Health Promotion

Front 1

What are the three way trauma/insult can be classified?

Back 1

-Physiological

-Psychological

-Cultural (trauma can be experienced differently depending on your culture)

Front 2

What re the most frequently involved Vertebrae?

Back 2

-5th,6th,7th Cervical

-12th Thoracic

-1st Lumbar

Front 3

Prior to WW2 why was life expectancy shorter?

What changed?

Back 3

Catheter was introduced

Front 4

Whats DABDA stand for?

Back 4

Denial

Anger

Bargaining

Depression

Acceptance

Front 5

How does a SCI impact someone?

Back 5

-Can disrupt the development of someone depending on their age

-Can alter family dynamics (economically, socially)

-May be expensive d/t no benefits

-High costs of rehab and long term care

-Cost to health care system is 1.6-3 million per SCI patient

Front 6

Whats a Primary Injury?

Back 6

initial insult or trauma which tend to be permanent (if the nerves are severed which they usually are for primary then you likely will not regain function)

Front 7

What is Secondary Injury?

Back 7

Can result from swelling, schema, deem, or bleeding which will likely resolve

Front 8

What is the difference between transient and transection?

Back 8

Transient - possibility to regain function

Transection - complete tear of spinal cord

Front 9

When is the potential for Reversal?

Back 9

Within hours to 72 hours

Front 10

What depends on the function you will have post injury?

Back 10

The severity and level of the injury

Front 11

How do you asses Spinal Cord Injury?

Back 11

-Motor function

-Sensation: Tongue blade

-Bladder paralysis and distention (Bladder scan, catheter)

-paralytic ileum - bowel sounds?

-Hyperthermia (body temp may be thrown off)

Front 12

What is Spinal Shock?

Back 12

Complete loss of reflex, motor, sensory, autonomic activity

- Muscles below the injury without sensation, paralyzed, flaccid, absent reflexes

Front 13

What happens with Spinal Shock?

Back 13

- Bladder paralysis and distention

- Paralytic ileus: may have abdominal distention. Tx: NG tube, medication to promote peristalsis

-Bowel function usually returns within a week: test this by listening to bowel sounds

- Diet: high fiber ad high protein and calories

Front 14

Whats Neurogenic Shock?

Back 14

Result of loss of autonomic nervous system function below the injury

Front 15

Whats affected with Neurogenic Shock?

Back 15

-Vital signs: decreased BP and HR, cardiac output, venous pooling in extremities and peripheral vasodilation

-Tx - correct underlying cause

Front 16

What can cause Neurogenic shock

Back 16

Spinal cord injury, spinal anesthesia, nervous system damage

Front 17

What are the symptoms of Neurogenic Shock?

Back 17

Warm/dry skin, bradycardia, decrease in BP, venous pooling in the extremities and peripheral vasodilation

Front 18

What does SCI affect?

Back 18

-mobility and skin breakdown

-Independence

-Finances and support

-Mental Health

-Muscle wasting, atrophy

-Infection

Front 19

What are some symptoms of SCI?

Back 19

- Acute pain in back or neck, may radiate along involved nerve

-Absence of pain does not rule out spinal injury

-Fear

-Presume SCI until ruled out

Front 20

What should you be aware of with a high cervical injury?

Back 20

Airway and respirations

Front 21

What are some things you can do for Acute Phase Management of SCI?

Back 21

-Medication prevent swelling and damage: Steroid (ex: prednisolone or methoprednisolone)

-Respiratory monitoring - may have to intubate

-Support oxygen function

-Surgery possibility: compression, unstable vertebrae, penetrated wound, bony fragment, unstable client

-Traction surgery possibly: can include fraction reduction and it can be done externally if you want to put it back into alignment

-Stabilize spinal cord - neck collar

-Support neurological and cardiac functioning

Front 22

Whats Tetraplegia?

Back 22

Loss of movement and sensation in all four extremities and trunk

Front 23

Whats Paraplegia?

Back 23

Loss of motion and sensation in the lower extremities and all or parts of the trunk

Front 24

What are potential causes of SCI?

Back 24

falls, gunshots, spinal cord lesions, MS, congenital cause

Front 25

Why might a patient have a wee cough and difficulty clearing throat?

Back 25

SCI may have affected chest and abdominal muscles

-you can help clear by suctioning, chest physio (clap on chest)

Front 26

Facts about mobility in SCI patients

Back 26

-Mobility is only initiated once spine stabilized

-Brace, vest, crutches

-If transection injury you can mobilize sooner

-Mobilizing early the better- use muscles to avoid atrophy

-Important to maintain proper alignment

- Helps prevent DVTs

Front 27

How do you prevent Contractures?

Back 27

-Range of motion (mobility)

-Splints

Front 28

How do you prevent DVTs? (most common in, S&S, prevention)

Back 28

-Most common in the lower legs

-Medications (anticoagulants, compression stockings

-Change in colour, pain, swelling, hot

Front 29

Whats orthostatic hypotension?

Back 29

When you get up BP is unstable and low

-can use vasopressor meds that vasoconstrictor to help

-compression stockings, abdominal binders (helps venous return and supports diaphragm)

Front 30

Whats autonomic dysreflexia?

Back 30

Its an acute emergency

-BP up and HR down

-Its an exaggerated autonomic response

-It is after spinal shock is resolved due to nervous system being easily stimulated

Front 31

What are the causes of Autonomic Dysreflexia?

Back 31

Distended bladder, Stool stuck in the rectum, cold draft blowing onto patient

Front 32

Symptoms of autonomic dysreflexia

Back 32

Pounding severe headache, nausea and vommiting, HTN, diaphoretic(sweating), bradycardia

Front 33

How do you manage Autonomic Dysreflexia?

Back 33

-Sitting position to lower BP

-Asses bladder and rectum

-Skin examined for breakdown look for any cold draft or object on skin that is causing this exaggerated response

-Find underlying cause

Front 34

Which SCI can start mobilizing sooner

Back 34

Transection injury

Front 35

How do you prevent disuse syndrome in clients with tetraplegia, paraplegia?

Back 35

Range of movement 4 times a day to prevent risk of contractors, DVTs ect

Front 36

What are the systems at risk for SCI patients?

Back 36

-GU: over distention and no sensation (risk of: post renal, kidney failure, infection)

-Neurogenic bladder

-GI: function usually returns within one week

-Diet: high calories, high fiver and high protein

-Digital Stimulation: insert finger into the rectum to initiate BM

-Impaction: client is at risk for solid stool stuck in rectum

-Skin integrity: watch pressure points especially sacrum, turn every 4 hours, Braden scale

-Sexual expression: counselling, meds and prosthetics

Front 37

Nursing Interventions for SCI patients (in terms of bladder)

Back 37

With the GU system the bladder can become over distended and have no sensation which causes the risk of injection, kidney failure, post renal failure ect. Therefore you need to manage fluid intake to 2 litres to manage a neurogenic bladder, catheterization (empty bladder frequently) and look for S&S of infection.

Front 38

Patients with paralysis are at increased risk for infection and sepsis what are the most common sources of infection?

Back 38

Urinary tract

Respiratory Tract

Pressure Ulcers