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32 Cards in this Set
- Front
- Back
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spinal cord injuries occur mostly in what gender and between what ages |
males 16-30 |
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causes of spinal cord injureis |
mva (most common reason) falls violence-gunshot wounds sporting and industrial accidents |
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risk factors for spinal cord injuries |
age (teens to young adults) gender (male) substance abuse (alcohol drugs) |
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Pathophysiology of spinal cord injuries |
damage to the spinal cord which range from transient concussion (full recovery possible) contusion (superficial ecchymosis/bruising) laceration (tear) compression (squeezing) complete transection (transverse cut) |
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spinal cord injuries most common areas involved |
5th, 6th, and 7th cervical (C5-C7) 12th thoracic (T12) 1st lumbar (L1) |
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WHY ARE TEH INJURIES IN THIS AREA MOSTLY |
greater range of mobility in these areas |
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methods of classifying spinal cord injuries |
classified according to sensory/motor fibers damaged below the level of spinal cord injury further identified according to area of SCI (central, lateral, anterior, peripheral) damage and location impairment scale (classifies the sic based on the degree of sensory/motor function preserved after the injury) range form complete loss to normal motor and sensory function function ranging from A-E (A-complete impairment, E-normal sensory and motor function ) |
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level of injury C1-C4 C3-C5 C5-T1 L1-L4 L4-S1 S2-S4 |
head and neck diaphragmn (chest and breathing) shoulders, arms, hands chest and abdomen abdomen (excluding internal organs), buttocks, genitals and upper legs legs genitals and muscles of the perineum |
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Neurological level |
lowest level at which sensory and motor functions are normal below this level there is a loss of bladder and bowel function control, loss of sweating, loss of vasomotor tone, marked reduction in blood pressure |
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Primary spinal cord injury |
injuries resulting from the initial insult and are permanent |
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Secondary SCI |
injuries resulting from tears and or contusions which cause the nerves fibers to swell and disintegrate (leads to ischemia, hypoxia, further edema, and hemorrhage), are thought to be the primary reason for spinal cord degeneration, may be reversed if treated within the first 4-6 hours after injury with steroids/hypothermia |
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what would be the clinical manifestations of a spinal cord injury |
depends on type and level of injury type (actual damage to the spinal cord) Level (involves the area of damage and the vertebrae involved |
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Severe SCi can result in |
paraplegia tetraplegia (Quadriplegia) respiratory compromise |
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Autonomic hyperreflexia (dysreflexia) |
acute emergency occurs only after spinal shock has resolved occurs as a result of an exaggerated autonomic response to stimuli that is innocuous(not harmful or offensive) in normal people |
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clinical manifestations of hyperrreflexia (dysreflexia) |
severe headache paroxysmal hypertension (sudden rise in BP) profuse diaphoresis (mostly on forehead) nasal congestion nausea bradycardia occurs most often in patients with (cord lesions above t6) can result in cerebral rupture, cerebral bleed, an increase in ICP |
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pathopysiology of hyperreflexia (dysreflexia) |
massive vasoconstriction leading to severe hypertension (BP>=drop in heart rate or bradycardia) Headache and nausea due to rapid increase in BP diaphoresis caused by changes in vasotone |
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causes of hyperreflexia (dysreflexia) |
distended bladder (most common cause) bowel distension (constipation, impaction) stimulation of the skin (tactile, painful, thermal stimuli) pressure ulcers |
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Emergency interventions for hyperreflexia |
patient is placed in a sitting position or high fowlers to reduce BP rapid assessment is done to assess for the cause bladder is emptied using a urinary catheter if urinary catheter is in place it is irrigated to ensure patency rectum is examined for fecal matter rectal matter should not be removed until 15 minutes after topical anesthetic is administered |
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Emergency interventions skin and meds |
skin is assessed and treated for irritation, breakdown, cold cool irrigating stimuli
apresoline IVP is given slowly hydralazine (apresoline) - direct acting smooth muscle relaxant, acts as a vasodilator primarily in arteries and arterioles, treats hypertension |
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list priority diagnosis and 2 interventions in caring for him |
ineffective cerebral perfusion related to increased ICP, decreased CPP (cerebral perfusion pressure) and possible seizures (reduce bp and ICP, high fowlers, medications, finding/treating the cause
monitoring urinary output and BM pattern maintaining skin integrity |
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AS the nurse who receives a patient who arrives tot he ER after a diving accident what are your initial concerns |
respiratory compromise related to the (level of injury, effects of the injury on the abdominal muslces, diaphragm, intercostal muscles) initially the most serious complication high cervical injuries - acute respiratory failure is the leading cause of death |
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what will be the diagnostic studies initially to confirm a spinal cord injury |
spinal x rays CT scans EKG and continuous cardiac monitoring (high cervical injuries lead to lethal arrhythmias) labs (ABGS) pulse oximetry |
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Neurological spinal shock |
caused by loss of sympathetic tone or innervations results in muscles below the injury becoming completely (paralyzed, flaccid, reflexes absent) |
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clinical manifestations of neurological spinal shock |
anxiety changes in LOC changes in respiratory effort dry warm skin hypotension (drop in cardiac output) bradycardia (drop in cardiac output) increased pooling of blood in the extremities |
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management for spinal cord sock meds |
atropine is provided IVP to speed put the heart rate and increase the cardiac output. the goal is to keep the heart rate at 60-100bpm large volumes of fluids-normal saline-are used to restore hemodynamic stability vasopressors, such as norepinephrine are used as a titrated IV drip to keep the systolic blood pressure in the range of 90-100mm hg |
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what are the nursing interventions for spinal cord shock |
monitor for neurogenic bladder(how bladder stores or empties urine). assess for urinary retention and bladder overdistension treat the underlying cause which is the spinal cord injury, through mobilization and decompression of the spinal cord injury. Methylprednisolone is used to decrease inflammation maintain skin integrity |
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what are signs that neurogenic shock is resolving |
return of reflexes development of hyperrreflexia instead of flaccidity return of ability to empty bladder, which depends on the level of injury |
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Nursing assessment of the patient with SCI |
monitor respirations and breathing pattern assess lung sounds and cough monitor for changes in motor or sensory function; report immediately assess for spinal shock monitor for bladder retention or distention, gastric dilation, and ileus take temperature assess for potential hyperthermia |
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Nursing interventions for spinal cord injury |
implement strategies to compensate for sensory and perceptual alterations implement measures to maintain skin integrity provide temporary indwelling cauterization or intermittent catherization use NG tube to alleviate gastric distention implement high calorie, high protein, high fiber diet implement bowel program and use of stool softeners implement traction pin care provide hygiene and skin care related to traction devices |
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what are some additional complications of a patient with a spinal cord injury |
deep vein thrombosis due to immobility, loss of vasomotor tone s&s (lower extremity - pain and edema) |
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pulmonary emboli |
anxiety rapid respiration tachycardia hypotension |
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complications of SCI |
pulmonary emboli SOB Pleuritic chest pain anxiety increased PCO2 with a decreased PO2 hypotension tachycardia |
