Sci-Lecture 2

Front 1

When does orthostatic hypotension most likely occur with SCI pts?

Back 1

First 3 months after injury (during shock)--after 3 months the sympathetic tone comes back

Front 2

When does autonomic dysreflexia most likely occur with SCI pts?

Back 2

1-3 months after injury (coming out of shock)

Front 3

What do SCI pts report when experiencing orthostatic hypotension? (5)

Back 3

1) Light headed
2) Nausea
3) Ringing in ears
4) Vision changes
5) Feeling faint

Front 4

What are the clinical signs of a SCI pt experiencing orthostatic hypotension? (3)

Back 4

1) Tachycardia b/c PNS will be told to decrease
2) Pupils will dilate
3) BP will decrease (no vasoconstriction below)

Front 5

What is the danger if orthostatic hypotension goes unrecognized in SCI pts?

Back 5

The pt will faint or pass out

Front 6

What level of SCI injury is at risk for developing orthostatic hypotension?

Back 6

T6 and above
(The higher the level and if complete injury, the higher the risk)

Front 7

What triggers orthostatic hypotension in SCI pts?

Back 7

Positional changes such as supine to sit or stand

Front 8

What is your immediate intervention to orthostatic hypotension?

Back 8

Lie the pt supine with feet propped up to return the blood back to the head

Front 9

What is your treatment to prevent orthostatic hypotension from occuring?

Back 9

Place ab binder around stomach and use compression hose on feet to push blood back up

Tilt table

Front 10

What do SCI pts report when they are experiencing autonomic dysreflexia? (3)

Back 10

1) Massive headache
2) Fear/anxiety due to adrenal gland shooting out epinephrine
3) Might sweat above lesion if T1-T5 is in tact or have combination of skin changes above/below

Front 11

What are the clinical signs of autonomic dysreflexia? (3)

Back 11

1) Bradycardia due to increase in PNS (CN X)
2) Increase BP (systolic increase of 20-40 from resting; >150)
3) Reflexive bladder

Front 12

What is the danger if autonomic dysreflexia is unrecognized? (3)

Back 12

1) Stroke
2) Heart attack
3) Kidney and eye damage

Front 13

When is a SCI pt at most risk for developing autonomic dysreflexia?

Back 13

1-3 months after injury

Front 14

What lesion level is at risk for autonomic dysreflexia?

Back 14

T6 and above (3x more common in complete)

Will have splanchnic outflow so all viscera will vasoconstrict below the injury

Front 15

What triggers autonomic dysreflexia? What is the #1 cause? Other causes?

Back 15

Pain or noxious stimuli below the lesion sensed by the SNS

#1 bladder distention

Impacted bowel
Skin pinch
PROM

Front 16

What are the signs and symptoms for DVT?

Back 16

1) Heat
2) Localized swelling
3) Veins protruding
4) Redness

Front 17

When is a SCI pt at the greatest risk for developing a DVT?

Back 17

First 2 weeks after injury

80% risk in 72hrs without treatment

Front 18

What are the risk factors for developing DVT? (5)

Back 18

1) Fracture
2) Vascular compromise
3) Skin lesions
4) Infection
5) Immobility

Front 19

How long does a complete SCI pt with some other risk factor for DVT need to take medicine?

Back 19

12 weeks (may have filter in vena cava; so no diaphragm cough for respiratory therapy)

Front 20

How long does a complete SCI pt with a DVT need to take medicine?

Back 20

8 weeks

Front 21

What is the differential diagnosis for DVT vs Heterotopic Ossification?

Back 21

DVT--doppler US
Heterotopic Ossification--bone scan

Front 22

What interventions can be used for a SCI pt with a DVT?

Back 22

1) Medication--some form of heparin
2) Compression hose for 2 weeks

Front 23

What are the signs and symptoms for a SCI pt with Heterotopic Ossification?

Back 23

1) Heat
2) Redness
3) Localized swelling
4) ROM change close to a joint caused by fracture, trauma, infection or immobilization

Front 24

What interventions can be given for pts with Heterotopic Ossificans?

Back 24

1) ROM
2) NSAIDs
3) Phosphates
No serial casting

Front 25

What are the signs and symptoms of a SCI pt experiencing a pulmonary embolism? (6)

Back 25

1) SOB/Increase breathe
2) Chest pain
3) Low grade fever associated with OH
4) Cough
5) Feels anxious
6) Looks gray

Front 26

What is usually the onset for pulmonary embolism in SCI pts?

Back 26

Rapid onset

Front 27

What are the risk factors for a SCI pt with pulmonary embolism?

Back 27

80% risk in the first 72hrs without treatment

Front 28

What is the differential diagnosis of a PE vs Acelectasis?

Back 28

PE--Lung scan, CT scan or pulmonary angiography

Acelectasis--x-ray, auscultation

Front 29

What interventions are used for pts with PE?

Back 29

1) Medication--heparins
2) Filters

Front 30

What are the signs and symptoms for atelectasis? (3)

Back 30

1) SOB
2) Increased breathing rate
3) Increased heart rate

Front 31

What is the onset for acelectasis?

Back 31

Gradual onsets of weeks often with pneumonia

Front 32

What are the risk factors for a SCI pt with atelectasis? (4)

Back 32

1) Have risk for the rest of their life
2) Impaired cough
3) Infection
4) Immobility

Front 33

What are the interventions for aceletasis? (2)

Back 33

1) Chest suction
2) Cough assist

Front 34

la chitarra

Back 34

guitar

Front 35

What are the overall goals in continuum of care for a SCI pt in ICU? (3)

Back 35

1) Survival
2) Medical stability
3) Prevent secondary complications

Front 36

What are the overall goals in continuum of care for a SCI pt in acute care? (3)

Back 36

1) Medical stability
2) Prevent secondary complications
3) Prepare for next level of care

Front 37

What are the overall goals in continuum of care for a SCI pt in inpatient rehab? (2)

Back 37

Return to life at home
1) ADLs
2) Mobility

Front 38

What is the most aggressive rehab level of care for SCI pts?

Back 38

Inpatient rehab (pt must tolerate at least 3hrs/day up to 30 min at a time)

Front 39

What are the overall goals in continuum of care for a SCI pt in SNF? (3)

Back 39

1) Return to home
2) Healing time
3) Initiate rehab or prepare for aggressive rehab

Front 40

What are the overall goals in continuum of care for a SCI pt with home health? (3)

Back 40

1) Home mobility
2) ADLs
3) IADLs
"Home bound" for reasons other than lack of transportation

Front 41

What are the overall goals in continuum of care for a SCI pt in outpatient? (4)

Back 41

1) IADLs
2) Community reintegration
3) Advance mobility
4) Work/School reentry

Front 42

What are the overall goals in continuum of care for a SCI pt in community center/work place/school?

Back 42

Successful living with SCI in lifestyle and setting