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61 Cards in this Set
- Front
- Back
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Primary Prevention Interventions for Spinal Cord Injuries (4)
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Education about unknown waters
Avoid ETOH during sports activities Helmet/seatbelt laws Protective headgear for bicycles |
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What is the part of the spine most vulnerable to injury?
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Cervical spine
C2-3 usually rapidly fatal |
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Cervical Spine Controls? (4)
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Diaphragm
Chest wall muscles Arms Shoulders |
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Thoracic Spine Controls (2)
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Upper body, GI function
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Lumbar and Sacral Spine Controls (3)
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Lower body
Bowel Bladder |
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Priority Assessments for SCI (10)
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1. Stabilize C-Spine
2. ABCs (intubate PRN) 3. Watch for early spinal shock 4. GCS 5. Interview for cause 6. ALOC, AMS, loss sensation, weakness, reflexes, paralysis, localized pain 7. Headache, hypothermia 8. Alterations bowel/badder function 9. Expect steroid IV stat 10. Safety: airway, aspiration, falls |
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S/sx of spinal shock (6)
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Flaccid paralysis
Bradycardia Hypotension Loss deep tendon reflexes below level of injury Loss of sensation Bowel/bladder dysfunction |
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Watch for s/sx of _____ during SCI recovery
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autonomic dysrflexia
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SCI: Types of Injuries
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Complete Injury: loss of motor, sensory, reflexes below level of injury
Incomplete injury: mixed patterns of loss |
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GCS <7 indicates ?
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coma level
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SCI: New thinking about emergent care
(3) |
Immediate immobilization and early decompression
Core body cooling High-dose steroids |
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External Immobilization of Spine (2)
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Thoracic Lumbar Sacral Orthoses (TLSO)
Cervical traction |
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What is spinal shock/neurogenic shock? (3)
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Loss of stimulation in higher centrers of brain
Temprary loss reflexes below level of injury Higher injury = greater risk for shock |
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Spinal Shock Symptoms (5)
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Vessels unable to constriction d/t sympathetic NS blockage
BP drop d/t domination of parasympathetic HR slows Core temperature drops Skin dry, warm skin |
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What is autonomic dysreflexia?
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Hyper reflexia
Rapid rise in BP |
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When is the greatest risk of autonomic dysreflexia?
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When reflexes return if paralysis resolves
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What triggers autonomic dysreflexia (7)
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Skin pressure
Blader distention UTI/Bladder stones Cath Surgical procedures of bladder/urethra Bone fractures Local infxn/wounds & skin sores |
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Symptoms of Autonomic Dysreflexia (10)
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HTN: severe, rapid-onset
Bradycardia Red blotches: skin above level of injury Flushed face Piloerection Headache Diaphoresis Nasal stuffiness Nausea Skin cold, clammy below level of injury |
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Actions: Autonomic Dysreflexia (5)
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Sit pt upright
Check bladder drainage Check bowel impaction Remove/reduce stimulation Prepare medicaitons (vasodilators, beta and Ca+ blockkers) |
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What is Guillain-Bare
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An acute inflammatory process characterizzed by motor weakness and paralysis
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Stages of Guillain-Barre
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Initial (1-3 weeks)
Plateau (3 days to 2 weeks) Recovery (4-6 months) |
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What aren't affected by guillain-barre? (2)
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LOC
Mental Status |
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What does guillain-barre affect (4)
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Motor: ascending weakness
Sensory: paresthesia, cramping muscle pain Cranial Nerves: facial weakness, dysphagia, diplopia Autonomic: Vagus nerve deficit: unstable BP, tachy |
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How does one diagnose Guilain-barre? (4)
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Symptoms
LP (high protein) EPS EMG |
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Guillain-Barre Priorities of Care (6)
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Airway
Psychosocial and impaired coping Unstable vital signs Impaired mobility Pain r/t paresthesia Plasmapheresis |
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What characterizes Parkinson's? (7)
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resting tremors
Decreased postural reflexes Extreme slowness of movement Bradykinesia, fine motor movement Poor gait and baance Orthostatic hypotension Difficulty swallowing and chewing |
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Types of Parkinson's (5)
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Primary (idiopathic)
Postencephalitic (following encephalitis) Iatrogenic (caused by psychotropic meds) Juvenile (before 40) Secondary (trauma/ischemia to cells) |
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Stages (3)
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Mild
Unilateral limb Bilateral |
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Other symptoms of Parkinson's (9)
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Urinary incontinence, retention, constipation
Muscle cramps Pain Fatigue Depression & emotional changes Sleep problems Speech changes Dementia/cognition Sexual Dysfunction |
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Priorities of care
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Complications: falls, skin breakdown, UTI
Death: aspiration pneumonia, infections Impaired: mobility, self-care, nutrition, communication, self-esteem/body image |
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What types of drug therapy are used to treat Parkinson's (5)
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Increase brain levles of dopamine (levodopa)
Mimic dopamine (dopamine agonists) Inhibit dopamine breakdown (selegiline, entacapone) Decrease anticholinergics (Benztropine, ethopropazine) Unknown mechanism of action (amantadine) |
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Side effects of Levodopa/carbidopa? (4)
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Confusion
Hallucinations Nightmares On-Off effect |
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What is alzheimer's disease?
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Progressive degeneration of cerebral cortical nerve cells and endings
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Five A's to remember alzheimers
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Amnesia
Anomnia Apaxia Agnosia Aphasia |
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Diagnosing alzheimers (4)
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MSE
Neuro exam Pet Scan Brain biopsy |
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Medications to manage Alzheimer's
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Antipsychotics (behavioral symptoms)
Cholinesterase inhibitors: reduce ACh breakdown) Memantine (Namenda) regulates activity of glutamate, messenger for learning/memory |
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What is ALS
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Upper and lower motor neuron disease
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If ALS affects upper motor neurons, then symptoms include (2)
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Spasticity
Weakness |
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If ALS affects lower motor neurons, then symptoms include (3)
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Flaccidity
Paralysis Atrophy |
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S/Sx of ALS (6)
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Slow
Weakness, irregular twitiching, ramps in hands/feet Impaired chewing, swallowing, speaking Drooling Spasticity, hyperreflexia, cramping in legs Flaccidity & atrophy of muscles |
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How to diagnose ALS (3)
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Symptoms
CSF analysis EMG |
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Monitor and Manage: ALS (5)
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Aspiration/Ventilatory failure
Impaired communication Malnutrition constipation skin breakdown |
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Clinical Manifestations: MS (6)
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Motor: fatigue, unsteady gait
Cerebellar: dysmetria Cranial Nerves: dysphagia, dysarthria, diplopia, nystagmus Sensory: numbness, tingling,burning, bowel/blader & sexual dysfunction Cognitive: (late) memory/attention loss Psychosocial: emotional lability |
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How to diagnose MS (5)
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LP
EEG EPS CT MRI |
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Monitor & Manage: MS (5)
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Impaired mobility & fatigue
Activity intolerance r/t weakness, dizziness Risk for injury Self-care deficit Sensory/perceptual alterations |
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Drug therapy for MS (4)
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Steroids
Anti-anxiety Muscle spasiticity Urinary retention |
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MG manifestations: exertion & rest
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Fatigue and muscle weakness that increases with exertion and improves with rest
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What visual disturbance is caused by MG
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accommodation impairments
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What symptoms indicate an advanced disease of MG (2)
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Respiratory muscles weak
Loss of bowel and bladder control |
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What is the tensilon test
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Administer tensilon to inhibit the breakdown of ACh (inhibit cholinesterase)
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What are the indications of the Tensilon test
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(+) = MG
(-) = Cholinergic Crisis |
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How to diagnose MG (5)
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Symptoms
Thyroid function ACh receptor antibody test EMG (+) Tensilon Test |
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Care Priorities: MG
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Airway
Mobility Self-care deficit High risk injury Impaired verbal communication Alteration nutrition Altered body image/self-esteem disturbance |
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Treatment of MG (2)
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Plasmapheresis
Patient teaching |
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Drug therapy for MG (3)
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Corticosteroid and immunosuppressants
Cholinesterase inhibitor drugs - Prostigmin, Mestinon Atropine |
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Long term tx of MG
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Plasmapharesis
Surgical thymectomy Medication |
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s/sx of myasthenic crisis (4)
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Often preceded by infection
Sudden muscle weakness Inability to cough, clear secretions, swallow, ventilate Sudden rise in BP and HR |
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How to manage myasthenic crisis (2)
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higher doses or more frequent medication
intubation and ventilator |
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What is cholinergic crisis
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Sudden muscle weakness d/t over medication of cholinesterase inhibitors
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S/sx of cholinergic Crisis (7)
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Acute muscle weakness
N/V Diarrhea Abdominal pain Blurred vision Pallor Facial muscle twitching |
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How to manage Cholinergic Crisis (3)
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Hold all medications
Intubate & ventilator support Severe symptoms give atropine |
