Term
| First priority with a Spinal Cord injury? |
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Definition
| Immobilization of the spine. |
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Term
| Disability involved with a Spinal Cord Injury? |
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Definition
| Depends on severity and location of the injury. |
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Term
| How does a Spinal Cord Injury occur? |
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Definition
| It's a result of movement beyond the normal ROM. |
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Term
| Types of Spinal Cord Injury? (2) |
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Definition
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Term
| Types of closed Spinal Cord Injuries? (3) |
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Definition
Hyperflexion
Hyperextension
Subluxation |
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Term
| How does Hyperflexion Spinal Cord Injury usually occur? |
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Definition
Sudden deceleration in a head on collision.
Diving into a shallow pool and hitting back of head & head flexes forward.
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Term
| Resulting injury due to a Hyperflexion Spinal Cord Injury? |
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Definition
Usually has a wedge shaped compression fracture of anterior vertebrae.
May cause dislocation.
Usually cervical or lumbar. |
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Term
| How does a Hyperextension Spinal Cord Injury usually occur? |
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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). |
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Term
| Type of injury involved with a Hyperextension Spinal Cord Injury? |
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Definition
Head & neck extend, spinal cord stretches- results in contusion & ischemia, resulting in severe damage.
Usually no fracture or dislocation. |
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Term
| Injury involved in a Subluxation Spinal Cord Injury? |
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Definition
Partial or incomplete dislocation of one vertebrae over another.
Spinal cord injury may or may not occur. |
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Term
| How does a Compression Spinal Cord Injury occur? |
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Definition
| Axial loading: Fall from a height- landing on feet, buttocks or top of head- vertebrae explode or burst. |
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Term
| Injury resulting from a Compression Spinal Cord Injury? |
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Definition
| Fragments from bursting vertebrae may cause spinal cord damage. |
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Term
| Diagnosing a Spinal Cord Injury? |
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Definition
History and physical exam.
X-ray of spine.
CT
MRI |
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Term
| Clinical manifestations of a Spinal Cord Injury? |
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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. |
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Term
| Types of permanent dysfunction r/t Spinal Cord Injury? |
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Definition
Quadriplegia
Paraplegia
Brown-sequard syndrome
Central cord syndrome
Cauda equina syndrome
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Term
| Management of a Spinal Cord Injury? |
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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)
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Term
| Devices used to treat Spinal Cord Injuries? |
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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) |
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Term
| Nursing management for a Spinal Cord Injury? |
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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. |
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Term
| What is another name for Spinal Shock? |
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Definition
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Term
| What is Spinal Shock (areflexia) |
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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. |
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Term
| How long does Spinal Shock (areflexia) last? |
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Definition
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Term
| Clinical manifestations of Spinal Shock (areflexia)? |
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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.
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Term
| Evidence of Spinal Shock (areflexia) resolution? |
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Definition
| Muscle spasms (possible), reflex emptying of bowel & bladder. |
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Term
| What is another name for Autonomic Dysreflexia? |
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Definition
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Term
| What is Autonomic Dysreflexia (hyperreflexia)? |
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Definition
Occurs with injury above T6 after spinal shock phase is over.
Stimuli --> massive sympathetic reflexive discharge from autonomic system --> catecholamine released --> vasoconstriction. |
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Term
| Stimulis resulting in Autonomic Dysreflexia (herperreflexia)? |
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Definition
Most common: BOWLE or BLADDER distention.
Pressure Ulcers
Ingrown toenail
Pt too hot or cold
UTI, kidney stones
Any pain/discomfort/local injury |
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Term
| Clinical manifestations of Autonomic Dysreflexia (hyperreflexia)? |
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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. |
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Term
| Management of Autonomic Dysreflexia (hyperreflexia)? |
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Definition
Prevention is most effective.
Prompt recognition.
Need emergent tx! - will cause CVA! |
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Term
| Treatment of Autonomic Dysreflexia (hyperreflexia)? |
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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)
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Term
What are vertebrae disks?
(A&P) |
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Definition
Disks that form cushion between vertebrae bodies.
Tough, fiberous material within a capsule.
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Term
What is the pulposus of a disk?
(A&P) |
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Definition
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Term
What is the annulus of a disk?
(A&P) |
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Definition
| A fibrous ring around the disk. |
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Term
| Herniated disks usually occur where? |
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Definition
| Usually affects the cervical or lumbar disks. |
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Term
| What is a Herniated Disk? |
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Definition
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Term
| Risk factors associated with Herniated Disks? |
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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.
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Term
| Who is more prone to Herniated Disks? |
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Definition
Obesity & poor posture & poor body mechanics cause increased weight load & predispose to injury.
Smoking has a difinite link- vasoconstriction causes decreased circulation. |
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Term
| Clinical manifestation of Herniated Disk? |
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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. |
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Term
| Diagnosis of a Herniated Disk? |
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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. |
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Term
| Goals of treatment for Herniated Disk? |
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Definition
Rest & immobilization of spine to allow soft tissues time to heal.
Decrease inflammation of soft tissue & nerve roots. |
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