Spinal Cord Injury

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  1. Edema
    always happen with SCI...and causes a decrease in fxn
  2. Where is the worst part of the spinal cord to have edema and why?

    C1 and C2 fractures with edema can cause death.

    In the area of C3-C5 the edema can cause phrenic nerve dysfunction and respiratory paralysis
  3. Diaphragm is inervated by ....
  4. When assessing a patient with a suspected SCI always assess this first....
    breathing patterns
  5. If a person has a C4 or above SCI what will I notice?
    shallow, guppy breathing...respiratory arrest is coming
  6. For a person with a SCI, first 2 interventions

    C spine collar...no twisting or moving of the head and neck
  7. How can you quickly tell if a patient has an injury at C5 or above?
    Tell they to take a deep breath....if the can, then the injury is lower than C5
  8. What SCI is the most life threatening
  9. Spinal precautions
    • no flexion/rotation of the patients head
    • cervical collar
    • backboard
    • sandbags
    • log roll
  10. What will help me to predict the level of independence my patient will be above to have when they recover?
    knowing their level of injury
  11. What is given to SCI patients within 3 hours of their injury and for the next 48 hours
    high dose IV methylprednisolone

    minimizes swelling and preserves function
  12. Acute treatment for SCI
    • methylprednisolone
    • IV fluids
    • DVT prophylaxis
    • NG tube for nutrition
    • Temp control
    • Position change for stress ulcers
    • Bowel and bladder training
  13. When does neurogenic shock occur?  Describe it....
    3 days to 3 weeks after the injury

    it is loss of vasomotor tone and impairment of autonomic function....seen a lot with cervical injuries
  14. Why do people with cervical injuries get neurogenic shock?
    cuz it can disrupt the sympathetic nervous system pathway, leading to a loss of sympathetic control....parasympathetic is in control
  15. What happens when the parasympathetic nervous system takes over....
    vasodilation of vascular beds causing hypotension

    vagus nerve stimulated by parasympathetic causing bradycardia

    loss of ability to sweat below the level of injury...no connectiong btwn hypothalamus and symp. nervous system
  16. If a persons BP and HR are dropping from neurogenic shock what do I give?
    Dopamine and/or Atropine
  17. What's spinal shock and how long does it last?
    loss of spinal reflexes and the resulting flaccid paralysis below the level of injury

    lasts weeks to months
  18. What occurs with spinal shock?
    complete loss of motor, sensory, reflex and autonomic function below the level of injury
  19. Describe what the person will present like who is experiencing spinal shock
    • flaccid, total paralysis of all skeletal muscles below the level of the injury
    • loss of spinal reflexes below the level of injury
    • loss of pain, proprioception and sensations to touch, temp, pressure, below the level of injury

    • *unstable lower BP
    • *loss of ability to perspire below the level of the injury
    • *bowel and bladder dysfunction
    • *priapism-erect penis cant return to flaccid
  20. When a person is experiencing bowel and bladder dysfunction with spinal shock...what kind and how is it treated?
    atonic bladder....they have not reflex to void

    have to do bladder training.....NO foleys cuz of risk for infection
  21. Describe recovery from spinal shock
    • once resolved, remaining deficits are permanent
    • lasts 1-6 weeks
    • it's a gradual process in which the spinal neurons slowly regain their excitiability
    • amount and type of recovery depends on degree of injury
  22. Medical management of a person with a SCI
    • #1 ABC
    • #2 Cervical spine stabilization...possible surgery too
    • Methylprednisolone IV Bolus
    • Motor and sensory exam
    • X rays, CT, MRI
  23. Laminectomy
    removal of the lamina of the vertebral ring to allow decompression or removal of bony fragments from the spinal canal
  24. Spinal fusion
    surgically fusing 2-6 vertebral segments together to provide stability...done with plugs or bone chips taken from the iliac crest
  25. Rodding
    stabilization and realignment of larger segments of the spinal column

    *most common with thoracic injuries
  26. Halo traction
    done pre surgery, or if a person doesn't require surgery ....usually thoracic injury

    8-12 weeks, can walk around....watch for skin irritation
  27. Foremost cause of early death after acute SCI
    • pulmonary issues.....
    • atelectasis
    • pneumonia
    • pulmonary emboli
  28. 6 common complications post SCI
    • pulmonary issues
    • orthostatic hypotension
    • GI Bleed due to stress ulcers
    • paralytic ileus
    • atonic bladder
    • skin integrity issues
  29. When does autonomic dysreflexia occur?  Why does it happen?
    6 weeks after injury

    • any injury that is T6 or above is at risk....
    • due to interruption in the feedback loop of the autonomic nervous system.  Any irritation below the level of the injury stimulates and exaggerated, unopposed autonomic response
  30. What will a person present like if they are having autonomic dysreflexia?
    • Sudden severe headache
    • nasal congestion
    • facial flushing
    • elevated BP
    • Bradycardia
  31. Interventions for a person experiencing autonomic dysreflexia
    • Sit them up immediately...decreases BP
    • Investigate the cause
    • Treat cause
    • Give sublingual Niphedipine and monitor BP....or Apresoline IV
  32. #1 Cause of autonomic dysreflexia
    #1 bladder issues....so try to stimulate urination, may need to straight cath them

    • or check for obstruction
    • Atropine to relieve bladder tetany
  33. 3 causes of autonomic dysreflexia
    • bladder issues/obstructions
    • bowel blockages...fecal impaction
    • skin issues
  34. How can skin issues cause autonomic dysreflexia?
    • clothes are too tight
    • look for irritations like pimples, boils, pressure sores, in grown toenails
  35. Medications to treat autonomic dysreflexia
    • Nifedipine sublingual
    • Apresoline IV
    • Hyperstat
Card Set:
Spinal Cord Injury
2014-11-21 20:39:04

Spinal Cord Injuries-N176, test 4
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