Spinal Cord Injury

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Author:
japanice27
ID:
306293
Filename:
Spinal Cord Injury
Updated:
2015-08-13 06:51:24
Tags:
SCI SPINALCORD SPINALCORDINJURY
Folders:
neuro
Description:
review about SCI
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  1. SPINAL CORD INJURY
    • injury to the SC causes partial or complete disruption of the nerve tracts and neuron.
    • the injury can involve contusion, concussion or lacerations of the cord.
    • (+)spinal cord edema; necrosis of the SC can develop as a result of compromised capillary circulation and venous return.
    • (+)LOSS of motor, sensory, reflex activity, and bowel and bladder control
    • MOST COMMON CAUSE: motor vehicular accident, falls, sporting and industrial accidents and gun shot and stab wounds
  2. CX of SCI:
    • respiratory failure
    • autonomic dysreflexia
    • spinal shock
    • further cord damage
    • death
  3. COMMON vertebrae involvement:
    • cervical: C5, C6, C7
    • thoracic: T12
    • lumbar: L1
  4. TRANSECTION OF THE CORD:
    1. COMPLETE- the SC is severed completely, with TOTAL loss of sensation, movement and reflex ability below the level of injury

    2. INCOMPLETE/PARTIAL- SC is severed and damaged partially; early tx is needed to px partial damage from developing into complete permanent damage.
  5. SPINAL CORD SYNDROMES IN INCOMPLETE INJURY:
    • 1. CENTRAL CORD SYNDROME:
    • -occurs from a lesion in the CENTRAL PORTION of the SC.
    • -loss of motor is more pronounced in the upper ext, and varying degrees and patterns remain intact.
    • 2. ANTERIOR CORD SYNDROME:
    • -damage: anterior portion of the gray and white matter of the SC;motor fxn, pain and temperature sensation are LOST below the level of injury; sensation of vibration, position and touch remain intact.
    • 3. POSTERIOR CORD SYNDROME:
    • -damage: the posterior white and gray matter of the SC.
    • -motor fxn remain intact, but the pt experiences a loss of vibratory sense, crude touch and position sensation.
    • 4. BROWN-SEQUARD SYNDROME:
    • -results from penetrating injuries that cause hemisection of the SC or injuries that affect half the cord
    • -motor fxn, vibration, proprioception, and deep touch sensation are lost on the same side of the body (ipsilateral) as the lesion or cord damage.
    • -on the opposite side of the body (contralateral) from the lesion or cord damage, the sensation of pain, temperature, and light touch are affected.
    • 5. CONUS MEDULLARIS SYNDROME:
    • -damage to the lumbar nerve roots and conus medullaris of the SC
    • -(+) bladder and bowel areflexia
    • -flaccid extremities
    • -(+)damage to the UPPER SACRAL of the SC=erection and micturition will remain.
    • 6. CAUDA EQUINA SYNDROME:
    • -injury to the LUMBOSACRAL NERVE roots below the conus medullaris
    • -(+) areflexia of the bowel, bladder and lower reflexes.
  6. Assess of SC injury:
    • TETRAPLEGIA
    • -injury between C1 and C8.
    • -paralysis involving ALL extremities

    • PARAPLEGIA
    • -injury bet T1 and L4.
    • -paralysis ONLY at LOWER extremities
  7. CERVICAL injuries:
    • *injury C2 to C3 is usually fatal
    • *C4-major innervation to the diaphragm by the phrenic nerve.
    • *injury above the C4 causes resp difficulty and paralysis of all extremities
    • *injury at C5 to C8- (+)movement in the shoulder, may also have decreased resp reserve
  8. THORACIC injuries:
    • *loss of movt of the chest, trunk, bowel, bladder and legs may occur, depending on the level of injury.
    • *leg paralysis may occur
    • *autonomic dysreflexia with lesion or injuries above T6 and in cervical lesions may occur.
  9. LUMBAR AND SACRAL injuries:
    • *loss of movt or sensation of the lower extremities may occur
    • *S2 and S3 (center of micturition; bladder will not contract but not empty.
    • *injury above S2 in males-may have an erection but cannot ejaculate (sympathetic nerve damage)
  10. EMERGENCY INT:
    • -assess airway
    • -maintain patent airway
    • -px: head flexion, rotation and extension
    • -maintain an extended position
    • -logroll the pt
    • -NO PART OF THE BODY SHOULD BE TWISTED AND TURNED, and the pt is not allowed to assume a sitting position
    • -CERVICAL FRACTURE-immediately place pt in skeletal traction via skull tongs or halo traction to immobilize the cervical spine and reduce fracture and dislocation
  11. INT during hospitalization:
    • I. RESP SYSTEM:
    • -monitor ABG levels and maintain mechanical ventilator as prescribed to px resp arrest
    • -use incentive spirometer and do deep breathing
    • -monitor for signs of infection (pneumonia)

    • II. CARDIOVASCULAR SYSTEM:
    • -WOF cardiac dysrhythmias
    • -assess for signs of bleeding and hemorrhage at fracture site
    • -WOF shock (hypotension, tachycardia, a weak and thready pulse)
    • -assess lower ext for DVT
    • -measure calf and thigh to identify increase in size
    • -remove antiembolism daily stocking to assess skin
    • -monitor for orthostatic hypotension when repositioning the pt.

    • III. NEUROMUSCULAR SYSTEM:
    • -assess NS
    • -assess motor and sensory status to determine level of injury
    • -assess motor ability: squeeze hands, spread fingers, move toes, turn feet
    • -assess sensation: pinching skin or pricking it with a pin starting from the shoulders and working down to the lower ext.
    • -WOF signs of AD and signs of shock
    • -immobilize pt
    • -assess and reduce pain, analgesics as prescribed

    • IV. GIT SYSTEM:
    • -assess abdomen for distention and hemorrhage
    • -monitor for bowel sounds and paralytic ileus
    • -px bowel retention
    • -initiate bowel control
    • -adequate nutrition and high fiber diet

    • V. RENAL SYSTEM:
    • -px urinary retention
    • -initiate bladder control
    • -maintain fluid and electrolyte balanced
    • -OFI: 2000ml/day
    • -WOF urinary infection and calculi

    • VI. INTEGUMENTARY SYSTEM:
    • -assess skin integrity
    • -turn pt every 2 hours
  12. SPINAL AND NEUROGENIC SHOCK:
    • SPINAL SHOCK: complete but temporary loss of motor, sensory, reflex and autonomic fxn
    • S/SX: HYPOTENSION, BRADYCARDIA

    • NEUROGENIC SHOCK: common to pt with above T6 injury; experienced usually after injury. Massive vasodilation occurs, leading to pooling of blood in BV, tissue hypoperfusion, and impaired cellular metabolism
    • S/SX: FLACCID PARALYSIS
    • LOSS OF REFLEX ABILITY BELOW THE LEVEL OF INJURY
    • BRADYCARDIA
    • HYPOTENSION
    • PARALYTIC ILEUS
  13. AUTONOMIC DYSREFLEXIA:
    • -also known as autonomic hyperreflexia
    • -occurs after the spinal shock is resolved
    • -occurs with lesions above T6 and cervical lesions
    • -caused by: visceral distention frm a distended bladder or impacted rectum
    • -EMERGENCY!!! tx ASAP!
    • S/SX:
    • *sudden onset, severe, throbbing pain
    • *severe hypertension and bradycardia
    • *flushing above the level of injury
    • *pale ext below the level of injury
    • *nasal stuffiness
    • *nausea
    • *dilated pupils or blurred vision
    • *sweating
    • *piloerection (goose bumps)
    • *restlessness and a feeling of apprehension

    • N/I:
    • -raise HOP (fowler's)
    • -loosen tight clothing
    • -check for bladder distention and noxious stimuli
    • -give antiHTN meds
    • -DOC: occurrence, tx and response

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