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Spinal Injury - Outline
Generalist Nursing Practice IV: Tertiary Care Across the Lifespan (NURS 4889)
Temple University
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Injuries: - Traumatic Brain Injury (TBI) - Spinal Cord Injury
Drowning: - Hypoxic-ischemic brain injury - Defined: process of respiratory impairment from submersion in a liquid medium - Children 1-4, males 15-24 years old - As little as 2-3 inches - Anoxia leads to cerebral edema and increased ICP & secondary cerebral injuries - 5-10 minutes submerged have few symptoms & often recover with little or no neuro deficits - 25 minutes or longer will likely have neuro deficits unless in icy water
Submersion Injury: - Treatment of submersion injuries o Correct hypoxia o Correct acid-base and fluid imbalances o Support basic physiologic functions o Rewarm if hypothermia present
Traumatic Brain Injury: - Children under 2 have a higher risk d/t the thinner & more pliable skulls - Primary injury is cellular damage - Secondary injury is biochemical and cellular response to the primary injury. - Cerebral edema begins immediately and increases over the next 72 hours - High potential for poor outcome - Deaths occur at three points in time after injury: o Immediately after the injury o Within 2 hours after the injury o 3 weeks after the injury - Scalp lacerations o The most minor type of head trauma o Scalp is highly vascular → Profuse bleeding o Major complication is infection. - Skull fractures o Linear or depressed o Simple, comminuted, or compound o Closed or open o Location of fracture alters the presentation of the manifestations. o Facial paralysis o Battle’s sign: Bruising around eye, associated with skull fracture o Conjugate deviation of gaze: Cannot rotate eyes one side to another, up or down o Rhinorrhea or otorrhea indicates that a fracture has traversed the dura. Leaking fluid should be tested to determine if fluid is CSF. No NG tube!
Types of Head Injuries: - Minor head trauma o Concussion A sudden transient mechanical head injury with disruption of neural activity and a change in LOC Brief disruption in LOC
Amnesia Headache Short duration o Post-concussion syndrome 2 weeks to 2 months Persistent headache Lethargy Personality and behavior changes Shortened attention span, decreased short-term memory Changes in intellectual ability
- Diffuse axonal injury o Widespread axonal damage following mild, moderate, or severe traumatic brain injury (TBI) o Decreased LOC
o Increased ICP o Decortication, decerebration o Global cerebral edema
- Major head trauma o Includes cerebral contusions and lacerations o Both injuries represent severe trauma to the brain. o Contusion Bruising of brain tissue within a focal area that maintains the integrity of the pia mater and arachnoid layers Usually associated with closed head injury Coup-contrecoup injury Prognosis is dependent on amount of bleeding around the contusion site.
- Coup Contre Coup Injury: o Subdural vessels are torn o Coup –initial contact o Contrecoup secondary impact Brain moves forward and back o Bruising occurs as brain moves over skull floor o Elderly and alcoholics have less brain mass, more space, greater injury.
- Lacerations o Intracerebral hemorrhage is generally associated with cerebral laceration. o Surgical repair of laceration is impossible. o Prognosis is poor with large intracerebral lacerations.
- Epidural hematoma o Results from bleeding between the dura and the inner surface of the skull o Neurologic emergency o Venous or arterial origin o Classic signs include Initial period of unconsciousness Brief lucid interval followed by decrease in LOC Headache Nausea, vomiting Focal findings
- Subdural hematoma o Occurs from bleeding between the dura mater and the arachnoid layer of the meningeal covering of the brain o Most common source is the veins that drain the brain surface into the sagittal sinus. o Usually venous in origin Much slower to develop into a mass large enough to produce symptoms o May be caused by an arterial hemorrhage
o Eye problems may include loss of the corneal reflex, periorbital ecchymosis and edema, and diplopia. o Hyperthermia may occur from injury to or inflammation of the hypothalamus. Hypothalamus regulates temperature; temps of 104 possible o If CSF rhinorrhea or otorrhea occurs, inform the physician immediately.
Spinal Cord Injury: - Greatest at risk young men between ages of 16 – 30 y. - Over 80% of all SCI patients are male. - Most go home or to some non institution setting at discharge from hospital.. - 50% of all SCI patients will experience some level of spinal shock. o Spinal shock – decreased reflexes, loss of sensation and flaccid paralysis below the level of injury. o Neurogenic shock – due to loss of vasomotor tone caused by injury with hypotension and bradycardia = decreased C. Usually associated with cervical and high thoracic injury. - 2 types o Complete (total loss of sensory/motor) or incomplete. o 6 syndromes associated with incomplete cord involvement.
Central Cord Syndrome: - Damage to the central cord such as herniation of disc - Most common in the cervical cord hyperextension of neck - More common in order adults - Motor weakness and sensory loss in both upper and lower extremities, but upper effected more.
Anterior Cord Syndrome: - Damage to anterior spine artery - Caused by acute compression anterior portion most often from a flexion injury. - Motor paralysis and loss of pain and temperature sensation below the level of injury. - Posterior tracts intact so sensation of touch, position, vibration, and motion remain intact. - Dive accidents, fall on head
Brown-Sequard Syndrome: - Damage to one half the cord - Often from a penetrating injury ex. stab - Motor function, paralysis, position and vibratory loss on same side (Ipsilateral). - Loss of pain and temperature sensation below the level of injury on the opposite (contralateral) side.
Posterior Cord Syndrome: - Compression to posterior spinal artery - Very rare injury - Loss of proprioception. - Pain, temperature, sensation and motor function below level of injury remain intact.
Conus Medullaris and Cauda Equina Syndrome: - Damage to the lowest parts of the spinal cord - Causes flaccid paralysis of the lower limbs and flaccid (areflexic) bladder and bowel.
Tetraplegia (Quadraplegia): - C1- 3 often fatal, movement of only neck and above, Loss of independent respiratory function. - C 4 – can breath independently but decreased respiratory reserve, movement and sensory of neck and above. - C5 – Partial shoulder, back and gross upper arm but unable to use hands, respiratory reserve still limited
- C 6 – Shoulder and back, full upper arm, some movement of lower arm and weak thumb, limited respiratory reserve.
- C 7 – 8 – Movement to lower arms, good grasp but some weakness, respiratory reserve still limited.
Paraplegia: - T 1-6 - Full innervation to upper extremities, full strength of hand, but limited trunk strength, decreased respiratory reserve. - T 6-12 – Full stable trunk and upper back, respiratory reserve increased. - L 1 – 2 – Varying control of pelvis and legs, unstable lower back. - L 3-4 – Upper leg and pelvis function but absence of stability and strength to lower legs and feet.
Acute Phase of Care: - ABC’s - C spinal immobilization - Treatment of shock-> IV fluids - CV instability – because of unopposed vagal response – bradycardia, which can be worsened by anything that can cause increase vagal stimulation such as turning or suctioning. - Loss of sympathetic tone = low bp - At risk for DVT because loss of muscle tone.
SCI Management: - Bowel management o Above T5 hypomotility o Paralytic ileus o Gastric distention o Ng tube
o H2 receptor blockers o Proton pump inhibitors o Neurogenic bowel
- Temperature control is difficult o no vasoconstriction – o Body temperature maintainer. Monitor temperature closely. Heat and cool prn
Bladder: - Loss of autonomic and reflex control. o Insert indwelling Urinary Catheter o At high risk for UTI o Beware of autonomic Dysreflexia Perfuse sweating, piloerections Check bladder, bowel
Autonomic Dysreflexia: - Occurs when reflexes return after spinal shock resolves. - Occurs in patient with T6 or higher injuries. - Can be a life-threatening event. - Is a response to visceral stimulation - Most common causes - Over distended bladder or bowel. - But can also include anything causing pain below the level of injury such as too tight of shoes. - S & S include: o HEADACHE o HTN o Bradycardia o sweating above the injury,
o goose bumps (piloerection), o blurred vision, o anxiety, nausea o nasal congestion.
o Analgesia for pain o Monitor for failure
Substance Abuse: - Cocaine: - Increase HR - CONSTRICTS Blood vessels
Spinal Injury - Outline
Course: Generalist Nursing Practice IV: Tertiary Care Across the Lifespan (NURS 4889)
University: Temple University
- Discover more from:Generalist Nursing Practice IV: Tertiary Care Across the LifespanNURS 4889Temple University30 Documents
- More from:Generalist Nursing Practice IV: Tertiary Care Across the LifespanNURS 4889Temple University30 Documents