Exam (elaborations)
NU410 Exam 3 Guide With Complete Solution
- Course
- Institution
NU410 Exam 3 Guide With Complete Solution...
[Show more]
Content preview
NU410 Exam 3 Guide WithComplete Solution
Incomplete SCI - ANSWER - Some function remaining below primary site of
injury
- Motor and sensory are partially interrupted with vlibre franklinble loss of
function below level of injury
- Degree of sensory and motor loss varies on level and reflects specific nerve
tracts damaged and those spared
- May demonstrate a mixture of symptoms
Assessment and Diagnostic Findings of Spinal Cord Injury (SCI) - ANSWER -
Detailed Neuro Assessment
- X-Rays
- CT scan
- MRI (myelogram if contraindicated)
- Continuous Cardiac Monitoring
Emergency Management of Spinal Cord Injury (SCI) - ANSWER - Rapid
Assessment
- Immobilization
- Extrication
- Stabilization
,- Transport
Medical Management (Acute Phase) of Spinal Cord Injury (SCI) - ANSWER -
Respiratory Therapy
- Diaphragmatic pacing
- Skeletal Fracture Reduction and Traction
- Surgical Management
- Pharmacologic Therapy
Care of client with Halo Device for Spinal Injury - ANSWER - Ensure that
wrench to release rods is attached to vest when using halo traction in the
event CPR is necessary
- Maintain body alignment and ensure cervical tong weights hang freely
- Monitor skin integrity by providing pin care and assessing skin under halo
fixation vest as appropriate
- Don't use halo device to turn or move a client
- If client goes home with a halo fixation device on, provide instruction on
pin and vest care
- Teach client signs of infection and skin breakdown
Halo Device Nursing Considerations - ANSWER - Ensure pulley is free of
knots, fraying and loosening every 8-12 hours
- Notify provider if patient experiences severe pain from muscle spasms
(unrelieved by meds or positioning)
- Assess neurovascular every hour for 24 hours
,- Provide pin care once a shift, 1-2 times a day
A nurse is preparing to discharge a client who has halo device and is
reviewing new prescriptions from the provider. The nurse should clarify
which of the following prescriptions with the provider?
a. Increase intake of fiber-rich foods
b. May place a small pillow under head when sleeping
c. May operate a motor vehicle when no longer taking analgesics
d. Take a tub bath instead of showers - ANSWER c. May operate a motor
vehicle when no longer taking analgesics
Complications of Spinal Cord Injury (SCI) - ANSWER - Spinal Shock
- Neurogenic Shock
- Autonomic Dysreflexia
Spinal Shock - ANSWER - Spinal cord's response to inflammation caused by
the SCI (secondary injury)
- A sudden loss of reflex activity below level of spinal injury
- Muscular flaccidity, lack of sensation and reflexes
- Client can have hypotension and bradycardia
- Reflexes that initial bowel and bladder function affected, bowel distension
and paralytic ileus occur
Spinal Shock Care - ANSWER - Keeping mean arterial pressure at least 85 mm
Hg can prevent further damage to spinal cord
, - NG tube
- Control of hypotension & bradycardia w/meds
Neurogenic Shock - ANSWER - Caused by loss of function of autonomic
nervous system
- Loss of communication with sympathetic nervous system cause
bradycardia, hypotension, dependent edema, loss of temperature regulation
- Massive venous pooling occurs because of peripheral vasodilation
(distributive shock)
- Paralyzed portions of body do not perspire
Neurogenic Shock Nursing Actions - ANSWER Treat adverse findings with
appropriate medications (vasopressors or atropine) and IV fluids
Autonomic Dysreflexia - ANSWER - Life-threatening HTN emergency
- Excessive uncontrolled sympathetic output caused by a stimulus
- Typically SCI above T6
- Seizures, cerebral hemorrhage, stroke, heart attack can result if not treated
Autonomic Dysreflexia S/S - ANSWER - Bradycardia, hypertension
- Anxiety, restlessness severe pounding H/A
- Nasal stuffiness/congestion
- Red blotches on skin
- Muscle spasms
- Flushed warm skin with profuse sweating above lesion and pale, cold, and
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Belina. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
76658 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now