Final Exam- Spinal Cord , Autonomic Dysreflexia

Gardner-Wells tongs

- U shaped tongs used for spinal traction. - pressure controlled pins are inserted into the skull at opposite ends to permit a longitudinal force to be applied to the axis of the spinal column. - Inserted under anesthesia - the tongs are attached to weights using a pulley system at the head of the bed. - free hanging weights , log roll patient , pin care

Spondylosis

A degenerative disorder that can cause the loss of normal spinal structure and function

A patient with a C5 spinal cord injury is tetraplegic. After being moved out of the ICU, the patient complains of a severe throbbing headache. What should the nurse do first? A) Check the patients indwelling urinary catheter for kinks to ensure patency. B) Lower the HOB to improve perfusion. C) Administer analgesia D) Reassure the patient that headaches are expected after spinal cord injuries.

A) Check the patients indwelling urinary catheter for kinks to ensure patency. A severe throbbing headache is a common symptom of autonomic dysreflexia, which occurs after injuries to the spinal cord above T6. The syndrome is usually brought on by sympathetic stimulation, such as bowel and bladder distention. Lowering the HOB can increase ICP. Before administering analgesia, the nurse should check the patients catheter, record vital signs, and perform an abdominal assessment. A severe throbbing headache is a dangerous symptom in this patient and is not expected.

An older adult patient has come to the clinic for a regular check-up. The nurses initial inspection reveals an increased thoracic curvature of the patients spine. The nurse should document the presence of which of the following? A) Scoliosis B) Epiphyses C) Lordosis D) Kyphosis

A) Scoliosis

Spinal Bifida diagnostic

Alphafetoprotein levels Amniocentesis Sonogram

Spinal surgery long term teaching:

Avoid flexion with long car rides or driving Avoid heavy work for months Warmth to decrease spasms Exercise and rest important T-shirt under brace

Following a spinal cord injury a patient is placed in halo traction. While performing pin site care, the nurse notes that one of the traction pins has become detached. The nurse would be correct in implementing what priority nursing action? A) Complete the pin site care to decrease risk of infection. B) Notify the neurosurgeon of the occurrence. C) Stabilize the head in a lateral position. D) Reattach the pin to prevent further head trauma.

B) Notify the neurosurgeon of the occurrence. If one of the pins became detached, the head is stabilized in neutral position by one person while another notifies the neurosurgeon. Reattaching the pin as a nursing intervention would not be done due to risk of increased injury. Pin site care would not be a priority in this instance. Prevention of neurologic injury is the priority.

A patient is admitted to the neurologic ICU with a spinal cord injury. When assessing the patient the nurse notes there is a sudden depression of reflex activity in the spinal cord below the level of injury. What should the nurse suspect? A) Epidural hemorrhage B) Hypertensive emergency C) Spinal shock D) Hypovolemia

C) Spinal shock In spinal shock, the reflexes are absent, BP and heart rate fall, and respiratory failure can occur. Hypovolemia, hemorrhage, and hypertension do not cause this sudden change in neurologic function.

Spinal surgery Interventions post op

Check operative site foR CSF leak & hemorrhage Check motor and sensory function below site

Neurogenic Shock

Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilation; seen in patients with spinal cord injuries. This leads to instability in HR, BP, temperature . Loss of ANS function below injury

Scoliosis contributing factors

Congenital, idiopathic, polio Onset: 10-15 years old , girls more than boys

Laminectomy post op care: CERVICAL

Elevate HOB slightly Small pillows under the neck Cervical collar/neck immobilized

Autonomic Dysreflexia Interventions

Elevate the head - prevent stroke (90 degree angle ) Relive the cause : Bladder, Bowel, Breakdown of skin Anti-hypertensive - phentolamine (regitine), nifedipine Avoid triggers: full bladder, abdominal distension, impacted feces, skin pressure , sexual intercourse - Bladder is the most common cause - remove binding devices/clothing

Halo traction

Frame apparatus for cervical fractures; four pins inserted in skull attached to metal ring and then to body frames - halo vest suspends weight around chest - Pin care - No powder - Monitor for skin problems

Neurogenic shock symptoms

Hypotension Bradycardia Warm, dry skin Unstable temperature Venous pooling - DVT Areflexia -absence of neurological reflexes ( knee jerk )

Disc disease clinical manifestations

Intense pain and muscle spams Radiculopathy - pinched nerve Paresthesia - burning/prickling feeling Lumbar disc - Sciatica -Postural deformity - Motor and sensory deficits Cervical disc - Stiff neck, pain, muscle spasm , decreased reflexes, unsteady gait

Pre- op closure of sac

Keep positioned off lesion No clothing Keep lesion moist with sterile saline- DON'T LET IT DRY OUT Cleanse and apply antimicrobial agents Monitor for hydrocephalus and meningitis Observe for CSF leakage Keep prone or side lying * surgery may not restore function but will prevent infection and further trauma

Laminectomy post op care: LUMBAR

Keep the bed flat or slightly elevate hOB Small pillow under the head/immobilized Small pillow under the knees Support the upper leg with lateral position Log rolling + Neuro assessments Pain medication + steroids Pre-op - Teach exercises tp strengthen abdominal muscles

Spinal Bifida Meningomyelocele

Myelomeningocele is the most serious type of spina bifida. With this condition, a sac of fluid comes through an opening in the baby's back. Part of the spinal cord and nerves are in this sac and are damaged. This type of spina bifida causes moderate to severe disabilities, such as problems affecting how the person goes to the bathroom, loss of feeling in the person's legs or feet, and not being able to move the legs Intervention: growth and development needs

Post surgery: immobilization braces - Thoracic and lumbar injuries

No traction needed Custom fit Velcro on & off Remove for AM care Log roll when off Wear t-shirt under

Spinal Bifida contributing factors

Obese women Poorly controlled Diabetes Women treated with carbamazepine ( seizure med )

Spinal cord injury interventions

Reduction/immobilization Laminectomy Debridement Exploratory

Neurogenic shock treatment

Secure airway, C-spine, High flow O2, Assist ventilation, ALS, Keep patient warm, Prompt Transport. IV fluids, vasopressor, atropine

What is the first priority with Autonomic Dysreflexia ?

Sit the patient up and loosen constrictive clothing

Spinal shock interventions include:

Steroids- increase BP Atropine - increase HR IV fluids

Spinal Bifida

a neural tube defect in which the child is born with a hole in the tube surrounding the spinal cord - Folic acid prevents this

Laminectomy

removes a portion of the vertebral bone - relives compression of cord

Spinal Bifida Meningocele

A sac of fluid comes through an opening in the baby's back. But, the spinal cord is not in this sac. There is usually little or no nerve damage. This type of spina bifida can cause minor disabilities. - mild elimination or sensory-motor problems - after closure no intervention is needed

A patient with a T2 injury is in spinal shock. The nurse will expect to observe what assessment finding? A) Absence of reflexes along with flaccid extremities B) Positive Babinskis reflex along with spastic extremities C) Hyperreflexia along with spastic extremities D) Spasticity of all four extremities

A) Absence of reflexes along with flaccid extremities During the period immediately following a spinal cord injury, spinal shock occurs. In spinal shock, all reflexes are absent and the extremities are flaccid. When spinal shock subsides, the patient demonstrates a positive Babinskis reflex, hyperreflexia, and spasticity of all four extremities.

A nurse is reviewing the trend of a patients scores on the Glasgow Coma Scale (GCS). This allows the nurse to gauge what aspect of the patients status? A) Reflex activity B) Level of consciousness C) Cognitive ability D) Sensory involvement

B) Level of consciousness

When estrogen decreases due to age, what happens to the bones?

Bones breakdown

Autonomic Dysreflexia

Exaggerated sympathetic response that occurs in patients with spinal cord injuries at or above the T6 level *** Severe hypertension, 20-40 systolic higher than baseline bradycardia, headache, nausea, blurred vision, flushed skin, sweating, death, seizures, pale, cool, clammy - can occur after initial injury - occurs after spinal shock has resolved

Post surgical interventions ( spinal )

Maintain traction with free hanging weights Log roll patient Maintain asepsis around pin sites No shampoo May need brace Provide prism glasses

Long term care of spinal cord injuries include :

Physical therapy Prevent disuse syndrome Skin integrity - turn q2 Toileting schedule , foley Infection , sexual function, autonomic dysreflexia

Degenerative Disc Disease

Potrusion of the central portion of disc causing compression of the spinal nerve

Scoliosis treatment

exercises (including back strengthening), bracing, and surgical correction (instrumentation or fusion) Braces- Milwaukee brace, Boston brace

Spinal Shock

loss of sympathetic reflex activity below the level of injury within 30 to 60 minutes to 6 weeks of a spinal injury *** Severe hypotension, bradycardia, warm skin

Spinal Bifida Occulta

most common and least severe form of spina bifida without protrusion of the spinal cord or meninges - Not visible externally, only see a dimple or hair tuft - No herniation of meninges or spinal cord - mild elimination or sensory-motor problems