Term
| 9 aspects of pre-admission screen |
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Definition
-Mechanism of injury
-LOC duration
-GCS scores
-PTA duration
-Neurological symptoms
-Seizures
-ETOH or other substance abuse
-Assoc. injuries such as resp insufficiency, hypotension, etc
-History of TBI |
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Term
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Definition
-Impaired attention
-Slurred or incoherent speech
-Gross incoordination
-Disorientation
-Emotional reactions out of proportion
-Memory deficits
-Agitation/aggression |
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Term
| In what tx session would this be placed: SCI without any signs of TBI |
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Definition
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Term
| In what tx session would this be placed: SCI with signs of mild to od TBI |
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Definition
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Term
| In what tx session would this be placed: SCI with signs of severe TBI |
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Definition
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Term
| Progression is __ if there is a TBI in addition to a SCI |
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Definition
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Term
| The type of bowel program a client had depends on what? |
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Definition
| The presence or absence of rectal (bowel) reflexes. If they have reflexes, they are placed on an UMN program. If not, they are placed on a LMN program. |
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Term
| What is another term used for the UMN bowel? |
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Definition
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Term
| Because of this, the bowel can be stimulated at the rectum which causes the stool to be passed and emptied. The stimulation can be done in two ways, either by the use of a suppository or with finger stimulation. |
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Definition
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Term
| These 2 things contain an active ingredient that acts as a mild irritant directly on the smooth muscle of the bowel. This "irritation" initiates peristaltic activity. The most common side effect is the possibility of intestinal cramping which will subside after the stool and melted suppository have been evacuated. |
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Definition
Dulcolax Suppository
Enemeeze Enema |
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Term
| Routinely ordered on admission. Vital ingredients in virtually all SCI bowel programs for the prevention of constipation. They do not treat existing constipation, but aid in preventing it from forming. They reduce the surface tension of the stool material promoting a softer mass. They do not stimulate peristalsis, which can cause unscheduled evacuations. Some over the counter brands may contain stimulant additives. |
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Definition
| Stool Softeners such as Surfak and Colace |
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Term
| What type of bowel program is usually performed every other day? |
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Definition
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Term
| What is the LMN bowel also called? |
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Definition
| Non-reflex or flaccid bowel |
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Term
| This client usually is a lower level para and has no rectal reflexes. The use of a stool softener is usually critical with this type of client. Daily bowel programs may be necessary |
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Definition
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Term
| Because there are no reflexes with a LMN bowel, how do you empty? |
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Definition
| Manually (with fingers) usually in conjunction with the use of a glycerin suppository |
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Term
| Draws water from the bowel lining into the feces and thus stimulates evacuation. It is a hyperosmolar laxitive. |
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Definition
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Term
| An important part of the LMN bowel program. Should be done approximately fifteen 'ninnies by rubbing the abdomen in a clockwise direction. Push in as you go up the right side, across, then down on the left side. This helps push fecal material along the intestinal tract. Then put on glove, lubricate finger, and insert it into rectum and take out any stool that can be reached. |
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Definition
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Term
| What 2 things can facilitate evacuation during abdominal massage |
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Definition
| Straining or bearing down with abs |
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Term
| What might be used prior to the bowel program and adequate fiber in the diet help made a bowel program successful? |
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Definition
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Term
| Additional bulking agents such at __ can often increase the effectiveness of the bowel program. |
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Definition
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Term
| Occasionally spot of blood either on finger, wiping cloth, or on the stool may be observed. This is the result of hard stool, or maybe fingernails are too long or jagged, or hemorrhoids secondary to what? |
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Definition
| The manual evacuation of stool |
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Term
| Name some helpful hints related to bowel care |
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Definition
-always try to use commode if pt is able
-always wash hands after bowel program
-double glove if fingernails are long
-maintain a schedule to prevent accidents |
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Term
| Name 4 chronic GI complications associated with SCI |
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Definition
-Elevated incidence of gallstone dz
-Abdominal pain
-Abdominal Distention
-AD, etc |
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Term
| Also known as hyper-reflexia |
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Definition
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Term
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Definition
1. HTN (120/50 can be AD if sympomatic)
2. Pounding headache
3. Bradycardia
4. Nasal congestion
5. Bronchospasm
6. Seizures
7. Chills without fever
8. Sweating above injury level
9. Skin flushing above injury level (uni or bilateral)
10. Goose bumps above injury level |
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Term
| If you think your pt could possibly have AD, what 3 things should you do first? |
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Definition
1. Sit pt up
2. Check BP in BOTH arms
3. Look for noxious stimulus below injury level
- Check for bladder distention
- Check bowels
- Check skin
- Evaluate for gastrocolic irritation
- Gender specific problems |
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Term
| AD can lead to what 3 things? |
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Definition
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Term
| Name the Top 6 causes of AD (most of them can also cause spasticity) |
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Definition
1. Bladder distention
2. UTI
3. Bladder or kidney stones
4. Cystoscopy, Urodynamics
5. Bowel Distention
6. Bowel Impaction |
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Term
| Bowel and Bladder are the top 2 causes of what? |
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Definition
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Term
| Besides the Top 6 causes name the other 23 causes of AD |
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Definition
1. Gallstones
2. Gastric ulcars or gastritis
3. Invasive testing
4. Hemorrhoids 5. Appendicitis
6. Menstruation 7. Pregnancy
8. Sexual intercourse 9. Ejaculation
10. DVT 11. Pulmonary Emboli
12. Pressure Sores 13. Ingrown toenails
14. Burns and Sunburns 15. Blisters
16. Insect Bites
17. Contact with hard/sharp objects
18. Constrictive clothing/shoes
19. Heterotropic bone 20. Pain
21. Fractures/trauma 22. Sx procedures
23. Temperature fluctuations |
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Term
| Do PTs decide a bowel and bladder program? |
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Definition
| No! Our goal is just mobility |
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Term
| What is the PT's function in bowel and bladder management? |
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Definition
-Skin precautions and protection
-Mobility, strength, and endurance requirements for technique used
-Equipment needs for technique used
-Time management and daily planning required for the technique
-Goals are directed to transfers and bed mobility |
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Term
| What type of lesion and levels will have reflexic and spastic bladder? |
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Definition
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Term
| What type of lesion and level has areflexic bladder or flaccid? |
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Definition
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Term
| Normal voluntary function is at what level? |
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Definition
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Term
-After a SCI, during this phase, it is very important to not allow the bladder to become over distended
-Keep accurate fluid intake and output records
-Drink a minumum of 3 quarts of fluid every 24 hrs
-Report urine that is not clear in light in color for signs of UTI
-All pts have this at first because of spinal shock |
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Definition
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Term
| Bladder fills with urine, the sphincter ms automatically relaxes and the bladder empties itself. Uncertain when the bladder will emplty and if it will empty completely. |
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Definition
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Term
| What are some techniques to do with the spastic bladder program to trigger emptying? |
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Definition
-Massaging or tapping abdomen
-Leading forward to change position
-Doing push-ups in w/c
-Pulling pubic hair
-Pinching or stroking inner thigh
-Inserting a gloved finger into rectum |
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Term
| Name 4 bladder program goals |
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Definition
1. Completely empty bladder
2. Pt to be able to manage bladder program at highest independence level
3. Restore bladder continence (meaning no leakage between program)
4. Bladder program does not interfere with lifestyle |
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Term
| What are 4 methods used in male spastic bladder programs |
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Definition
1. Foley - indwelling cath (initially)
2. Intermittent cath (every 3-4 hrs during day; every 4-6 hrs during night)
3. External condom cath (texas rig or T drain ;bedside drainage bag at night)
4. Combination of IC and Tx Rig (if pt isn't emptying completely) |
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Term
| Name 3 methods used in flaccid male and femal bladder programs. |
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Definition
IC typically
Crede
Combination of Crede and IC |
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Term
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Definition
| Tapping on bladder to get it to empty |
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Term
| Name 2 common methods used for femal spastic and flaccid bladder program |
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Definition
-IC - must be able to see area
-Foley - females use this longer and more often than males
- Comes with high UTI risk |
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Term
| Name 2 alternate methods for bladder management |
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Definition
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Term
| This alternate method of bladder management has a higher infection rate than the other and is located lower than the umbilicus. |
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Definition
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Term
| This procedure uses the appendix to create a channel between the abdominal wall and the bladder. This procedure is particularly useful in pts with limited hand function. In general, it is easier to manipulate clothing and pass the catheter thru the umbilicus than to transfer, remove lower extremity garments, and perform IC |
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Definition
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Term
| A major medical concern. Caused by bacteria in the bladder. Most often from IC, foley, or suprapubic methods. |
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Definition
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Term
| A person with a Foley is __ times more likely to get a UTI than someone with IC. |
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Definition
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Term
| This makes the pt unable to completely empty the bladder especially in external devices. Over 80% of individuals with SCI have bacteria by urine culture but are not symptomatic. |
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Definition
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Term
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Definition
-Fever
-Chills
-Nausea
-Headache
-Increased spasms
-AD (above T6)
-Milkly urine color; or dark red
-Smelly
-Thick in texture |
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Term
| Name 5 ways to prevent UTIs |
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Definition
1. Drink plenty of fluids (indwelling - 15 glasses per day; IC or condom - 8-10 glasses per day)
2. Empty the bladder on a schedule
3. Have regular check-ups
4. Keep skin clean
5. Keep personal care supplies clean and use proper technique |
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Term
| Name 4 additional complications of the urinary system in SCI |
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Definition
1. Urine leakage or incontinence (esp with L1 and below)
2. Bladder cancer (increased risk with indwelling)
3. Kidney and bladder stones
4. Kidney failure (used to be SCI leading cause of death) |
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Term
| Spastic or reflex bowel occurs in UMN injuries above T12. Name 4 methods for emptying the bowel. |
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Definition
1. Manual Removal
2. Digital Stimulation
3. Suppository
4. Mini-enema |
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Term
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Definition
1. Individualized to time of day that fits lifestyle
- Should be done at same time
- At least every 2-3 days
2. Begins with insertion of suppository or mini-enema
3. Program should be done in sitting on a padded toilet seat
4. Digital Stim
- No more than 4X per session is recommended
5. Most require 30-60 min to complete |
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Term
| What bowel program might a person resort to if they have pressure sores? |
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Definition
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