Term
| What are 2 primary causes of pressure sores? |
|
Definition
1. Prolonged pressure over bony prominences
2. Comprised peripheral blood flow, decreased O2 and decreased nutrition |
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Term
| What types of cushions are good for C4 SCI to prevent pressure sores? |
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Definition
-Air Cushion
-Jay Cushion (deep contour) |
|
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Term
| Name 8 ways to prevent pressure sores? |
|
Definition
1. Turning at least every 2 hours
2. Specialized beds
3. Bridging with pillows
4. Bridging on customized mattress
5. Progressive sitting programs
6. Up-right seating surface
7. Weight Shifts
8. Prone mattress |
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Term
| What are 3 things you should educate the pt on about pressure relief? |
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Definition
Skin Inspection
Hot Spots
PT/Family Education |
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Term
| Name 5 ways in which pressure sores develop? |
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Definition
1. Unrelieved pressure
2. Friction or sheer
3. Abrasions or bruises
4. Too much moisture or excess dryness
5. Extremes of temperature |
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Term
| Name the 3 stages of development of pressure sores |
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Definition
1. Pressure marks
2. Pressure area
3. Pressure sore |
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Term
| Name 6 ways in which a PT is involved related to pressure sores |
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Definition
1. Prevention
2. Pt education
3. Positioning
4. Pressure monitoring/pressure mapping
5. Equipment ordering
6. Wound care |
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Term
| Name 8 causes for skin breakdown |
|
Definition
Pressure
Heat
Moisture
Friction
Poor Hygiene
Poor Nutrition
Loss of Sensation
Anemia |
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Term
| This is caused by weight bearing against an outside source such as the wheelchair or against another body part |
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Definition
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Term
| Caused by lack of ventilation to an area or by another source, such as an electric heater, hot water, or the sun |
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Definition
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Term
| Caused from perspiration, urine, lying in a wet bed, etc. |
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Definition
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Term
| May be caused from scooting instead of lifting the buttocks from one place to another |
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Definition
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Term
| May be casued from sitting sllumped down in the wheelchair or lying in bed with the head elevated for long periods of time |
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Definition
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Term
| May cause a sore from dampness |
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Definition
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Term
| May result in unhealthy skin which is more difficult to heal |
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Definition
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Term
| May cause other problems to go unnoticed |
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Definition
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Term
| Lack of oxygen carried to the tissues by the blood makes them more susceptible to pressure |
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Definition
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Term
| A sudden drop in BP when assuming the upright position |
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Definition
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Term
| Occurs because of the loss of sympathetic control of blood vessels below the level of injury and as a result hte normal vasocontriction does not occur. Related problem is edema of the legs, ankles, and feet which is usually symmetric and pitting in nature. Its complicated by decreased lymphatic return. |
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Definition
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Term
| Name 8 clinical signs of orthostatic hypotension |
|
Definition
1. Anxiety
2. Pallor of face and neck
3. Sweating
4. Dizziness
5. Tachycardia
6. Nausea/fainting
7. Drop in BP
8. Unable to palpate pulse |
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Term
| Name 5 ways to prevent orthostatic hypotension |
|
Definition
1. Use of supportive stockings
2. Abdominal binder
3. Slow progression to sitting upright and/or use of a reclining w/c
4. Pt education
5. Pt should not be left unattended |
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Term
| If pt has a TLSO do they still need an abdominal binder? |
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Definition
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Term
| If pt has a halo do they still need an abdominal binder? |
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Definition
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Term
| Increased tone or involuntary spasms. Secondary to the SCI there is a disruption or lack of inhibition from the cortex. Below the injury the spinal reflexes are still intact. The results are a cycling of the spinal reflexes without the damping effect of cortical control. It has been found that the ms innervated below the level of injury become more irritable. This increased irritability along with any noxious stimulus can set off spasticity (characterized by hypertonicity, hyperactive stretch reflexes and clonus) |
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Definition
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Term
| The onset of spasticity is usually within the first __ months of injury. Within the first year the level of spasticity may be established however it may continue to be severe. |
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Definition
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Term
| What are 3 Pro's to spasticity? |
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Definition
1. Maintain good ms mass (good for LE blood flow and less risk for pressure sores b/c gluts have ms mass)
2. May be an asset to good bowel and bladder training
3. May provide stability |
|
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Term
| Name 4 Cons to Spasticity |
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Definition
1. May be painful if severe
2. It may limit or prevent independence in functional skills
3. Contractures of the spastic joints
4. Skin breakdown due to shearing |
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Term
| Name 6 treatments for spasticity |
|
Definition
1. Removal of noxious stimulus
2. Prolonged stretch/standing (standing frame at least 1 hr 3x/wk)
3. Prone sleeping (gets pt off butt)
4. Medications - injections of peripheral nerve blocks and intrathecal injections (baclofen)
5. Botox injections (short-term)
6. Surgical intervention (extreme) |
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Term
| An ossification in abnormal locations primarily in extraarticular soft tissue or intramuscular areas surrounding selective joints. This process seems to follow metabolic and autonomic nervous systems changes resulting from CNS injury. |
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Definition
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Term
| The location of this is always below the level of injury. The most likely candidates are the hip, medial knee, elbow, or shoulder. It can begin within one month of injury. |
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Definition
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|
Term
| Takes 18-24 months to mature and usually occurs within 6 months of injury |
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Definition
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Term
|
Definition
1. Localized or general heat and localized redness
2. Soft tissue swelling surorunding sight of lesion
3. Decreasing or restricted ROM
4. Palpable firm mass of callous formation
5. Pain in the involved area where sensation is spared |
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Term
| Complete SCI seem to have an increased chance of this. Also pts with severe spasticity and existing pressure sores |
|
Definition
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Term
|
Definition
1. Gentle aggressive ROM to try to maintain ROM
2. Medication (this is only to slow down the bone growth) |
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Term
| Major changes in bone metabolism occur within days after SCI that result in significant loss of bone mineral density below the level of lesion. Exact mechanism is unknown however it may be related to the neurological, circulatory system, and hormonal changes combined with immobility. |
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Definition
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Term
| Bone mineral density can be reduced by 22% in as little as __ months post injury and as much as 32% at __ months. |
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Definition
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Term
| Where is the most common sight of fracture in chronic SCI? |
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Definition
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Term
| Name 3 possible prevention techniques for osteoporosis |
|
Definition
1. Standing (WB) (static may not be enough, need dynamic)
2. Assisted Gait
3. E-stim with cycling (combo of movement with e-stim is good for pts who can't walk) |
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Term
| Since signs of a DVT and HO are similar, what should you rule out first. |
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Definition
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Term
| Every SCI person has a predisposition to the development of __ in the LE with the added risk of pulmonary embolism. This is related to the absence of the pumping mechanism of the LEs musculature and the venous stasis that occurs. |
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Definition
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Term
| What 2 medications can help to prevent DVTs |
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Definition
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Term
| Trauma pts also have the tendency to have changes in their blood properties, they become hypercoagnuable. This tendency is commonly found in SCI pts. Some studis show a 40% incidence of this in total SCI pts and a 72% incidence in older clients |
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Definition
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Term
| DVT can occur within __ days after the injury and up to __ months after injury. |
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Definition
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Term
| Most SCI pts are put on anticoagulant therapy for __ months post injury. Anti-embolism (ted hose) stocking are also used to promote venous return. Daily leg measurements of the thighs and calves are also helpful to indicate early signs and symptoms of DVT. Possible surgery for vascular filter. |
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Definition
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|
Term
|
Definition
Thrombophlebitis
Swelling
Erythema
Localized Heat
Fever
+ Holman's Sign |
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Term
| If your pt has a DVT, can you proceed with tx? |
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Definition
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Term
| SCI pts regulatory system is above the level of lesion. The pt will not sweat where? |
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Definition
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Term
| Low body temperature. Usually more of a problem in pts with tetraplegia. Requires extra clothing as prevention. If left untreated, could result in decreased pulse rate and eventually death. Treatment includes warm blankets, clothing, and drinks. Do not use heat blankets at night because pt could burn. |
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Definition
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Term
| High body temperature. It is caused by the inability of the body to cool itself (by sweating) below the level of injury. Prevention includes monitoring time in the sun or heat, beginning with short periods of time (15 min.) and extending the time as endurance improves. Clothing should be loose and lightweight to allow air circulation. A sunscreen should be used on all exposed areas. |
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Definition
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Term
| How to treat SCI from getting hyperthermia |
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Definition
| If person becomes faint, weak, or has difficulty breathing, he/she needs to get out of the heat and cool down immediately. This can be done with tepid baths, fans, cool towels, or the yard hose (be sure water in the hose is not hot first). PREVENTION IS THE KEY |
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Term
| The most common complication of SCI pts |
|
Definition
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|
Term
|
Definition
1. Any change in the color, appearance or odor of urine
2. Chills & fever (many UTIs are asymptomatic)
3. Increase in spasticity (body spasms or bladder spasms)
4. Occurrence of AD |
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Term
| To have full respiratory function, you must be __ level or below because you will need full abdominal function. |
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Definition
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|
Term
| The __ and __ are not typically affected by a SCI. |
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Definition
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Term
| Respiratory complications are dependent upon the level of injury and what? |
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Definition
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Term
| Is the respiratory system affected by injuries in the lumbar or sacral regions? |
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Definition
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Term
| Individuals with complete injuries in the cervical and thoracic levels have __ respiratory control with resultant loss of __ and __ control. |
|
Definition
Decreased
Intercostals and Abdominal |
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Term
| Complete injuries between __ and __ lose all control of the diaphragm muscles. |
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Definition
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Term
| Complete injuries at the __ level or higher will result in the loss of all four ms groups and will be vent dependent. |
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Definition
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|
Term
| Name 5 types of alternate ventilation |
|
Definition
Iron Lung
Pneumobelt
Pneumowrap
Mouth Piece
Nose Piece
etc |
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|
Term
| Are ALL levels of SCI at risk for pulmonary embolism? |
|
Definition
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|
Term
| What is the 2nd leading cause of death for persons with SCI within the 1st year of injury? |
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Definition
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Term
| Individuals with __ to __ injuries are 100 X more likely to die from diseases of pulmonary circulation regardless of time since injury than the general population. |
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Definition
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|
Term
| Individuals with paraplegia are 50X more likely to die from __ |
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Definition
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|
Term
| A respiratory complication (primarily __) is the leading cause of death for all persons with SCI. |
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Definition
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Term
| Persons with high level __ are 150X more likely to die of pneumonia at any time post injury than the general population. |
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Definition
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|
Term
| Persons with __ are 10X more likely to die of pneumonia or flu. |
|
Definition
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|
Term
|
Definition
SOB
Pale skin
Fever
Feeling of heavy chest
Increase in congestion |
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|
Term
| One of the primary issues with respiratory complications is that persons with high level tetraplegia have difficulty clearing what? |
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Definition
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|
Term
| These levels have no cough |
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Definition
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|
Term
| These levels have a severly impaird cough |
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Definition
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|
Term
| These levels have a moderately impaired cough |
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Definition
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|
Term
| These levels have a mildly impaired cough |
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Definition
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|
Term
| These levels can produce a normal cough. |
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Definition
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|
Term
| Name 11 ways to prevent respiratory complications |
|
Definition
1. Treat all symptoms aggressively
2. Vaccination
3. Cough assist regularly
4. Maintain proper posture and mobility
5. Stretching
6. Wear abdominal binder
7. Healthy diet and weight management
8. Drink plenty of water
9. Do not smoke
10. See doctor once a year at least
11. Exercise, including breathing ex. |
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Term
| Weight gain increases the risk for what? |
|
Definition
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|
Term
| A growing respiratory concern for persons with SCI. Persons especially with high tetraplegia are at a very high risk due to decreased respiratory function. Symptoms include: irregular breathing and/or snoring, daytime sleepiness, problems with memory or concentration, waking up often during the night and waking up tired or with a headache. Sleep study is indicated for those at risk. |
|
Definition
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|
Term
| Cauda equina injuries are very likely to have __ pain |
|
Definition
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|
Term
| Severe pain is seen in ~15% of pts with ___, 25% in pts __ at the thoracic level and highest in pts with cauda equina lesions |
|
Definition
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|
Term
| Name 2 types of pain seen post SCI |
|
Definition
Nociceptive Pain
Neuropathic Pain |
|
|
Term
| Caused by a noxious stim that is primarily from damage or inflammation that may involve bones, ligaments, or ms. It can also be caused by visceral stimuli such as UTIs and bowel impaction, it may be transmitted by the autonomic nervous system. |
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Definition
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|
Term
| It is usually located in an area with preserved sensation above or near the level of injury in complete injuries. In incomplete injuries it may occur below the level of injury. One common pain following SCI is chronic musculoskeletal pain tha tis cause by overuse of the arm or shoulder. |
|
Definition
|
|
Term
| How can Nociceptive Pain be treated? |
|
Definition
| Rest, pharmacological intervention, injections. Address cause to prevent reoccurrence or address compensatory techniques to minimize continued abuse. Promote balance of strength and flexibility of the UEs. Address posture, limit overhead activities. Address wheelchair propulsion and decrease energy expenditure. |
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|
Term
| Most people with this type of pain are complete injuries. |
|
Definition
|
|
Term
| Most people with this type of pain are imcomplete injuries. |
|
Definition
|
|
Term
| This pain occurs as a result of injury or disease to the peripheral or central nervous system. In SCI can be divided into categories; radicular/segmental, visceral or central pain. Almost 50% of pts with this type of pain report that it interferes with their daily function. |
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Definition
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|
Term
| This type of neuropathic pain is caused by injury to one or more nerve roots at the level of injury. It is most often limited to specific dermatomes and can be described as burning, aching, tingling, or tightness |
|
Definition
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|
Term
| This type of neuropathic pain is the most common and least understood, and most difficult to treat. Described as cutting, burning, piercing, radiating, or nagging pain, usually saddle distribution and LEs. Usually begins within 6 months of injury. |
|
Definition
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|
Term
| This type of neuropathic pain is diffuse and unable to isolate. Very common in gunshot wounds. |
|
Definition
|
|
Term
| This type of neuropathic pain is typically seen in patients with injuries above T6 who cannot perceive pain in their visceral organs (abdomen and bladder). Its characterized by deep diffuse pain in the abdominal and pelvic areas. May be an indication of other complications such as DVT, HO, fx, UTI, etc. |
|
Definition
|
|
Term
| How can Neuropathic pain be treated? |
|
Definition
| Difficult as few medications or modalities target this type of pain. Important to accurately dx and decrease stress related activities as these will increase symptoms. Tx with medication is trial and error. Surgical intervention is only considered as a last resort and if the pain severly limits daily activities. |
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|
Term
| Anyone who is vented must have what with them at all times? |
|
Definition
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