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med surg Unit 7 Neuro
Spinal Injury
40
Nursing
Undergraduate 1
03/15/2011

Additional Nursing Flashcards

 


 

Cards

Term
First priority with a Spinal Cord injury?
Definition
Immobilization of the spine.
Term
Disability involved with a Spinal Cord Injury?
Definition
Depends on severity and location of the injury.
Term
How does a Spinal Cord Injury occur?
Definition
It's a result of movement beyond the normal ROM.
Term
Types of Spinal Cord Injury? (2)
Definition
Closed and Compression.
Term
Types of closed Spinal Cord Injuries? (3)
Definition

Hyperflexion

Hyperextension

Subluxation

Term
How does Hyperflexion Spinal Cord Injury usually occur?
Definition

Sudden deceleration in a head on collision.

Diving into a shallow pool and hitting back of head & head flexes forward.

 

Term
Resulting injury due to a Hyperflexion Spinal Cord Injury?
Definition

Usually has a wedge shaped compression fracture of anterior vertebrae.

May cause dislocation.

Usually cervical or lumbar.

Term
How does a Hyperextension Spinal Cord Injury usually occur?
Definition

Whiplash- mild form without injury to vertebrae or spinal cord from a rear end collision.

Fall and hit chin (ie falling on a slip and slide).

Term
Type of injury involved with a Hyperextension Spinal Cord Injury?
Definition

Head & neck extend, spinal cord stretches- results in contusion & ischemia, resulting in severe damage.

Usually no fracture or dislocation.

Term
Injury involved in a Subluxation Spinal Cord Injury?
Definition

Partial or incomplete dislocation of one vertebrae over another.

Spinal cord injury may or may not occur.

Term
How does a Compression Spinal Cord Injury occur?
Definition
Axial loading:  Fall from a height- landing on feet, buttocks or top of head- vertebrae explode or burst.
Term
Injury resulting from a Compression Spinal Cord Injury?
Definition
Fragments from bursting vertebrae may cause spinal cord damage.
Term
Diagnosing a Spinal Cord Injury?
Definition

History and physical exam.

X-ray of spine.

CT

MRI

Term
Clinical manifestations of a Spinal Cord Injury?
Definition

Pain in the area.

Respiratory distress/apnea if injury is at T6 or above.

Numbness/paralysis.

Permanent dysfunction depending on area of cord damaged.

Term
Types of permanent dysfunction r/t Spinal Cord Injury?
Definition

Quadriplegia

Paraplegia

Brown-sequard syndrome

Central cord syndrome

Cauda equina syndrome

 

Term
Management of a Spinal Cord Injury?
Definition

First priority- immobilization of neck & back and airway management.

IV meds/fluids to lower BP (Decadron to decrease swelling)

Surgery- repair & stabilize (Fusion, rods, plates)

 

Term
Devices used to treat Spinal Cord Injuries?
Definition

Neck:

Cervical traction (gardner-wells, crutchfield, vinke tongs)

Halo

(both require pin site care)

 

Spine:

Turning frames (circo-lectric bed, Stryker frame, foster frame)

Term
Nursing management for a Spinal Cord Injury?
Definition

Maintain immobilization & alignment.

Monitor neuro & resp status and vitals.

Observe for autonomic dysreflexia.

Skin care- high risk for pressure ulcers.

Bowel & bladder care.

 

REHAB to teach self care & independance at home.

Term
What is another name for Spinal Shock?
Definition
Areflexia
Term
What is Spinal Shock (areflexia)
Definition

Immediate response to acute spinal cord injury.

 

Loss of all spinal cord function including sympathetic reflex activity (muscles, vessels & viscera) below the level of the injury.

Term
How long does Spinal Shock (areflexia) last?
Definition
1-6 weeks.
Term
Clinical manifestations of Spinal Shock (areflexia)?
Definition

Decreased BP, decreased pulse, hypothermia.

Flaccid paralysis below injury.

No sensation below injury.

Bowel & bladder retention.

Respiratory failure in injury above C6

 

Unable to perspire below level of injury- body can't cool itself, can lead to heat stroke.

 

 

Term
Evidence of Spinal Shock (areflexia) resolution?
Definition
Muscle spasms (possible), reflex emptying of bowel & bladder.
Term
What is another name for Autonomic Dysreflexia?
Definition
Hyperreflexia
Term
What is Autonomic Dysreflexia (hyperreflexia)?
Definition

Occurs with injury above T6 after spinal shock phase is over.

Stimuli --> massive sympathetic reflexive discharge from autonomic system --> catecholamine released --> vasoconstriction.

Term
Stimulis resulting in Autonomic Dysreflexia (herperreflexia)?
Definition

Most common: BOWLE or BLADDER distention.

Pressure Ulcers

Ingrown toenail

Pt too hot or cold

UTI, kidney stones

Any pain/discomfort/local injury

Term
Clinical manifestations of Autonomic Dysreflexia (hyperreflexia)?
Definition

HTN (massive, life threatening)- 300/150 mmHG.

Bradycardia in response to massive HTN (to decrease CO to decrease BP).

Pounding HA, blurred vision, nausea.

Nasal congestion in some.

Sweating above level of injury.

Cyanosis below level of injury r/t vasoconstriction.

Anxiety, goosebumps, flushing, chills w/o fever.

Term
Management of Autonomic Dysreflexia (hyperreflexia)?
Definition

Prevention is most effective.

Prompt recognition.

Need emergent tx! - will cause CVA!

Term
Treatment of Autonomic Dysreflexia (hyperreflexia)?
Definition

First priority- Check foley for kinks/ bowel & bladder distention. (If present, use anesthetic & cath pt or remove stool)

HOB up 90 degrees to decrease BP.

ID & remove other immediate causes.

Give meds if already ordered, or call MD to order med stat (apresoline, hyperstat, nipride IV; nifedipine SL)

 

Term

What are vertebrae disks?

(A&P)

Definition

Disks that form cushion between vertebrae bodies.

Tough, fiberous material within a capsule.

 

Term

What is the pulposus of a disk?

(A&P)

Definition
Nucleus center.
Term

What is the annulus of a disk?

(A&P)

Definition
A fibrous ring around the disk.
Term
Herniated disks usually occur where?
Definition
Usually affects the cervical or lumbar disks.
Term
What is a Herniated Disk?
Definition
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Term
Risk factors associated with Herniated Disks?
Definition

Aging: degeneration of disks.

H2O content in disks dereases --> Small cracks form in annulus --> Annulus weakens & nucleus pulposus pushes out.

 

Trauma.

Severe or repeated minor injury causes weakened annulus allowing nucleus pulposus to protrude.

 

Term
Who is more prone to Herniated Disks?
Definition

Obesity & poor posture & poor body mechanics cause increased weight load & predispose to injury.

Smoking has a difinite link- vasoconstriction causes decreased circulation.

Term
Clinical manifestation of Herniated Disk?
Definition

Vary depending on level of injury.

 

Pain, weakness, paralysis, numbness, tingling radiating down arm or leg over distribution of nerve root.

Pain increases with straining, coughing & lifting because disk bulges more r/t increased CSF pressure in spinal column.

Eventually walking & sitting becomes difficult.

Loss of bowel & bladder control.

Term
Diagnosis of a Herniated Disk?
Definition

MRI (most often) or CT.

Straight leg raises (lie supine & raise one leg with knee straight = increased pain).

Rarely myelogram (MRI noninvasive & better).

EMG to evalute nerve impulses.

Term
Goals of treatment for Herniated Disk?
Definition

Rest & immobilization of spine to allow soft tissues time to heal.

Decrease inflammation of soft tissue & nerve roots.

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