NUR 405 Exam 4 (with Complete Solutions)
Spinal Cord Injury (SCI) correct answers 1. Damage to any part of the spinal cord causing a temporary or permanent loss of sensory, motor, or autonomic dysfunction below the level of injury
2. Causes: -MVA (38%) -Falls (30.5%) -Violence (13.5%) gun shot wounds, stabbing
-Sport injuries (9%) diving, football
-Degenerative older w osteoporosis
-Cancer, hemorrhage
3. Permanent disability
-don't know extent when first occurs
-affects independence, economics
-body image changes, possible wheelchair, bedridden
-decrease in lifespan, higher mortality rate
-affects all of the body systems
4. Psychosocial issues
Primary Injury correct answers 1. Initial disruption of spinal cord
2. Direct trauma to spinal cord d/t blunt or penetrating trauma
3. Compression by bone displacement, interruption of blood supply or distraction from pulling
-spinal cord blood supply interrupted, could be breakage impacting spinal cord and compressing it
4. Penetrating trauma causes tearing and transection
-transection: cut in it
Secondary Injury correct answers 1. Ongoing progressive damage
2. Causes further permanent damage
3. Results in edema, ischemia and inflammation
4. Blood brain barrier disruption, neuron destruction
5. Spinal cord compression
6. Apoptosis for weeks
-cell death: apoptosis
7. Irreversible nerve damage and permanent neurological deficit
Spinal Shock correct answers 1. Occurs shortly after injury
2. Loss of deep tendon and sphincter reflexes, loss of sensation and flaccid paralysis below level of injury
3. Lasts days to weeks
-can have improvement after
4. Hard to determine extent of injury -cannot give prognosis
Neurogenic Shock correct answers 1. Occurs with injuries T6 and above
-T6: thoracic (T10 hip level)
-cervical, thoracic, lumbar
-dermatomes in book different colors of where sensation occurs
2. Causes peripheral vasodilation, venous pooling, decreased cardiac output
3. S & S - hypotension, bradycardia, temperature deregulation
-temp deregulation: body not regulating own temp, takes on temp of atmosphere
-want BP over 90 systolic
-also look at MAP
-don't want hypotension so bad that it lessens blood flow to spinal cord
4. Can continue for 1-3 weeks
Classification of Spinal Cord Injury correct answers 1. Mechanism of injury
2. Level of injury
3. Degree of injury
Degree of injury (pg. 1422) correct answers 1. Complete: Loss of sensory and motor function below level of injury
2. Incomplete: mixed loss of voluntary motor activity and sensation
3. 5 major syndromes
-Anterior cord Syndrome
-Brown-Sequard Syndrome
-Cauda Equina Syndrome
-Central Cord Syndrome
-Conus Medullaris Syndrome
Incomplete Spinal Cord Injury correct answers 1. Anterior cord syndrome: direct injury to anterior spinal artery leads to compromised blood flow to anterior spinal cord,
~d/t acute compression, common w/flexion injury
motor paralysis and loss of pain and temp sensation below
level of injury, intact touch, position, vibration, and motion
2. Brown-Sequard Syndrome: damage to half of spinal cord
~d/t penetrating injury
-opposite side of injury: loss of pain and temp below level of
injury
-Same side of injury: loss of motor function, light touch,
pressure, position, and vibration
Incomplete correct answers 1. Cauda Equina Syndrome: damage to lumber and sacral nerve roots, asymmetrical distal weakness and patchy sensation to lower extremities, may have flaccid paralysis of lower extremities, loss of sensation over saddle area (perineal area—> loss of bladder control), areflexic bowel and bladder, pain
2. Central cord Syndrome: damage to central spinal cord, most often in cervical region, seen with
older people ~d/t hyperextension in people with DJD (degenerative joint disease)
motor weakness, altered sensation, and burning pain in upper
extremities, lower not affected
3. Conus Medullaris Syndrome: damage to lowest part of spinal cord, leg motor function preserved, weak, or flaccid, loss of sensation to perianal area, areflexic bowel and bladder, impotence
4. older people: already have degenerative disease and then fall forward
Motor and Sensory effects correct answers 1. The American Spinal Injury Association (ASIA) Scale
2. Classify severity of impairment
3. Motor and sensory function
4. Rehabilitation potential
Complications correct answers 1. Respiratory -Above C3- total loss of resp muscles -above C5 intubate stat -Aspiration, atelectasis, pneumonia
-cannot take deep breaths, no chest expansion, sats dropping rapidly, cannot cough/move secretions
-can go into pulmonary edema d/t fluid overload issues
-want O2 over 92%
-if high up may need initial intubation
2. Cardiovascular: T6 or above -bradycardia, hypotension (neurogenic shock)
3. Urinary: neurogenic bladder -Overdistension, incontinence, reflux of urine into kidneys
-check amt of volume w bladder scanner and then straight cath
-one of the reasons of renal failure—>kidney stones, pyelonephritis
-bladder can happen at any level
Complications
-general complications of any spinal cord injury correct answers 1. GI: -Gastric distension -Paralytic ileus -Stress ulcers -Dysphagia
-decreased GI motor activity, emptying
-produce more hydrochloric acid-> stress ulcers-> PPIs, histamine blockers
2. Bowel: -Neurogenic bowel -Stool retention and constipation -Impaired peristalsis -Incontinence -Impaction
3. Integumentary: Pressure injuries leading to infection and sepsis -not getting out of bed, sitting for long periods of time
-sitting in incontinence
4. Thermoregulation: poikilothermia
-takes on ambient temp of room
-cannot sweat or shiver to reg body temp esp higher cervical injuries
5. Metabolic needs: increased nutritional needs
-try to start TPN/tube feedings within 72 hrs of injury
-need protein to heal, muscles are atrophying and losing weight
6. Lean body mass decreases, muscles atrophy
7. PV problems: VTE
-peripheral vascular problems due to immobility and blood statuses
8. Pain: nociceptive and neuropathic
-neuropathic: nerve pain r/t injury itself, pins and needles when hitting elbow
-can be sensitive to someone touching them
-nociceptive: chronic aching tissue pain due to injury
-can have combination of both types of pain
Emergency management correct answers 1. ABCs
2. Preventing extension of spinal cord injury w/ cervical collar and backboard
-want to stabilize injury, dont want to get worse
-log rolling
-keep supine initially until know extent
3. Intubation?
-intubate initially
4. Treat shock w/ IV fluids and vassopressors
5. Assess for other injuries
6. Control bleeding
7. CT scan
-MRI sometimes used, but CT easier and quicker
8. History/Neuro assessment/ASIA tool -how did injury occur?
9. ABGs, lytes, glucose, Coags, hgb, hct
Acute care correct answers 1. Surgery
-can go anterior or posterior for surgery sometimes both
-may put in plates, screws
2. Methylprednisolone mixed recommendations
3. VTE prophylaxis
-prevent VTE with lovenox, heparins, SCDs
4. Vassopressors
-phenylephrine or norepinephrine (levophed) to maintain the MAP at greater than 85 to 90 mm Hg to improve perfusion to the spinal cord 5. NGT
-don't want to vomit, will strain spinal cord
6. Nutrition
7. Body temp
