Spinal Cord Injury

Front 1

A pt with spinal shock will manifest which of the following symptoms?

A.hypertension, headache, flushing

B.Hypotension bradycardia, and lack of tendon reflexes

C.Hypertension, bradycardia

D. A lack of deep tendon reflexes

E.Hypertension, flushing bradycardia

Back 1

D. A, lack of deep tendon reflexes (rational; lack of reflexes, lack of sensation, flaccid paralysis)

Front 2

Automomic dysreflexia will result in

a. Hypertensionb.Hypotension

c.loss of sensation

Back 2

a. Hypertension

Front 3

A complete spinal cord injury that involves C3 will result in

a.Diaphragmatic breathing

b.Ormal respiratory function

c. Ventilator Dependent

d.Decreased tidal volumes

Back 3

c. Ventilator dependent

Front 4

Early treatment of a spinal cord injury may include

a.Nsaids

b.Anticoagulants

c. Steroids

d.D. morphine

Back 4

c. Steroids

Front 5

An injury to the spinal cord that results in loss of pain and temperature on the contralateral side and loss of motor function on the isisilateral side. This is likely what type of cord injury?

A.Brown SequardB.Anterior cordC.Central cord

D.Lateral cord

Back 5

a. Brown Sequard

Front 6

What are the three meninges around the spinal column?

Back 6

Pia - innermost layer

Arachnoid - delicate middle layer

Dura - toughest

Front 7

There is usually a primary and secondary injury to the spinal cord, how does the primary commonly occur?

Back 7

Mechanical disruption, stretching or lacerating axons

Torn by direct trauma like by stabbing or gun shots

Front 8

There is usually a secondary injury following the primary, how does this occur?

Back 8

Ongoing progressive damage caused by ischemia, hypoxia, microhemorrhaging, and edema

These further progress the primary injury

Front 9

What results from the secondary injury?

Back 9

Apoptosis that may go on for weeks and months

Complete cord damage usually due to autodestruction

Hemorrhaging that infarcts the grey matter within 4 hours

Edema and compression of the spinal column due to lack of space

Front 10

At what time is the extent of injury and prognosis most accurately determined?

Back 10

72 hours

Front 11

Spinal shock is characterized by

Back 11

Decreases reflexes below injury, including bowel and bladder function

Loss of sensation

Flaccid paralysis below level of injury

Front 12

Neurogenic shock is characterized by

Back 12

Damage at or above T5

Loss of ANS function below injury leading to

Hypotension

Bradycardia

Warm, dry extremities

Peripheral vasodilation

Venous pooling

Decreased CO

Front 13

The goal for neurogenic shock management are

Back 13

Adequate perfusion with the following parameters

BP systolic should be 90-100

HR should be 60-100 sinus rhythm

Bradycardia be treated with atropine if applicable

Urine output > 30 ml/hr

Prevent hypothermia

Front 14

Classification is based on

Back 14

Mechanism of injury

Level of injury both skeletally (vertebral with the most damage)

Neurologically (lowest segment with function on both sides of the body)

Completeness or degree of injury

Front 15

What scale combines both motor and sensory function?

Back 15

American Spinal Injury Association Impairment Scale

Front 16

What level of injury is most common?

a. Cervical

b. Thoracic

c. Lumbar?

Back 16

Lumbar

Front 17

Complete cord lesion results in...

Back 17

total loss of sensory and motor function below the the level of the lesion

Front 18

Incomplete cord lesion results in...

Back 18

mixed loss of sensory and motor function

Front 19

Brown sequard syndrome is...

Back 19

Any presentation of spinal injury that is an incomplete lesion (hemisection) can be called a partial Brown-Séquard or incomplete Brown-Séquard syndrome.

Front 20

Anterior cord syndrome and brown sequard syndrome both involve half damage to the spinal cord, but what's the difference?

Back 20

Anterior cord syndrome involves variable loss of motor function, pain, and temperature. Proprioception remains intact (sense of how body is positioned)

Brown sequard syndrome an ipsilateral loss of (same side) of proprioception and motor function, however contralaterally loses pain and temperature.

Front 21

What does central cord syndrome involve?

Back 21

Motor function weakness in the upper extremities more than the lower

And distal extremities more than proximal

Front 22

What is Conus medullaris syndrome?

Back 22

a sacral cord injury that may involve lumbar nerves. Areflexia (absence of reflexes) in the bladder, bowels, and to a lesser degree the lower limbs. Motor and sensory loss to the lower limbs is variable.

Front 23

What is Cauda equina syndrome?

Back 23

An injury to the lumbosacral nerve roots caused by a central lumbar disk herniation. Areflexia of bladder, bowel, and the lower limbs. Motor and sensory loss to the lower limbs is variable. This is a nerve root injury rather than a spinal cord injury

Front 24

Quadra/tetraplegia is...

Back 24

paralysis in all extremities

Front 25

Paraplegia is...

Back 25

paralysis of the lower half of body

Front 26

Quadraparesis

Back 26

Weakness in all extremities

Front 27

Paraperesis

Back 27

Weakness in legs

Front 28

What are the biggest concerns immediately after an injury?

Back 28

ABCs

Airway

Ventilation

Circulation

Front 29

Cervical injury at or above C3 can result in ___________ and the pt would then need to be ____________

Back 29

Respiratory arrest; intubated, mechanical vent, tracheostomy

Front 30

Injury at C4 or below would result in what kind of breathing?

Back 30

Diaphragmatic breathing ==> hypoventilation

Front 31

Because of reduced muscle control, how do you prevent atelactasis and pneumonia in these patients?

Back 31

Chest physiotherapy

Assisted coughing

Tracheal suctioning prn

Incentive spirometry

Front 32

At what level of injury would you be concerned about cardiac functioning?

Back 32

T6

Front 33

What type of drug would you use to treat bradycardia? What would the physician apply to the pt heart?

Back 33

Anticholinergic drugs to increase HR

Pacemaker to regulate HR

Front 34

What would you do to treat peripheral vasodilation; what type of drug? What kind of therapy?

Back 34

Fluids and vasopressors

Front 35

Why would you use intermittent catheterization rather than just leaving one in the bladder?

Back 35

To prevent urosepsis, intermittent catheters are done q3-4h

Front 36

What is a neurogenic bladder and what can be done for it

Back 36

A bladder that is hyperreflexic or areflexic

Besides catheterization, a hyperreflexic bladder can benefit from anticholinergics, kegal exercises, bladder reflex training, and even surgery

Front 37

Above the level of T5 we are concerned with a pt GI and may have a paralytic ileus, how is this managed?

Back 37

NGT

Monitor electrolytes

Gradual return of fluids and food

High calorie and high protein

Front 38

Stress ulcers occur within 6-14 days, so how should we test pt for them? What are the prophylatic drugs we give patients?

Back 38

Stool occult blood

PPI

H2 receptor blockers

Front 39

How to manage a neurogenic bowel

Back 39

use stool softeners

get them up for physical activity

get them on bowel routine

Valsalva maneuver

Suppository or mini enema at end of day

Front 40

Monitor albumin levels in pt for

a. skin breakdown

b. liver function

Back 40

Skin Breakdown!

Front 41

Pt commonly can't control their body temperature t/f?

Back 41

True

Front 42

Pulmonary embolisms and DVT are common in pt? t/f

Back 42

True

Front 43

How are spinal cord injuries diagnosed?

Back 43

x-ray

Spinal films

ct scan

MRI

comprehensive neurological examination

Front 44

How do you move a patient with a spinal cord injury? It's ________ rolling

Back 44

Log rolling

Front 45

What device is screwed to the head like a halo?

Back 45

Cervical traction/ Halo Brace

Front 46

What is the goal of surgical therapy?

Back 46

To stabilize the spinal column

Front 47

Why is methyprednisone (MP) - Solu Medrol given

Back 47

Improve recovery of neurological function

within 8 hours of injury

improves blood flow

reduce edema

Front 48

What complications are associated with MP - Solu Medrol

Back 48

Immunosuppression

GI Bleeding

Infection risk

Front 49

Why are vasopressors used?

Back 49

Maintain MAP for spinal cord perfusion

Front 50

There are a **** ton of nursing assessments needed to be done, but name some key ones

Back 50

Bradycardia

Hypotension

Ability to cough

hypoventilation

bowel sounds

urinary incontinence

Front 51

A family sees a patient respond to reflexes you've tested. The family becomes excited and say that the patient is getting better, what must you do?

Back 51

Tell the family that the return of reflexes is not indicative for the return of function

Front 52

Autonomic dysreflexia occurs at what level?

Back 52

It occurs at T6 or above. It is life threatening and is a response to noxious stimuli shutting down both the PNS and SNS

Front 53

What are some symptoms of autonomic dysreflexia?

Back 53

Severe HTN (up to 300 mmHg systolic)

Throbbing headache

Bradycardia

Flushing above level of lesion

Diaphoresis

Blurred Vision

Front 54

How do you manage autonomic dysreflexia?

Back 54

Notify physician

Elevate hob 45 degrees

assess to determine cause

Remove the stimulus - remove all stimuli

Front 55

Respiratory rehabilitation for SCI pt includes

Back 55

Ventilator care

Assisted Coughing

Incentive Spirometry

Deep breathing

Front 56

Male sexuality complications may include

Back 56

Absent

Psychogenic only

Reflexogenic (short lived)

Only 10% of men are fertile

Erectile Dysfunction

Poor sperm quality

Front 57

Female sexuality complications may include

Back 57

Usually remain fertile

50% have orgasms

Menses may cease upwards of 6 months

Uterine contractions not felt

Front 58

Health promotion involves supporting legislation on seat belts? T/F

Back 58

True

Front 59

Acute nursing interventions for patients with SPC include

Back 59

Immobilization

Respiratory

Cardiac

Fluid and nutritional maintenance

Bladder/Bowel management

Temp control

Stress ulcers

Reflexes assessment

Autonomic dysreflexia

Front 60

Help patients through the grieving process by promoting

Back 60

Independence

Assist in anger control

Allow mourning

Expect wide fluctuations of emotions

Regression at different stages