spinal cord problems

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Author:
kelc
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122905
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spinal cord problems
Updated:
2011-12-11 23:07:53
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spinal cord problems
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spinal cord problems
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  1. One of the most common reasons for HCP visits
    Back pain
  2. Lumbosacral back pain
    • low back pain
    • muscle, spasm, ligament problems, degeneration
    • herniated nucleus pulposis - puts pressure on spinal cord
    • spinal stenosis - narrowing of spinal canal - bony overgrowth
    • spondylolisthesis - vertebrae slide on each other putting pressure on nerve roots causing pain in lower back and butt
  3. Health promotion/maintenance to prevent low back pain
    • good posture
    • proper lifting
    • exercise
    • ergonomics
  4. Nonsurgical management of low back pain
    • positioning - William's position = semi fowler with pillows under knees or in a recliner
    • drug therapy - pain meds, muscle relaxants, epidural injections to reduce inflammation, antiepileptics for chronic nerve pain
    • heat therapy
    • physical therapy
    • weight control
    • CAM - chiropractor
  5. Surgical management of low back pain
    • diskectomies
    • laminectomy
    • spinal fusion
  6. Post-op care after low back surgery
    • neuro assessment
    • voiding ability
    • pain control
    • wound care - infection prevention
    • CSF check
    • positioning and mobility - log rolling
  7. Cervical neck pain treatment
    • conservative treatment is same as described for back pain except that the exercises focus on shoulder and neck
    • if these treatments do not work, soft collar may be used at night no longer than 10 days
    • surgery - diskectomy and fusion - performed if nothing else works
  8. Hyperflexion injury of spinal cord
    head flexed forward
  9. Hyperextension injury of spinal cord
    Head extended back
  10. Axial loading injury or vertical compression injury of spine
    • hit on top of head - diving
    • fall on butt
  11. Spinal cord injuries
    • hyperflexion
    • hyperextension
    • axial loading/vertical compression
    • excessive rotation of head beyond range
    • penetration injury
  12. Secondary injuries that worsen spinal cord injuries
    • hemorrhage
    • ischemia
    • hypovolemia
    • neurogenic shock
  13. Etiology of spinal cord injuries
    • trauma is leading cause - usually in men
    • 50% of injuries occur in car accidents
    • falls
    • acts of violence
    • sports/recreation
    • cervical cord injuries are most common
  14. Initial assessment for spinal cord injury
    • Airway, breathing, circulation
    • indications of intra-abdominal hemorrhage or hemorrhage around fracture sites
    • LOC
    • level of spinal injury
  15. Spinal shock syndrome
    • occurs immediately as a concussion response to injury
    • flaccid paralysis
    • loss of reflex activity below level of lesion
    • usually resolves within 24 hrs
    • muscle spasticity begins in patients with cervical or high thoracic injuries
  16. Hypoesthesia
    decreased sensation
  17. Hyperesthesia
    increased sensation
  18. Cardio/Respiratory assessment post spinal injury
    • cardio dysfunction if injury is above 6th thoracic vertebrae
    • systolic BP below 90 requires treatment b/c lack of perfusion to spinal cord could worsen client condition
    • hypothermia
    • possible swelling
    • risk for respiratory problems r/t immobility or interruption of spinal innervations to respiratory muscles
    • THORACIC 4 AND 5 KEEP THE DIAPHRAGM ALIVE
    • monitor pulse oximetry
  19. GI assessment post spinal injury
    • abdomen assessment for hemorrhage, distention, paralytic ileus
    • decrease in peristalsis and gastric distention reflex
    • assess for areflexic (neurogenic) bladder which later leads to urinary retention
  20. Lower motor neuron assessment
    • muscle tone, size and strength
    • longer term damage below level of damage = muscle atrophy
  21. Upper motor neuron assessment
    • muscle spasticity
    • contracture after spinal shock has resolved
  22. Skin assessment post spinal cord injury
    high risk for pressure ulcers
  23. Heterotrophic ossification assessment post spinal cord injury
    bony growth in soft tissue
  24. Lab assessments post spinal cord injury
    • UA for blood
    • ABGs for respiratory sufficiency
    • CBC for blood loss, infection
  25. Nonsurgical management of spinal cord injry
    • constant assessment
    • assess for neurogenic shock
  26. Neurogenic shock
    spinal shock syndrome with bradycardia, decreased/absent bowel sounds, warm, dry skin, hypothermia, hypotension
  27. Immobilization for cervical injuries
    • fixed skeletal traction to realign vertebrae, facilitate bone healing and prevent further injury
    • halo fixation and cervical tongs
    • stryker frame, rotational bed, kinetic treatment table
    • pin site care and monitoring of traction ropes
  28. Immobilization for thoracic and lumbosacral injuries
    • for patients with thoracic injuries - bedrest and possible immobilization with body cast
    • for patients with lumbar and sacral injuries - immobilization of spine with a brace or corset worn when patient is out of bed
  29. Drug therapy for spinal cord injuries
    • Methylprednisolone
    • - glucocorticoid
    • - monitor for infections, Cushings, BGs, stress ulcers
    • Dextran - plasma expander for hypotension
    • Atropine sulfate for HR below 50-60
    • Tizanidine - CNS acting muscle relaxant
    • Intrathecal baclofen - pain
  30. Surgical management for spinal cord injuries
    • emergency surgery necessary for spinal cord decompression
    • decompressive laminectomy
    • spinal fusion
    • harrington rods to stabilize thoracic spinal surgeries
  31. Interventions for impaired urinary elimination post spinal cord injury
    • bladder retraining program
    • external pressure on a spastic bladder
    • valsalva maneuver for flaccid bladder
    • 2000-2500 ml of fluid daily
    • UTI monitoring
    • long-term catheterization is possible
  32. Autonomic dysreflexia
    • commonly seen in patients with upper spinal cord injury
    • sudden, severe throbbing headache and hypertension
    • bradycardia
    • flushing above level of lesion
    • nasal stuffiness
    • sweating
    • nausea
    • blurred vision
    • goose bumps
    • impending doom
  33. Treatment of autonomic dysreflexia
    • sitting position - priority
    • notify HCP
    • loosen tight clothing
    • assess for and treat cause - monitor BP q10-15min; nitrates or hydralazine; I&O
  34. Causes of autonomic dysreflexia
    • catheter obstruction
    • bladder distention
    • fecal impaction
    • room temp too cool/drafty
  35. Bowel retraining program
    • consistent time for bowel elimination
    • high fluid intake
    • high fiber diet
    • rectal stimulation
    • stool softener meds as needed
  36. Spinal cord tumors
    • primary - meninges
    • intramedullary - small # within spinal cord
    • extramedullary - in spinal dura outside of the cord - most common
  37. Assessment of spinal cord tumors
    • depends on location and rate of growth
    • pain
    • weakness
    • mobility problems
    • loss of bowel/bladder control
    • MRI, CT scan
    • possible need for emergency surgery
    • radiation/chemotherapy
  38. Multiple sclerosis
    • chronic autoimmune disease affecting the myelin sheath and conduction pathway of CNS - leading cause of disability in young adults
    • characterized by remission/exacerbation
    • inflammatory response resulting in random or patchy areas of plaque in the white matter of CNS impairing nerve conduction
    • unknown cause
    • seen more in colder climates
    • more common in women
  39. Physical assessment for MS
    • vague symptoms
    • double vision
    • flexor spasms at night
    • intnetion tremor
    • dysmetria - inability to direct/limit movement
    • decreased visual acuity
    • change in peripheral vision (scotomas)
    • blurred vision
    • nystagmus
    • hypalgesia (decreased sensitivity to pain)
    • numbness
    • tingling
    • burning
    • bowel/bladder dysfunction
  40. Lab for MS
    • nothing specific
    • CSF - may find increased proteins
  41. Interventions for MS
    • drug therapy
    • promoting mobility
    • managing symptoms
    • CAM - bee stings
  42. Amyotrophic lateral sclerosis
    • Lou Gehrig's disease
    • adult onset upper and lower motor neuron disease characterized by progressive weakness, muscle wasting and spasticity eventually leading to paralysis
    • generally die of respiratory failure
  43. Early symptoms of Lou Gehrig's
    • fatigue while talking
    • tongue atrophy
    • dysphagia
    • weakness of hands and arms
    • fasciculations
    • nasal speech quality
    • dysarthria
  44. Interventions for Lou Gehrig's
    • no known cure
    • no treatment
    • no preventive measures
    • Riluzole is the only drug approved to extend survival time
    • exercise and mobility programs
    • swallow management
    • respiratory support

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