Patho Exam 3; L. 29 Spinal Cord injury, disorders of neuromuscular function

signs and symptoms of autonomic dysreflexia?

-ELEVATED BP by at least 20 from baseline -POUNDING HEADACHE -PRONOUNCED BRADYCARDIA/IRREGULAR HEART BEATS ^^^^ most important to look for others: face & neck flushing, shivering, profuse sweating above the level of injury, cutis ansernia (goose bumps), blurred vision, dizziness, nausea, eyes watering, rapid breathing person may experience one, several or all of the symptoms with each episode

tetraplegia affects what parts of the body?

-arms -trunk -legs -pelvic organs

clinical signs to look for with respiratory problems with SCI pt?

-changes in respiratory rate -shortness of breath -increased HR -increased anxiety -increased volume or thickness of secretions -decreased oxygen saturation -elevated temp

clinical signs to look for with neurogenic bowel?

-constipation -abdominal distention -respiratory compromise -early satiety, nausea -evacuation difficulty -unplanned evacuations -rectal bleeding -pain

primary SCI?

-external lacerations -vertebral fractures -contusions -cord laceration -diffuse axonal injury

what are the different types of SCI?

-flexion (forward dislocation, damage to spinal cord, ruptured posterior ligaments) -extension/hyperextension (ruptured anterior ligament, compressed ligament) -compression (compression of spinal cord, fractured vertebrae) -rotation (displacement of vertebrae)

clinical signs to look for with neurogenic bladder?

-incontinence -overactive bladder -urinary retention -pelvic pain -dysuria (painful or difficult) -increased spasticity -malaise -fever/chills -nausea/headache

secondary SCI?

-inflammation -increased intracranial pressure -hypoxia -hypertension -electrolyte disturbances -release of toxins -excitotoxicity -oxidative stress -synaptic dysfunction

alterations in body function that result from SCI will depend on?

-location of injury along spinal cord -severity of injury to spinal cord

SCI signs and symptoms?

-loss of movement -loss of sensation, including ability to feel heat, cold, touch -loss of bladder or bowel control -exaggerated reflex activities or spasms -changes in sexual function, fertility -pain in head, neck, back -difficulty breathing, coughing -numbness, tingling in hands, fingers, feet, toes -oddly positioned or twisted neck or back -weakness, incoordination or paralysis in part of body

subacute SCI trauma happens?

1-14 days

when are SCI patients most vulnerable to respiratory illness?

in the first year after injury but continue to suffer from respiratory complications throughout life

there is some residual motor and or sensory function below the level of the injury; the prognosis for returning of function is better because of preservation of axonal function

incomplete SCI

hyperacute SCI trauma happens ?

instant

areflexic bowel is upper or lower motor neuron bowel syndrome?

lower below T10

L1-L5?

lumbar spine vertebrae nerves (leg muscles)

chronic SCI trauma happens?

months

complete or partial loss of bladder control, resulting in incontinence, renal impairment, UTI, stones and poor quality of life

neurogenic bladder

complete or partial loss of bowel control; symptoms comprise constipation and fecal incontinence

neurogenic bowel

lowest part of spinal cord that functions normally after injury

neurological level of the injury

vertebrae can be fractured by trauma but unless spinal cord is injured there will be?

no motor/sensory deficits so only if spinal cord is injured will you get loss of function

impairment or loss of motor or sensory function (or both) after damage to neural structures in the thoracic, lumbar, or sacral segments of spinal cord

paraplegia

localized injuries to the skin or underlying tissue resulting from prolonged pressure on skin

pressure ulcers bed sores

primary or secondary SCI injury: contusions

primary

primary or secondary SCI injury: cord laceration

primary

primary or secondary SCI injury: diffuse axonal injury

primary

primary or secondary SCI injury: external lacerations

primary

primary or secondary SCI injury: vertebral fractures

primary

what are common causes of death in SCI?

respiratory dysfunction and pneumonia

SCI affects innervation of abdominal muscles and compromises the ability to generate coughs, which causes ?

retention of secretions during infections

S1-S5?

sacrum vertebrae nerves (bowel, bladder, sexual functions)

primary or secondary SCI injury: excitotixicity

secondary

primary or secondary SCI injury: hypertension/electrolyte emabalances

secondary

primary or secondary SCI injury: hypoxia

secondary

primary or secondary SCI injury: increased intracranial pressure

secondary

primary or secondary SCI injury: inflammation

secondary

primary or secondary SCI injury: oxidative stress

secondary

primary or secondary SCI injury: release of toxins

secondary

primary or secondary SCI injury: synaptic dysfunction

secondary

acute SCI trauma happens?

seconds minutes

highest priority to paraplegics?

sexual function

complete or partial damage to the neural elements of the spinal cord that causes permanent changes in sensation and loss of voluntary control below the site of injury

spinal cord injury

which type of SCI trauma: -neuroimmune response (neutrophils, lymphocytes) -BSCB breakdown/inflammation vicious cycle -upregulation of axonal growth inhibitors/initiation of scar -neuropathic pain

sub acute (1-14 days)

with supra-sacral injuries describe what happens with the bladder

suppression of the brains ability to control the bladder reflex resulting in urinary incontinence, residual urine volume

impairment or loss of motor or sensory function (or both) after damage to neural structures in the cervical segments of the spinal cord

tetraplegia

Why is autonomic dysreflexia dangerous?

the result in high blood pressure and bradycardia can lead to a stroke, seizure or death

T1-T12?

thoracic spine vertebrae nerves (chest muscles, abdominal muscles)

paraplegia is damage to neural structures in what segment of spinal cord?

thoracic, lumbar or sacral

people at most risk for pressure ulcers?

those with a condition that limits their ability to change positions

hyperreflexic bowel is upper or lower motor neuron bowel syndrome?

upper above T10

most recent leading cause of spinal cord injury?

vehicle crashes closely followed by falls -acts of violence (gunshots) and sports activities are also common causes

a patient with a complete T12 classification ?

will have no inspiratory or expiratory impairment

those dermatomes and myotomes caudal (towards end) to the neurologic level that remain partially innervated in complete injuries

zone of partial preservation

which type of SCI trauma: axons are severed and blood vessels rupture from mechanical forces

hyperacute (instant)

upper motor neuron bowel syndrome caused by lesion above T10; involuntary contractions of muscles of the rectum and anus remain intact; there is an inability to voluntarily relax the anal sphincters and defecate, leading to constipation

hyperreflexic bowel

Main causes of autonomic dysreflexia?

3 big B's -bladder (most common); make sure bladder is empty properly, look for signs of infection -bowel; check for impacted stool, palpate abdomen for distention, asses bowel movement -break down of skin; asses skin regularly, protect from injury, remove binding devices

pt with a spinal cord injury at the T1 level complains of a severe headache and an "anxious feeling" which is the most appropriate initial reaction by the nurse? a. try to calm the patient and make the environment soothing b. assess for a full bladder c. notify the healthcare provider d. prepare the patient for diagnostic radiography

b

lower motor neuron bowel syndrome caused by lesion below T10, loss of peristalsis and slow stool propulsion. no spinal cord mediated reflex occurs, leading to constipation with leaking of stool

areflexic bowel

highest priority of quadriplegics?

arm/hand function

Autonomic Dysreflexia is at what level?

at or above the level of T6

most serious consequence of neurogenic bladder?

autonomic dysreflexia

serious consequence of neurogenic bowel?

autonomic dysreflexia

with SCI damages are below or above the site of injury?

BELOW

very serious condition often experienced by individuals with SCI usually at or above the level of T6

autonomic dysreflexia

spinal cord injury resulting in some motor or sensory function below the level of the injury is classified as which type of injury? a. complete SCI b. incomplete SCI c. secondary neurologic injury d. focal injury

b

priapism which is prolonged erection of the penis not caused by sexual dysfunction is indicative of?

SCI

irritating stimuli below the level of autonomic dysreflexia cause activation of?

SNS leading to increased in BP -baroreceptors in the vessels send signals to the brain which sends message via the PNS vagus nerve to heart to slow it down

with autonomic dysreflexia it is a medical emergency and as nurses we must do what first?

TAKE ACTION check 3 big B's (bladder, bowel, break down of skin)

frequent respiratory assessment is important in acute spinal cord injury because: a. loss of defensive respiratory muscles places them at high risk for respiratory failure b. arterial blood gas results can be inaccurate in these patients c. they frequently develop phrenic innervation, which can be worsened by the use of steroids d. it is the third leading cause of death for quadriplegic patients

a

what is the functionally relevant muscle at C4? a. neck muscles b. pectorals c. biceps d. quadriceps

a

if pt vital signs are not stable with SCI we can infer that it is an injury?

above T6; SCI injury above this area can result in neurogenic shock, where pt may exhibit extremely unstable hypotension & bradycardia

which type of SCI trauma: -uncontrolled influx of blood and blood proteins -hypoxia/ischemia -release of excitatory neurotransmitters

acute (seconds-minutes)

paraplegia affects what parts of the body?

affects all or part of the trunk, legs and pelvic organs LOWER HALF of body

more than 80% of pt with SCI exhibit at least some degree of?

bladder dysfunction

with sacral injuries what happens to the baldder?

bladder reflex is ABSENT; retain urine

pt with SCI report which dysfunction the most problematic?

bowel dysfunction

injuries above C3?

cause virtually complete paralysis of both the muscles of inhalation AND exhalation and dependence on mechanical ventilation

tetraplegia is damage to neural structures in what segment of spinal cord?

cervical

C1-C8?

cervical spine vertebrae nerves (head, neck, diaphragm, deltoids, biceps, wrist, triceps, hand)

which type of SCI trauma: -decreased neurotropic support -scar firmly established around lesion site -demyelination -axonal growth failure

chronic (months)

all or almost all sensory and motor function are los below the spinal cord injury

complete SCI

SCI severity of the injury is called the ?

completeness

whats the most important of teaching a wheelie? a. pressure relief b. uneven terrains c. ramps d. turns e. all of these

e