized by...
loss of voluntary bowel control
With neurogenic bowel, a complication of SCI, how do we prevent constipation?
- Increased fluids & fiber
- Enema if needed
How is an SCI diagnosed?
- X-ray: vertebrae alignment/Fx
- CT: SCI injury, compression, bleeding
- MRI: soft tissue, ligaments
Treatment for SCI:
- Motor & sensory function
- Pain management
- Psychological considerations
Treatment of SCIs:
What are some measures regarding airway and breathing that we do for SCIs?
- Immobilize and maintain neutral head position
- O2 right away
- Flatten them, no raising bed
- Aggressive pulmonary therapy
Treatment of SCIs:
with ABCs, their injury needs to be ___________ immediately and head kept in a _______ position
(prevent flexion or extension of the neck)
A pt with a ____ and above injury definitely needs an ETT
(bc the phrenic nerve is affected)
If an SCI pt is having trouble breathing, what position is best to put them in?
Flat - no raising the bed
With circulation management after an ACI, what are some things to monitor?
- Watch for drop in BP or HR
- Look for signs of neurogenic and hemorrhagic shock
- Monitor for and Tx bradycardia
How do we treat bradycardia in the SCI pt?
Symptomatic bradycardia - give atropine
Sustained bradycardia - pacemaker
In the SCI pt, we want to keep MAP >_____mmHg, and may need vasopressors to do so
One treatment of SCI is monitoring/preserving motor and sensoery function. How do we do this?
- Neuro checks qhr
- Possible use of traction to realign spine and relieve compression
- Surgical fusion/fixation
What are some ways of providing traction in the SCI pt?
- Can use chin strap around head; or bolts screwed into skull
- Halo brace with special vest - allows for ambulation; only movable part of body is lumbar
If a pt has a traction with a Halo device anything with pins going ingo the body, make sure to...
do pin care every shift
A bowel program is used after an SCI to prevent what again?
- Autonomic dysreflexia
- Paralytic ileus
What meds are used for pain management of SCIs?
- Muscle relaxants for musculoskeletal pain
- Gabapentin, Neurontin, Lyrica for nerve pain
Also, consider the SCI pt's psychosocial stauts. Some common emotions r/t an SCI might include...
- Suicide ideations
What are some nursing considerations/interventions for the psychosocial health of SCI pts?
- Watch for signs of suicide
- Encourage self-care
- Let them make decisions and be involved in plan of care
- Establish a trusting relationship with them
What is the goal of SCI recovery?
adjusting to the new limitations they have
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