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Spinal Cord Injury - Lecture notes Chapter 60
Adult Health Nursing II (NSG-430)
Grand Canyon University
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Spinal Cord Injury. Chapter 60 Trauma or damage to spinal cord Injury happens below the trauma Highest in men ages Increased in older adults Decreased mortality Long term issues remain Disruption in growth and development Altered family dynamics Economic loss Round the clock care. Complications can arise. Etiology Motor vehicle collisions Falls Violence Sport injuries Football, soccer, baseball, hockey Other miscellaneous cases. Pathophysiology SCI due to cord compression Bone displacement Interruption of blood suppy Traction from pulling on cord Penetrating and transection Secondary lose function of nerves. why we give steroids On going progressive dammage that occurs after primary injury Spinal Shock Characterized Decreased reflexes Loss of sensation Absent thermoregulation Flaccid paralysis below level of injury Last days to weeks We answer family questions about what the future will be like. Just because they walk now, mean they might not walk in the future May be quad, para, wheelchair bound May have issues with breathing, urination. Cervical has more issues than lumbar. Neurogenic Shock Characterized Hypotension Bradycardia Loss of SNS innervation Peripheral vasodilation Venous pooling Sequential hose, heparin, lovenox Dec cardiac output If someone already has a history of heart failure then this happens to them, it could cause things to get worse. T6 or higher injury Classification of sci Classified Mechanism of injury Level of injury Degree of injury Major mechanisms of injury are Flexion Hyperextension Compression. Compare them always Level of injury Skeletal vs. neurologic level Level of injury may be Cervical Thoracic Lumbar Sacral Tetraplegia (quadriplegia) Most likely cold but do not know it because they detect it They will need help with social coping Muscle atrophy will be an issue. Paraplegia More mobility More indepence Will have wheelchairs but can move them better Mentally, how are they doing? They have just one problem Degree of Injury Complete Total loss of sensory and motor function below level of injury Incomplete (partial) Mixed loss of voluntary motor activity and sensation Some tracts intact. LOOK AT SYNDROMES ASSOCIATED WITH INCOMPLETE SCI Brown Seguard Incontinence problem Surgical bladder procedure Straight cath Teach them Kegels Gastric distention Development of paralytic ileus Gastric emptying may be delayed A Do a cbc Worrieda bout bleeding GI Integumentary Potential for skin breakdown Poikilothermism Interupption of SNS Dec ability to sweat or shiver below the level of injury More common tell you hot so monitor Peripheral vascular problems Venous thrmoboembolism Pulmonary cause of death Nociceptive Pain Pain that is dull or aching it, moving it hurts extra Hypersensitive to stimuli Neuropathic pain Located at or below level of injury Hot, burning, tingling, pins, and needles, cold, shooting May be extremely sensitive to stimuli Diagnosts CT scan, cervical MRI, comprehensive neurologic exam, ct angiogram. Interprofessional Care Pre hospital Immediate goals Patent airway Adequate Adequate circulating blood volume Prevent extension of spinal cord damage Immobilization Rigid cervical collar Backboard with straps Spinals immobilization with penetrating trauma not recommended Maintain systolic BP greater than 90 mmHg Acute Care Initial care Cervical injury requires more intense support Obtain history, emphasizing inciden Assess extent of injury Initial assessment Managing abcs and vitals signs Medical intervention and diagnostics additional assessment Brain injury and or vertebral artery injury History of unconsciousness Signs of concussion Increased intracranial pressure Musculoskeletal injuries Trauma to internal organs Initial survery, whats obvious and wrong with them. Neuro checks. Move patient in alignment as a unit (logroll with at least 2 people) Surgical therapy Used following acute SCI to fix instability and decompress the spinal cord Surgery within first 24 hours associated with improved neurologic outcome Posterior approach Anterior approach Fusion Assess breathing and airway Facial edema for lying down all day Innervation problems in airs Shoulders could ache Drug therapy Mannitol Osmotic diuretic heparin Prevent VTE Vasopressor agents (Levo and Norepi) Maintain mean arterial pressure greater than afdklasjfd Fluid and nutritional maintenance Paralytic ileus may occur, requiring NG tubes Monitor fluid and electrolytes Nutrition should be started within 72 hours Individualized high calorie diet
Spinal Cord Injury - Lecture notes Chapter 60
Course: Adult Health Nursing II (NSG-430)
University: Grand Canyon University
