Spinal Cord Injuries

Front 1

Within the first 24 hrs of a spinal injury permanent damage can occur because of?

Back 1

Edema

Front 2

What results from edema in a spinal injury?

Back 2

Compression of cord and increase in ischemic damage

Front 3

What nervous system is affected in spinal injuries?

Back 3

Sympathetic nervous system

Front 4

What is a primary injury?

Back 4

Actual physical disruption of axons (actual wound/ injury itself)

Front 5

What is a secondary injury?

Back 5

Happens after the main injury; ischemia, hypoxia, microhemorrhage, and edema

Front 6

What are s/s of spinal shock?

Back 6

- decreased reflexes
- loss of sensation
- flaccid paralysis below level of injury

Front 7

How long does spinal shock usually last?

Back 7

Few day to a few months

Front 8

What does the sympathetic nervous system do?

Back 8

Increases HR and contractility

Front 9

What happens in neurogenic shock?

Back 9

- loss of vasomotor tone caused by the injury
- Hypotension and bradycardia- hallmark sign

Front 10

What happens when you lose sympathetic nervous system innervation?

Back 10

- peripheral vasodilation
- venous pooling
- decreased cardiac output

Front 11

What is the most unstable type of injury? why?

Back 11

- Flexion- rotation b/c ligaments in spine get torn

Front 12

What is a skeletal level injury?

Back 12

Injury is at the vertebral level, where most damage is to the vertebral bones and ligaments

Front 13

What is a neurologic level injury?

Back 13

Lowest segment of spinal cord with normal sensory and motor fuction on both sides of body

Front 14

What are the 3 levels of injury?

Back 14

- Cervical
- Thoracic
- Lumbar

Front 15

Higher the injury the ________.

Back 15

More severe

Front 16

When does paralysis of all four extremities occur?

Back 16

C1-C8 is involved

Front 17

At what level does paraplegia occur?

Back 17

T1- L4 are involved

Front 18

Phrenic nerve is at what vertebrae?

Back 18

C3-C5

Front 19

What results in complete cord involvement?

Back 19

Results in total loss of sensory and motor function below level of lesion

Front 20

What results in incomplete cord involvement?

Back 20

Results in mixed loss of voluntary motor activity and sensation and leaves some tracts intact

Front 21

Degree of sensory and motor loss depends on?

Back 21

- Level of lesion
- specific nerve tracts damaged and those spread

Front 22

Injuries above C4 will require what?

Back 22

Ventilation

Front 23

C5 injuries will have control of? will lose control of?

Back 23

- Control shoulder and biceps
- Can't control wrist or hand

Front 24

C6 injuries will have control of? will lose control of?

Back 24

- control wrist
- No hand function

Front 25

C7-T1 injuries will have control of? will lose control of?

Back 25

- Control straightening their hands
- Have problems with dexterity of hand and fingers

Front 26

T1- T8 injuries will have control of? will lose control of?

Back 26

- Control of head, neck, diaphram, arms, hands
- Poor trunk control due to poor abdominal muscle control

Front 27

T9- T12 injuries will have control of? will lose control of?

Back 27

- allow good truck control and good abdominal muscle control. Sitting balance is very good
- No leg, bladder, bowel control

Front 28

L1- L2 injuries will have control of? will lose control of?

Back 28

- Varying control of legs and pelvis
- Instability of lower back

Front 29

L3-L4 injuries will have control of? will lose control of?

Back 29

- Control quads and hip flexors
- Absence of hamstring function, flail ankles

Front 30

What level spinal injuries have an effect on heart and breathing?

Back 30

C1-T6

Front 31

What is the first thing you do for a spinal cord injury?

Back 31

IMMOBILIZE

Front 32

What CPR technique would you use on a spinal cord patient?

Back 32

Jaw thrust

Front 33

What almost always occurs with diaphragmatic breathing?

Back 33

Hypoventilation

Front 34

What are some ways to avoid a patient getting VAP?

Back 34

- oral hygiene
- elevate HOB
- O2
- suctioning
- turning

Front 35

Cervical and thoracic injuries cause paralysis of?

Back 35

Abdominal and intercostal muscles

Front 36

At what level is the cardiovascular system affected? how is it affected? treated?

Back 36

- T6 and above
- decreased SNS leading to decreased HR and BP
- Atropine, Dobamine

Front 37

At what level is the GI system affected? how is it affected? treated?

Back 37

- T5 and above
- Paralytic illius= no bowel sounds, possible necrosis
- Reglan

Front 38

After a spinal injury patient is stablized, what are you assessing for?

Back 38

- Brain injury
- bleeding internally
- musculoskeletal injuries
- trauma to organs

Front 39

How would you monitor a patient for signs of internal bleeding?

Back 39

- V/S
- H&H
- hemauria

Front 40

What do you always what to avoid in a spinal injury?

Back 40

Cord Compression

Front 41

What can a UAP be assigned to do on spinal cord injury patient?

Back 41

- log roll
- I & O
- V/S

Front 42

After surgery what are you assessing for?

Back 42

- bleeding
- CSF
- pain

Front 43

When and why are steroids used with spinal injuries? Name one

Back 43

- Within 8 hrs of injury, to decrease edema
- Methylprednisolone

Front 44

Are steroids used for penetrating trauma?

Back 44

No

Front 45

What are the overall goals for someone recovering from a spinal cord injury?

Back 45

- Maintain an optimal level of neurologic functioning
- Have minimal to no complications of immobility
- Learn skills, gain knowledge for self care
- Return to home and community

Front 46

What is the number 1 intervention?

Back 46

- immobilization with correct body alignment

Front 47

When turning a spinal injury patient what technique do you use?

Back 47

Log roll

Front 48

If patient is in traction should the weights be touching the floor?

Back 48

No

Front 49

When in skeletal traction what is a key intervention?

Back 49

Keeping pins clean to prevent infection

Front 50

What do you want to regularly assess on a patient on a vent?

Back 50

- Breath sounds/ breathing patterns
- ABGs
- tidal volume
- vital capacity
- skin color
- amt and color of sputum

Front 51

When turning or suctioning a patient, what can they be at risk for?

Back 51

Cardiac arrest

Front 52

What are the s/s of autonomic dysreflexia?

Back 52

- throbbing headache
- HTN
- flushing skin
- sweating
- bradycardia

Front 53

What are the nursing interventions for autonomic dysreflexia?

Back 53

- Elevate head of bed to 45 degrees
- Remove the stimulus: bladder retention, fecal impaction, tight clothes
- Notify MD if nothing is relieving it