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Spinal Cord Injury

The flashcards below were created by user alyn217 on FreezingBlue Flashcards.

  1. What is the major risk factor for traumatic brain injury (TBI)
    ETOH
  2. Mechanism of Injury
    • Acceleration: when immobile head struck
    • Deceleration: head is moving and object it hit is still
    • Rotation injury when head twists as it hits
    • Acceleration-deceleration injury: Moving object hits immobile head which then hits second object
  3. Types of TBI
    • Blunt Trauma
    • --Brain actually moves inside skull as struck, as it's only tethered at the base
    • --Disruption to small blood vessels occurs as it scrapes the inside of the skull
    • Penetrating Trauma
    • --Velocity of object and fracture of bone creates the damage
    • --High velocity (bullets) produce shock waves
    • Coup-Contrecoup (Counterblow in French)
    • --Injury is to side opposite of the side hit
    • Scalp Injury
    • --Lacerations, hematomas
    • Skull Fractures
    • --Linear
    • --Depressed: adds pressure to brain
    • --Basilar: at back of skull-->raccoon eyes. 
    • Brain Injuries
    • Concussions: Short decrease in LOC, amnesia
    • Contusions: May be severe, will be localized
    • Diffuse Axonal Injuries: small injuries all over the brain r/t anorexia, anemia, hypoxia, post cardiac arrest. May--> posturing (flexion/extension). 
    • Decreased LOC is primary S&S
    • May present with posturing, increased ICP
  4. What do you need to know about epidural hematoma?
    • Between skull and dura mater usually associated with skull fracture:
    • --Forms large clot, usually quickly (arterial)
    • --Unconscious immediately after HI
    • --Awakens with lucid interval
    • --LOC rapid deteriorates, needs prompt attention.
    • --Quickly becomes comatose
    • --Confirm with CT scan
    • --Prompt intervention is essential
  5. Subdural Hematoma?
    • Subdural Hematoma (blood collects between the dura mater and arachnoid mater)
    • Acute/subacute: will cause bleeding in area of edema
    • --S&S appear 24-48 hours after injury
    • --Comprise ¼ of all TBI
    • --Onset of S&S is slower than Epidural Bleed
    • --May have variable change in LOC (fluctuates)
    • --HA, irritable and confused
    • Chronic: common with ETOH
    • --Occurs with atrophy, so more room for bleeding
    • --Appears recovered then gets hemiparesis, pupil changes
    • --Surgical evacuation with drains left in
  6. Intracrerbral bleeds?
    • Bleeding directly into parenchymal tissue of the brain
    • Can't be resected
  7. Reperfusion injuries?
    • From rapid reversal of ischemia
    • Cell wall damage from oxygen free radicals
    • Occurs after massive hypotension (like cardiac arrests or awaking from anesthesia)
  8. Nuring care for Traumatic Brain injury
    • Airway, airway, airway
    • Circulatory support
    • Protect cervical spine, keep ICP low
    • F&E, Elimination (IV lines, foley catheter)
    • Nutritional support (feeding tubes)
    • Complication management
    • Some are surgically managed
    • Rehabilitation for nearly everyone. 
  9. Things to know about Spinal Cord Injuries
    • 10,000 new injuries each year, males 16-30 most common
    • Auto,  motorcycle, gunshot or knife wounds
    • Non-traumatic injuries
    • Spondylosis
    • Osteoporosis
    • Tumors
    • Vascular diseases
  10. Mechanisms of injury for spinal cord injury
    • Flexion rotation
    • Hyperextension (diver's fracture)
    • Compression fractures
    • C1 (odontoid process) fractures
    • C2 (hangman's fracture)
    • Most common are C1-C2, C4-C5, T11-T12
    • Early cord edema can make exact location difficult to recognize (even reflexes are distorted)
  11. Pathyphys of spinal cord injury
    • Rarely torn or transected by direct trauma
    • Due to cord compression by bone displacement, interruption of blood supply to cord, traction from pulling on cord
    • GSW and Stab wounds can cause tearing and transection
    • Primary injury- initial disruption of axons as a result of stretch or laceration
    • Rectal tone is a good diagnositc for spinal cord injury
  12. Pathophys of secondary injury r/t spinal cord injury
    • Damage from ischemia, hypoxia, microhemorrhage and edema
    • Molecular level- cell death occurs, can continue for weeks or months after initial injury
    • Complete cord damage in severe trauma related to autodestruction of cord initial care and management critical to limit processes
    • Edema- can cause permanent damage within 24 hours, can develop secondary to inflammatory response, can compress cord and increase ischemic damage. Think about admin Decedron. 
    • Extent of injury and prognosis for recovery most accurately determined at least 72 hrs or more after injury
  13. SnSs of SCI
    • Reflexes altered
    • Cord bladder? 
    • Automatic bladder
    • Autonomic dysreflexia with exaggerated ANS reflexes related to full bladder/bowel distention with massive HTN (vasoconstriction) fever,dilated pupils. This is life threatening!!
    • Muscle spasms
    • Spinal Cord Shock: hypotension, multiorgan destruction.
  14. SnSs of spinal cord shock
    • Affects about 50% with acute SCI
    • Temporary neurologic syndrome lasting days to months. 
    • Decreased reflexes below level of injury
    • Loss of sensation below level of injury
    • Flaccid paralysis below level of injury
    • May mask post injury neurologic function
    • Active rehab. may still begin
  15. What is neuorgenic shock
    • Due to the loss of vasomotor tone caused by injury
    • Characterized by hypotension and bradycardia- important clinical clues
    • Loss of sympathetic nervous system tone innervation causes peripheral vasodilation, venous pooling, decreased cardiac output
    • Usually with cervical or high thoracic injury 
  16. Care for spinal cord injury?
    • Care at accident scene
    • Care in ED and radiology
    • Early hospital care
    • --Halo Traction
    • --Respiratory support
    • --Cardiovascular support  (hypotension)
    • --Aspiration risk
    • --Safety
    • --Depression management
    • --Nutritional support
    • --Neuro assessments
  17. Possible nursing diagnosis?
    • Pretty much all of them
    • Management of constipation becomes important. Intervention is typically digital stimulation.
  18. Nursing management for SCI pt.
    • Maintain airway, oxygenation, suction, ventilation
    • Immobilize spine- skeletal traction via tongs (Crutchfield or Gardner-Wells), halo traction
    • Monitor VS, fluid balance, neuro assessment
    • Prevent complications of immobility- rehab starts on admission- specialty beds
    • Medications- Methylprednisolone considered within 8 hours of injury possible neuro risks and potential risks
    • relieve edema- corticosteroids, anti-inflammatories
    • prevent discomfort- analgesics, sedatives, muscle relaxants
    • Prepare for surgery- possible decompressive laminectomy, spinal fusion
    • If SCI is suspected, DO NOT MOVE PT. WAIT FOR DR./ROTATION TEAM TO DO IT.
Author:
 alyn217
ID:
 201769
Card Set:
 Spinal Cord Injury
Updated:
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Description:
Adult MedSurg 2
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