Acute Test 2

Front 1

SCI

Initial mechanical disruption ofaxons as a result of stretch or laceration

Back 1

Primaryinjury

Front 2

SCI

Ongoing, progressive damage that occurs after initial injury

____ (cell death) for weeks or months after initial injury

Back 2

Secondary injury

Apoptosis

Front 3

SCI

Completecord damage related to auto destruction

___ appear within 1 hour

____ by 4 hours

By≤24 hours, permanent damage may occur because of ____.

Back 3

Hemorrhages

Infarction

edema

Front 4

SCI

Prognosiscannot be determined for at least ____ hours until swelling has gone down

Back 4

72

Front 5

____: characterizedby decreased reflexes, loss of sensation and flaccidity below level of injury

Back 5

Spinal Shock

Front 6

____:loss of vasomotor tone caused by injury and is characterized by hypotension andbradycardia

Back 6

Neurogenic shock

Front 7

_____injury of the cervical spine ruptures the posterior ligaments.

Back 7

•A, Flexion

Front 8

____ injury of the cervical spine ruptures the anterior ligaments.

Back 8

•B, Hyperextension

Front 9

_____ crush the vertebrae and force bony fragments into the spinal canal.

Back 9

•C, Compression fractures

Front 10

_____ injury of the cervical spine often results in tearing of ligamentous structures that normally stabilize the spine.

Back 10

•D, Flexion-rotation

Front 11

_____:loss of sensation in the legs

Part of spine __2__

Back 11

¡Paraplegia

Thoracic / Lumbar

Front 12

____:paralysisof all four limbs

Part of spine ___

Back 12

Tetraplegia (quadraplegia)

cervical

Front 13

Degree of SC Injury

____ Total loss of sensory and motor function below levelof injury

Back 13

Complete

Front 14

Degree of SC Injury

____ Mixed loss of voluntary motor activity and sensation Some tracts intact

Back 14

Incomplete (partial)

Front 15

Damageto central spinal cord

Mostcommonly cervical region

Morecommon in older adults

Motorweakness and sensory loss

Upperextremities affected more than lower

Back 15

Incomplete SCI

Central Cord Syndrome

Front 16

•injury causingacute compression of anterior portion of the spinal cord, often a ___ injury like ___

•__3___ below the level of injury

•Because posterior cord tracts arenot injured, sensations of touch, position, vibration, and motion remainintact.¡

Back 16

Anterior Cord Syndrome

Whiplash

Motor paralysis and loss of pain and temperature sensation

Front 17

Incomplete SCIBrown-Séquard Syndrome

Damageto___ of cord

Caused by __ -- __2__

Back 17

one-half

Penetrating trauma - Gunshot wound, stabs

Front 18

Incomplete SCIBrown-Séquard Syndrome

Type of injury

___(same side of injury) ___3___

___(opposite side of injury)___2__

Back 18

Ipsilateral

loss of motor function and position and vibration sense

Contralateral

loss of pain and temperature sensation

Front 19

•Results fromcompression or damage to the posterior spinal artery • Very rare condition •

Back 19

Incomplete SCI

Posterior Cord Syndrome

Front 20

•resulting in loss of proprioception.

May have unsteady gait •

•Pain, temperature sensation, and motor function below the level of the injury remain intact.

Back 20

Incomplete SCI

Posterior Cord Syndrome

Front 21

¡Resultfrom damage to very lowest portion of spinal cord (conus)and lumbar and sacral nerve roots (cauda equina)

Back 21

Conus Medullaris Syndrome/ Cauda Equina Syndrome

Front 22

Injuryto these areas produces flaccid paralysis of lower limbs and areflexic(flaccid) bladder and bowel.

Back 22

Conus Medullaris Syndrome/ Cauda Equina Syndrome

Front 23

Level of injury

____Total loss of respiratory muscle function →mechanicalventilation

Back 23

Above level of C4

Front 24

Level of injury'

____ Diaphragmaticbreathing→respiratory insufficiency

Back 24

Below level of C4

Front 25

__2__ injuries

Paralysis of abdominal andintercostal muscles → ineffectivecough →atelectasis or pneumonia

↑Riskfor infection -Cant move around a lot, cough, etc

Back 25

Cervical and thoracic

Front 26

Level of injury'

____↓influence of sympathetic nervous system

This causes __3__

Back 26

Injury above level T6

Bradycardia, Peripheral vasodilation → hypotension

Front 27

SCI

Cardiacmonitoring necessary

____ to ↑heart rate and prevent hypoxemia, which is a ____ drug

Back 27

Atropine

Front 28

Spinal shockAcutephase

Urinary____

Bladderatonic and over distended

use ___

Back 28

retention

Indwelling catheter

Front 29

Level of injury'

____

Paralyticileus

Gastricdistention

May give ___ or use ____

Back 29

¡AboveT5→hypo-motility

Metoclopramide(Reglan)*

Nasogastrictube

Front 30

Level of injury'

Neurogenic bowel

Back 30

Injury level of T12 or below

Front 31

Bothareflexicand reflexicneurogenic bowel can be managed successfully with a ____ coordinated with the gastrocolicreflex to minimize fecal incontinence.

Back 31

regular bowel program

Front 32

↓Abilityto sweat or shiver

Morecommon with high cervical injury

Inabilityto regulate temperature

Back 32

nursing

Front 33

¡NGsuctioning →metabolic ____

¡Monitor____

Back 33

alkalosis

Electrolyte imbalances

Front 34

SCI

____ gold standard to locate thedegree of injury

Back 34

CT scan

Front 35

SCI Initialcare__6__

in order

Back 35

Ensure patent airway.

Stabilize cervical spine. Log roll/C-collar

Administer oxygen.

Establish IV access.

Assess for other injuries.

Control external bleeding.

Front 36

SCI

Usea hard cervical collar, and a backboard to stabilize the neck to prevent____

Back 36

lateral rotation

Performturning so that the patient is moved as a unit

Front 37

SCI

OngoingmonitoringVS,LOC, O2sat, cardiac rhythm, urine output

Keepwarm.

Monitorfor urinary retention, hypertension.

Anticipateneed for intubation if no gag reflex.

Back 37

Nursing

Front 38

____ Earlysurgery indicated ifEvidenceof cord compression

Back 38

laminectomy

Front 39

____Vasopressoragent Usedto maintain mean arterial pressure ____

Back 39

dopamine

> 90 mm Hg

Front 40

with neck braces and traction __2___

Back 40

Checkfor skin integrity around braces and pin care.

Front 41

____ critical with all types of immobilization

Back 41

¡Meticulous skin care

Front 42

____ Mayincreased during first 48 hours of SCI

Mayneed intubation and mechanical ventilation

↑Riskfor ___2___

Interventions: 6

Back 42

Respiratory Dysfunction

pneumonia and atelectasis

RegularassessmentAggressivechest physiotherapyAdequateoxygenationProperpain managementAssistedcoughing TrachealsuctioningIncentivespirometry

Front 43

Cardiovascular Instability with SCI

Riskfor ____ and cardiac arrest

Chronic___ blood pressure with postural hypotension

↑Riskfor___

Back 43

bradycardia

low

DVT

Front 44

SCI Bowel Management 3

Back 44

Dailyrectal stimulant

Digital stimulation or manual evacuation

Uprightposition when able

Front 45

Massiveuncompensated cardiovascular reaction mediated by sympathetic nervous system

•Vitalsigns change

Hypertensionand bradycardia

Back 45

Autonomic Dysreflexia

Front 46

Level of injury ____

____ caused by Autonomic Dysreflexia

Back 46

T6and higher insult

Hypertension and bradycardia

Front 47

¡Mostcommon precipitating factor is distended bladder or rectum.

HypertensionThrobbingheadache Markeddiaphoresis above level of injuryBradycardia

Back 47

Autonomic Dysreflexia

Front 48

when someone has a throbbing headache

Back 48

( take blood pressure)

Front 49

Autonomic Dysreflexia

Nursinginterventions

Elevatehead, notify HCP

3

Back 49

immediatecatheterization

removestool impaction if cause

removeconstrictive clothing and tight shoes

Front 50

Areflexic(flaccid), hyperreflexic(spastic), or dyssynergia

Commonproblems : Urgency,frequency, incontinence, inability to void, and high bladder pressuresresulting in reflux of urine into kidneys

Back 50

Neurogenic Bladder

Front 51

____ Bowel Voluntarycontrol may be lost.

interventions 7

Back 51

Neurogenic Bowel

High-fiber diet / Adequate fluid intake / Suppositories / Small-volume enemas / Digital stimulation /Stoolsoftener /Oralstimulant laxatives

Front 52

Thebrain requires a continuous supply of blood to provide the___2___ that neurons need to function. A ____ occurs when there is an interruption,either from ischemia to a part of the brain or hemorrhage into the brain, inthe blood supply that results in the death of brain cells.

Back 52

oxygen and glucose

stroke, CVA

Front 53

•Followingthe onset of a stroke, immediate ___ is crucial to decreasedisability and death.

Back 53

medical attention

Front 54

Stroke

•Loss of function varies according to__2__

Back 54

the location and extent of brain tissue involved.

Front 55

Control thinking, memory, behavior, movement

Back 55

frontal lobe

Front 56

controls hearing, learning, and feelings

Back 56

temporal lobe

Front 57

control breathing, hr, and temp

Back 57

brain stem

Front 58

controls language and touch

Back 58

parietal lobe

Front 59

control sight

Back 59

occipital lobe

Front 60

control balance and coordination

Back 60

cerebellum

Front 61

•Most effective way to decrease theburden of stroke is __2__

Back 61

prevention and teaching.

Front 62

Stroke

•____ is the single most important modifiable risk factor, but it is still oftenundetected and inadequately treated.

Back 62

Hypertension

Front 63

LipidPanel

•Cholesterol – ___

•Triglyceride – ____

•Low density lipoprotien– ____

•High density lipoprotien–____

Back 63

less than 200

less than 150

less than 100-139

more than 40

Front 64

• waist circumference: >40 men and >35 women•

• triglycerides: > 150•

• HDL: >40•

•Hypertension: >135/85•

•Fastingblood glucose > 110

Back 64

MetabolicSyndrome

Front 65

•____ is responsible for about 20% of all strokes; incidence increaseswith age. àthese can be large clots and cause major damage

Back 65

Atrial fibrillation

Front 66

•____ is a transient episode of neurologic dysfunction caused by focal brain, spinalcord, or retinal ischemia, but withoutacute infarction of the brain.

should be treated as ___

Back 66

TIA

medical emergency

Front 67

•____ may be due to microemboli thattemporarily block the blood flow. they are a warning sign of progressivecerebrovascular disease.

•Symptomstypically last ___.

•___will progress to an ischemic stroke.

Back 67

TIAs

< 1 hour

1/3

Front 68

•Strokesare classified based on the underlying pathophysiologic findings:

•___: blood flow restriction

•___: bleeding out

Back 68

Ischemic

Hemorrhagic

Front 69

•____,a hardening and thickening of arteries, is the major cause of ischemic stroke.It can lead to thrombus formation and contribute to emboli.

Back 69

Atherosclerosis

Front 70

•____ stroke•Occurs from injury to a bloodvessel wall and formation of a blood clot

Most common cause of stroke 60%

•Signsand symptoms develop slowly

Back 70

Thrombotic

Front 71

•____ stroke occurs when an emboluslodges in and occludes a cerebral artery, resulting in infarction and edema ofthe area supplied by the involved vessel. •This accounts for about 24% ofstrokes.

Back 71

Embolic

Front 72

•Patient with an ___ strokecommonly has a rapid occurrence of severe clinical manifestations.

Back 72

embolic

Front 73

• _____ is one cause of embolic stroke in young to middle-aged adults. Anembolus arising from an atherosclerotic plaque is more common in older adults.

Back 73

Rheumatic heart disease

Front 74

•Prognosisis poor with a 30-day mortality rate of 40-80%.

•Bleeding within brain caused byrupture of a vessel•Sudden onset of symptoms

Back 74

HemorrhagicStroke

Front 75

HemorrhagicStroke

•____ is most common cause.

•Hemorrhage occurs during activity.

Back 75

Hypertension

Front 76

•Intracranial bleeding intocerebrospinal fluid–filled space between the arachnoid and piamater

•Commonly caused by rupture of acerebral aneurysm, trauma, or drug abuse

Back 76

•Subarachnoidhemorrhage (SAH) stroke

Front 77

•Majority of aneurysms are in the___

Back 77

Circle of Willis.

Front 78

•____the ballooning artery applies pressure to brain tissue

minor warningsymptoms may result from leaking before major rupture.

Viewed as a “____r” as individuals donot have warning signs until rupture has occurred.

Back 78

aneurysm

silent killer

Front 79

S/S ofruptured aneurysm – 5

Med Emergency

Back 79

Suddensevere headache

Visionproblems

Nauseaand vomiting

Confusion

Stiffor painful neck

Front 80

A lesion on the right of the brain

There is effects on the____

Back 80

left side

Front 81

•Most obvious effect of stroke

•Includeimpairment of•Mobility•Respiratory function•Swallowing and speech•Gag reflex•Self-care abilities

Back 81

Motor Function

Front 82

Stroke Drug therapy

3

Back 82

•Commondose for aspirin is 81 to 325 mg/day. Other drugsinclude clopidogrel(Plavix)*

Forpatients who have atrial fibrillation, oral anticoagulation can includewarfarin (Coumadin)*

•Statins(simvastatin [Zocor],* have also been shown to be effective in the prevention of stroke forindividuals who have experienced a TIA in the past.

Front 83

•In a ____, the atheromatous lesion is removed from the carotidartery to improve blood flow.

Back 83

carotid endarterectomy (CEA)

Front 84

o Neurogenic shock:

Give 2

Back 84

atropine and dopamine

Front 85

o ___ – Mini stroke, med emergency, should go backto normal w/in 1 hr

Back 85

TIA

Front 86

§ ____ stroke starts as a plaque build up· FROM High ___

Back 86

Thombotic

cholesterol

Front 87

§ ____ stroke – blood clot· ____cause·

____ is cause in children

Back 87

Embolic

A fib

Rheumatic heart disease

Front 88

o ___ stroke – burst blood vessel

§ __2__ cause

Severe throbbing headache that is persistent

“Thunderclap”

Back 88

Hemorrhagic

HTN & cerebral aneurysm

Front 89

ClinicalManifestations of Stroke are related to ___

Back 89

location of stroke

Front 90

o R/L Brain Stroke

Right side: ____

Left side: __3__

Back 90

very impulsive people

slow, cautious, aware of impairment

Front 91

•Most obvious effect of stroke ___ includes __5__

Back 91

Motor Function

Includeimpairment ofMobilityRespiratoryfunctionSwallowingand speechGagreflexSelf-careabilities

Front 92

•Loss of skilled voluntary movement

Back 92

•Akinesia

Front 93

•___ occurs when stroke damages dominant hemisphere of the brain and affectslanguage.

•___ – loss of comprehension

•___ – loss of production oflanguage

•___ – total inability tocommunicate

Back 93

Aphasia

Receptive

Expressive

Global

Front 94

•___ refers to impaired ability to communicate.

Back 94

Dysphasia

Front 95

•Patients who suffer a stroke may havedifficulty controlling their emotions.

•Emotionalresponses may be exaggerated or unpredictable.

Back 95

nursing

Front 96

•Strokeon the right side of the brain is more likely to cause problems in____

Back 96

spatial-perceptual orientation. -

•Incorrect perception of self andillness•Unilateral neglect•Agnosia•Apraxia

Front 97

Stroke prevention

•Goalsinclude management of modifiable risk factors •Healthy diet•Weight control•Regular exercise•No smoking•Limited alcohol consumption•Routine health assessments

Back 97

nursing

Front 98

•Antiplatelet drugs are used in patients who have had a TIA related toatherosclerosis.

•___ is the most frequently usedantiplatelet agent.

Back 98

Aspirin

Front 99

•Forpatients who have atrial fibrillation, oral anticoagulation can include___)

Back 99

warfarin (Coumadin

Front 100

•Carotidendarterectomy isperformed to prevent impending cerebral infarction.

•A, Atube is inserted above and below the blockage to reroute the blood flow.

•B,Atherosclerotic plaque in the common carotid artery is removed.

•C,Once the artery is stitched closed, the tube can be removed. A surgeon may alsoperform the technique without rerouting the blood flow.

Back 100

nursing

Front 101

•Brainstent used to treat blockages in cerebral blood flow.

•A, Aballoon catheter is used to implant the stent into an artery of the brain.

•B, Theballoon catheter is moved to the blocked area of the artery and then inflated.The stent expands due to the inflation of the balloon.

•C, Theballoon is deflated and withdrawn, leaving the stent permanently in placeholding the artery open and improving the flow of blood.

Back 101

nursing

Front 102

o Affect is ___2__ with stroke

Back 102

unpredictable (may be depression)

Front 103

•___ is common immediately after a stroke.

Back 103

Elevated BP

•TheUse ofdrugs to lower BP is recommended only if BP is markedly increased (meanarterial pressure greater than 130 mm Hg or systolic pressure greater than 220mm Hg). In the case of an acute stroke,

Front 104

•Must be administered within 3 to4.5 hours of onset of clinical signs ofischemic stroke

Back 104

•Recombinanttissue plasminogen activator (tPA)(Immediate use)

Front 105

Stroke o Diagnostic: ___

Back 105

CT scan

Front 106

CEA

Postoperative care is important 4

Back 106

o Neurovascular assessment o BP management o Assessment of stent occlusion o Keep legs straight *

Front 107

Stroke Pt

o Make sure pt is adequately hydrated – *do notuse ___ like ___2___

Back 107

hypotonic solutions

These include 0.45% NS AND D5W

Front 108

· After stroke, patient is at risk for ___ becausethey are not moving as much

Back 108

VTE

Front 109

•Sensory-perceptualalterations

•Patients with stroke on ___ side ofbrain•Difficulty in judging position,distance, and movement•Impulsive, impatient, and denyproblems related to stroke•Respond best to directions givenverbally

Back 109

right

Front 110

•Sensory-perceptualalterations•Patients with stroke on ___ side ofbrain•Slower in organization andperformance of tasks•Impaired spatial discrimination•Have fearful, anxious response tostroke•Respond well to nonverbal cues

Back 110

left