spinal cord injury
Pharmacological Intervention for SCI
-High dose IV steroids- methyl prednisolone sodium acetate(Solu-Medrol)- used in 1st 24-48 hrs. -Vasopressor agents-used in acute phase -Maintain mean arterial pressure(MAP) -mannitol
why is there continous ekg monitoring with SCI
-bradycardia and asystole common in acute SCI injuries
Spinal injury association scale for motor strength assessment
1- no contraction or movement- 2-minimal movement 3-active movement but not against gravity 4-active movement against gravity 5-active movement against gravity 6-active movement against full strength
The nurse is caring for a client following a spinal cord injury who has a halo device in place. The client is preparing for discharge. Which statement by the client indicates the need for further instruction?
"I can apply powder under the liner to help with sweating."
Primary injury
- may be a permanent result of initial trauma. -This leads to the secondary injury -Early treatment-to prevent partial injury from developing into more extensive, permanent damage.
Autonomic Dysreflexia
Acute emergency Occurs after spinal shock has resolved in an acute phase and may appear years after the spinal cord injury. Occurs in persons with a SC lesion above T6. Autonomic nervous system responses are exaggerated.
Post-Op management for sci surgery
Begins in the PACU to minimize post-op complications. Assessing Patient Needs and Vital Signs Pain Management Proper Breathing
neurogenic bladder tx
Bladder control-continuous- intermittent or self- catheterization- low calcium diet- liberal fluid intake- mobility Bladder training-spastic bladder. Use a timed schedule e.g., every 2 hrs. To facilitate emptying of flaccid bladder-"double void" ----- remain on toilet after voiding for couple of minutes (1-2) then attempt to void
common causes of SCD
MVIs Falls Violence sports -Males -15-35 years old Approximately 65% are Caucasian, 25% are African Americans, 8% are Hispanic, 2% are others
which Cervical vertebrae are the most damaged
Cervical vertebrae 5th - 7th are most often damaged 12th Thoracic & 1st Lumbar has the most mobility, therefore most susceptible to injuries.
Subjective Data/Pt's Point of View of SCI
Complaints of Acute pain Fearful of what will happen Weakness Patients sensations, feelings, values, beliefs, attitudes, perceptions of personal health, and life situations
Surgery indicated for:
Cord compression Unstable or fragmented vertebrae Penetrated wound of the cord-from knife-bullet shrapnel Bony fragments in spinal cord Neurological deterioration
Nursing Intervention Enhance Mobility:
Maintain proper body alignment Turn only if spine is stable and as indicated by physician Monitor blood pressure with position changes PROM at least four times a day Use neck brace or collar, as prescribed, when patient is mobilized Move gradually to upright position Maintain: Skin integrity-urinary elimination-bowel function Provide comfort measures-halo traction Prevent infection-skeletal tractions Prevent injury due to sensory/perceptual alterations
Pathophysiology of spinal cord injury
Damage in Spinal Cord Injuries range from transient concussion (full recovery) to contusion, laceration, and compression of the spinal cord. -To transection (severing)of the spinal cord.
Orthostatic Hypotension
Detection: detect by checking BP and esprically when they stand up Management: have them sit down on the side of the bed and evaluate how they feel before they stand up. More fluid and sodium in the diet
obtunded LOC
Difficult to arouse, responds slowly, needs repeated stimulation. *When they respond it's very slow and you have to repeat yourself*
confused LOC
Disoriented to surroundings time or people, impaired judgement, needs to be cued to respond to commands.
lethargic LOC
Drowsy but easily aroused, needs gentle touch or verbal stimulations to attend to commands.
Respiratory Therapy for SCI
ETT-O2 to maintain high Pa O2 Diaphragmatic pacing (electrical stimulation in phrenic nerves to stimulate diaphragm, helps patient breathe) Intramuscular diaphragmatic pacing used in trial phase for high cervical injury-implanted via laparoscopic surgery after acute phase
A nurse is caring for a client with L1-L2 paraplegia who is undergoing rehabilitation. Which goal is appropriate?
Establishing an intermittent catheterization routine every 4 hours
Acceleration
External force applied to rear end collision, upper torso and head forced backward then forward This is called hyperflexion
Nrsg Int: Prevention of Complications Associated with Immobility
Maintain proper body alignment always. Reposition frequently When spinal column is stabilized: Assist out of bed Use splints to prevent foot drops: remove splint and reapply every 2 hours. Trochanter rolls positioned from ilium to thigh to prevent rotation of hip joints.
Pre-Op management for SCI surgery
Identify coexisting medical problems. Identify important social issues which may have a bearing on the planned procedure and the recovery period. Familiarize patients with the planned procedure and the hospital processes.
goals for SCI
Improve breathing pattern and airway clearance Improve mobility Improve sensory and perceptual awareness Maintain skin integrity Promote comfort Promote absence of complications
Vagus nerve or cranial nerve x(10)
It forms part of the involuntary nervous system and commands unconscious body procedures, such as keeping the heart rate constant and controlling food digestion. Responsible for swallowing, speech and regulation of viscera Damage causes hoarseness or loss of voice, impaired swelling and fatal if both are cut
Skeletal Fracture Reduction Halo and Vest Traction
It has a halo attached to the vest There an area that keep the chin and neck immobile Allows the pt to function outside the hospital This stabilizes the cervical spine and allows the pt to go up and go The pt cannot turn their head at all they would have to move there entire body
Diagnostic Test for SCI
Neurological examination EMG Diagnostic x-rays CT scanning MRI
comatose LOC
No observable response to stimulation.
Paraplegia
Paralysis of the legs and lower body, typically caused by spinal injury or disease
tetraplegia/quadriplegia
Partial or total paralysis of all four limbs and torso *Affected the 4 limbs depend on the level of the injury from c1 to thorax 3*
Autonomic Dysreflexia nursing interventions
Place patient in seated/upright position to lower BP Rapid assessment to identify and eliminate cause Empty bladder using a urinary catheter or irrigate/change indwelling catheter if present Examine rectum for fecal mass Examine skin Examine for any other stimulus Administer ganglionic blocking agent such as hydralazine hydrochloride (Apresoline) IV Label chart or medical record that patient at risk for autonomic dysreflexia Instruct patient in prevention and management
Signs of spinal injuries
Pressure in the head,neck or back Intense back pain Paralysis, lack of coordination or weakness in any part of the body Loss of sensation, numbness or tingling in the hands, feet finger or toes Twisted of oddly positioned neck or back Impaired breathing Loss of control of bladder
Skeletal Fracture Reduction-Tractions: Gardner wells
The metal piece is attached and it is going through the skull It is not touching to the brain but it's anchored to the skull and attached to that are weight Depending on how much traction is needed to align the doctor will decided it The amount of weight is allowing the traction to pull the person's spine apart a little bit especially if the had a compressed fracture.
Treatment immediately after SCI
Provide/maintain patent airway Immobilize on long spine board, rigid or transparent neck brace (Philadelphia or California Collar) Head & neck in neutral position prior to transport Prevent incomplete injury from becoming complete If must intubate, use jaw-thrust technique, do not hyperextend neck Log roll, treat as if other injuries present like chest/abdominal injuries, bone fractures
home/ rehab
Respiratory rehabilitation Neurogenic skin Sexuality grief/depresison, coping mechanism
Alert LOC
Responds appropriately to questions, commands with stimulation.
Glossopharyngeal Nerve CN IX(9)
Responsible for taste from posterior one third of the tongue, gag and swallow reflexes Damage results in loss of bitter and sour taste, and impairment in swallowing
Skeletal Fracture Reduction-Tractions: Crutchfield Tongs
Similar to gardners well its just older It gives the same result by aligning the spinal area to heal or until the pt needs surgery
Stuporous (LOC)
Slightly responds to vigorous stimulations, moans mutters responds.
causes of neurogenic bladder
Spinal cord injury-spinal tumors herniated disc-MS-congenital disorder e.g., spina bifida (myelomeningocele)-infection
Roto Rest: Kinetic treatment table (Oscillating bed)
The bed moves around and goes very far to the left and right This ease pressure on certain parts of the body for the pt
Compression fracture
The compression fracture occurs in the between the two disc which causes the breaking of the bone
sexuality
level of injury determines male impotence, can be treated with prosthesis or drugs. -Sexuality-an issue regardless of age. - Counseling-small group meetings are necessary. - Female can become pregnant achieve vaginal delivery
Spinal cord affects how our
limbs work, our bodily systems, because our spinal cord carries all the information, between the brain and the rest of the body
if an MRI is contraindicated for SCI what can you use
mylelogram
If there is injury around the lumbar area(lower back) it could affect both lower extremities and anything from the waist down. this is termed
This is called a paraplegia Mainly affects lower extremities and this is anywhere from below the arms down to the legs
Injury at the thoracic leaves the upper extremities(arms) free from injury but the rest of the body and both lower extremities are affected. This is termed
This is paraplegia b/c the legs are affected Affects mostly below the armpit level and the person might have resp issues down to there legs but there arms, head and shoulder are okay
complications of spinal cord injury
Venous Thrombophlebitis (VTE) Deep Vein Thrombosis (DVT) Pulmonary Edema (PE) Pneumonia Respiratory failure Infection Pressure ulcers Local infection at skeletal traction pin site spinal shock neurogenic shock autonomic dysreflexia
ex of axial loading
When someone dives into shallow water, hits the top of head on the bottom of the pool
Risk factors for SCI
Young age Male Alcohol use Drug use
C4 is the cervical spine, the injury from there down to the rest of the body is usually term as
a tetraplegia -Anywhere between C6 would also be termed as a tetraplegia b/c it also involved the 4 limbs as well of the rest of the body -Whenever you have a cervical injury it causes damage anywhere from the neck down to the toes where you end up being a tetraplegic person b/c ot causes that injury
Penetrating injuries force occurs from
bullets sharp objects shrapnel from explosions or guns
When assessing a client who has experienced a spinal injury, the nurse notes diaphragmatic breathing and loss of upper limb use and sensation. At what level does the nurse anticipate the injury has occurred?
c5
hyperflexion occurs mainly in
car accidents
triggers for autonomic dysreflexia
distended bladder (most common cause) distention or contraction of visceral organs (such as constipation) stimulation of the skin
neurogenic shock
due to the loss of function of sympathetic nervous system parasympathetic takes over: Hypotension, bradycardia, and decrease cardiac output Dry, warm skin Venous pooling, in extremities and peripheral vasodilation
Neurogenic bladder
dysfunction that results from a lesion in the nervous system led to urinary incontinence. The bladder can become Spastic bladder or Flaccid bladder
Excessive rotation force is from
football, skiing
Axial loading
force administered along lines of axis of body or application of weight, or force along the course of the long axis of the body. -Used to describe injury in which there is compression of spine from head
Deceleration
head-on collision, external force applied from front. Causing head and body to move forward until they meet a stationary object(windshield, airbags) and are then forced backward hyperextension
DVT prevention
hey need to see a doctor, lose weight, stop smoking, do exercises
Respiratory rehabilitation
high cervical may need phrenic nerve stimulator or electronic diaphragmatic pacemaker, portable ventilator b/c their lung might be affected they might be on a ventilator
flextion rotation injury occurs mainly in
horseback riding
dvt s/s
pain in the calf, soreness, cramps, discoloration, and feels warm. -The patient can end up with sob, chest pain and difficulty breathing, rapid pulse and coughing up blood
Which of the following is a late symptom of spinal cord compression?
paralysis
hemiplegia
paralysis of one side of the body
Autonomic dysreflexia is an acute emergency that occurs with spinal cord injury as a result of exaggerated autonomic responses to stimuli. Which of the following is the initial nursing intervention to treat this condition?
raise the HOB
Autonomic Dysreflexia s/s
severe pounding headache sudden increase in blood pressure profuse diaphoresis nausea nasal congestion bradycardia.
The nurse is seeing a client who is being investigated for a possible spinal tumor. The nurse knows that a tumor in this region of the body is more likely if the client reports increased pain when:
sleeping on the stomach
Hyperextension(Deceleration) can happen when
someone falls down stairs and lands on their chin. Swimming accident as well
A client with spinal trauma tells the nurse she cannot cough. What nursing intervention should the nurse perform when a client with spinal trauma may not be able to cough?
suction the airway
spinal shock
sudden depression of reflex activity below the level of spinal injury Result-muscles flaccid or paralyzed lack of sensation and reflexes Affects-bowel and bladder functions- Paralytic ileus often occurs 2-3 days following injury resolved in 3-7 days
Pneumonia cab be due to
to injury, long stay bed and hospital stay. They is not much movement of fluid/blood secretion in the lungs and you have a stasis of fluid and lead to infection pneumonia Detection is from vital signs, symptoms and test that are performed for infection Management is move around, exercise, good oral hygiene
Secondary injury
usually result of ischemia, hypoxia, and hemorrhage that destroys the nerve tissues. -may be reversible/preventable during the first 4-6 hours post injury.
long term tx for bowel problems
• Bowel training to include sitting on toilet half- hour to one hour after meals • Stool softeners • High fiber with increased fluids • Exercise/mobility • Educate about self-care
