Multiple Sclerosis and Spinal Cord Injuries Quiz

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Questions and Answers

Which of the following is NOT a typical symptom of Multiple Sclerosis (MS) as described?

Impaired immunity

Decreased visual acuity

Impaired cognition

Increased muscle strength (correct)

A patient with a spinal cord injury due to a hyperflexion mechanism likely sustained what type of injury?

A twisting motion of the spine.

Forward bending of the spine beyond its normal range. (correct)

Compression of the spinal column by a vertical force

Forced backward bending of the spine.

What is a common demographic for spinal cord injuries (SCIs) based on the provided statistics in the United States?

Adolescent females involved in sports

Older adult females over 65 years old

Young males, with an average age of 43 (correct)

Middle-aged adults with a history of neurological conditions

In the context of Multiple Sclerosis (MS), what is the primary focus of the 'Planning and Implementation' stage?

Developing strategies for managing deficits and symptoms. Signup and view all the answers

Which mechanism of spinal cord injury involves a force that pushes the spinal column directly downward?

Axial loading Signup and view all the answers

Which of the following is NOT listed as a common cause of spinal cord injuries (SCIs)?

Autoimmune disorders Signup and view all the answers

What does the 'Care Coordination and Transition Management' stage of Multiple Sclerosis (MS) primarily emphasize?

Support and transition into community resources and self-management. Signup and view all the answers

Why are cervical spinal cord injuries more common than thoracic or lumbar injuries, based on the content provided?

There is no evidence in the provided information to support this statement. Signup and view all the answers

What is the first priority when assessing a patient with a spinal cord injury?

Ensuring the airway, breathing, and circulation (ABCs) Signup and view all the answers

Which of the following is a potential complication of spinal cord injury due to interrupted sympathetic innervation?

Autonomic dysreflexia Signup and view all the answers

What is a key focus when planning and implementing care for a patient with a spinal cord injury?

Managing the airway, monitoring for cardiovascular instability, and preventing secondary injury Signup and view all the answers

What specific assessments should be performed when recognizing signs and symptoms of a spinal cord injury?

Priority of ABCs, sensory perception and mobility, and other assessments Signup and view all the answers

What is a primary expected outcome for a patient with a spinal cord injury?

Maintenance of a patent airway and adequate ventilation. Signup and view all the answers

What is the potential cause of respiratory distress/failure in a patient with a spinal cord injury?

Aspiration, decreased diaphragmatic innervation, or decreased mobility Signup and view all the answers

A patient with low back pain that has lasted 6 weeks would be classified as having what type of pain?

Subacute Signup and view all the answers

Why is it important to prevent secondary spinal cord injury?

To avoid further damage from hypoperfusion, edema, or delayed stabilization Signup and view all the answers

What elements should be included in self-management education for a patient with a spinal cord injury?

Mobility skills, pressure injury prevention, ADL skills, bowel and bladder programs, sexuality education, and autonomic dysreflexia prevention Signup and view all the answers

Which of the following is a recommended preventive measure for low back pain?

Proper posture Signup and view all the answers

Which imaging assessment is LEAST likely to be used to evaluate low back pain?

Ultrasound. Signup and view all the answers

What imaging studies are typically used to assess a spinal cord injury?

Spine CT, MRI, and X-ray series Signup and view all the answers

What is a key element of the assessment for low back pain?

A complete pain assessment. Signup and view all the answers

What type of intervention is typically recommended for low back pain before considering surgery?

Interprofessional nonpharmacologic interventions. Signup and view all the answers

Which of the following is an expected outcome related to mobility for a patient with a spinal cord injury?

Performing mobility skills and basic ADLs as independently as possible. Signup and view all the answers

What does paresthesia usually result from regarding the back?

Nerve compression. Signup and view all the answers

Which surgical procedure for low back pain is considered minimally invasive?

Microdiskectomy Signup and view all the answers

A client undergoing a microdiskectomy can typically expect which of the following post-operative care timelines?

Discharge on the same day or day after the procedure. Signup and view all the answers

Which of the following is not considered a typical cause of cervical neck pain?

A fracture of the lumbar vertebrae. Signup and view all the answers

According to the information provided, what would be the first priority when assessing a client who has just been in a motor vehicle accident and is complaining of neck pain?

Assessing the airway Signup and view all the answers

For low back pain, which surgical management option involves cutting away part of the vertebral bone?

Laminectomy Signup and view all the answers

Which intervention is considered part of the conservative treatment approach for cervical neck pain?

Physical therapy Signup and view all the answers

What does low systolic blood pressure in a client with a spinal cord injury indicate?

Decreased perfusion to the spinal cord. Signup and view all the answers

What is a primary goal of early post-operative care following low back surgery?

Preventing complications Signup and view all the answers

What is the significance of an increased Glasgow Coma Scale (GCS) score?

Represents improvement in the client’s condition. Signup and view all the answers

A client post motor vehicle accident with neck pain has a blood pressure of 90/70. How should the nurse respond?

Report this finding immediately to the provider. Signup and view all the answers

A client with a spinal cord injury has a heart rate of 48/min, blood pressure of 78/64, and warm dry skin. What immediate action should be taken?

Immediately notify the provider. Signup and view all the answers

What are the primary goals of rehabilitation for a client with a spinal cord injury?

Learning self-care, mobility, and bowel/bladder training. Signup and view all the answers

During initial assessment per the content, which is NOT a stated concern?

Increased Glasgow Coma Scale score Signup and view all the answers

When assessing a client's pain, which question should the nurse prioritize to gain a deeper understanding of their pain experience?

"What helps you to manage the pain?" Signup and view all the answers

A nurse is caring for a client with a spinal cord injury at T6. What initial action should the nurse take when the client presents with sudden severe headache, flushing, and a blood pressure of 190/100 mmHg?

Place the client in a sitting position. Signup and view all the answers

What are the hallmark signs of neurogenic shock, according to the text?

Bradycardia, warm/dry skin, severe hypotension. Signup and view all the answers

Which action is NOT identified as part of nursing interventions for neurogenic shock?

Raising the head of the bed. Signup and view all the answers

Which factor is most closely associated with an increased risk of developing multiple sclerosis (MS)?

Being female Signup and view all the answers

How long is the typical stay in rehab according to the content?

1 to 2 months. Signup and view all the answers

A client with a C5-C6 spinal cord injury is showing signs of autonomic dysreflexia. After placing the client in a sitting position, what should be the next priority action?

Contacting the health care provider to treat increased blood pressure. Signup and view all the answers

When a client reports pain, what is the most important thing to understand about the pain experience?

The client's current use of pain management techniques. Signup and view all the answers

In a client with autonomic dysreflexia, which of these is most often the cause of the noxious stimulus?

A distended bladder or constipation. Signup and view all the answers

What should be the primary focus of a nurse when assessing a client's pain?

Identifying effective pain-management methods. Signup and view all the answers

Why is rapid treatment essential in clients experiencing autonomic dysreflexia?

To prevent a life threatening stroke. Signup and view all the answers

Study Notes

Chapter 40: Care of Patients with Problems of the Central Nervous System: The Spinal Cord

This chapter focuses on the care of patients with issues related to the central nervous system, specifically the spinal cord.
Priority concepts include immunity and mobility.
Interrelated concepts include pain, sensory perception, cognition, and sexuality.

Multiple Sclerosis (MS)

Pathophysiology: MS affects the myelin and nerve fibers in the brain and spinal cord.
Types:
- Relapsing-remitting
- Primary progressive
- Secondary progressive
- Progressive-relapsing
Etiology/Genetic Risk: Changes in immunity are the most likely etiology for MS, and colder climates are a significant risk factor.
Incidence and Prevalence:
- Ages 20-50
- 400,000 in the U.S.
- 2.3 million worldwide
- 100,000 in Canada
- More common in people of Northern European ancestry, but occurs in all races and ethnicities

Multiple Sclerosis (MS): Assessment

History: Includes assessment of vision, mobility, and sensory perception changes.
Physical Assessment/Signs and Symptoms: Includes muscle weakness, spasticity, tremors, dysmetria, and dysphagia.
Psychosocial Assessment: Focuses on the client's emotional experience related to the disease, such as anger and frustration.
Laboratory Assessment: Includes cerebrospinal fluid (CSF) analysis and MRI of the brain.

Multiple Sclerosis (MS) Analysis & Prioritize Hypotheses

Impaired Immunity: Due to the disease and related drug therapy.
Impaired Mobility: Due to muscle spasticity, intention tremors, and/or fatigue.
Decreased Visual Acuity & Cognition: Due to dysfunctional brain neurons.

Multiple Sclerosis (MS): Planning & Implementation

Managing Impaired Immunity: Emphasizes health promotion in relation to the disease
Improving Mobility: Focuses on the patient's ability to move freely, often via treatment and rehabilitation.
Managing decreased vision and cognition: Emphasizes the patient's cognitive abilities and sight, often via treatment and rehabilitation

Multiple Sclerosis (MS): Care Coordination & Transition Management

Home Care Management: Supporting the patient's home care needs.
Self-Management Education: Teaching the patient about the disease and how to manage it.
Health Care Resources: Directing patients to national MS societies or similar resources.

Spinal Cord Injury

Pathophysiology Overview: Describes complete versus incomplete injuries, and the mechanisms of injury.
Mechanism of Injury:
- Hyperflexion
- Hyperextension
- Axial loading/vertical compression
- Excessive rotation
- Penetrating trauma

Spinal Cord Injury (SCI)(Etiology)

Trauma: The most common cause of SCI.
Falls: A significant cause of SCI, frequently in older adults.
Acts of violence: Can lead to substantial SCI.
Sports/recreation-related accidents: Can frequently lead to SCI

Spinal Cord Injury (SCI)(Incidence & Prevalence)

18,000 new SCIs per year in the U.S.
80% are young males.
Cervical injuries are more common than thoracic or lumbar injuries.
Average age is 43.

Spinal Cord Injury (SCI)(Assessment)

History: Includes how the injury happened, the mechanism of injury, and pre-hospital care.
Physical Assessment/Signs and Symptoms: Focuses on priorities including ABCs (Airway, Breathing, Circulation) and assesses Sensory Perception and Mobility.
Other assessments (as needed)

Spinal Cord Injury (SCI) (Analysis & Prioritize Hypotheses)

Respiratory Distress/Failure: Due to aspiration, decreased diaphragmatic innervation, and/or decreased mobility.
Cardiovascular Instability: Includes shock and autonomic dysreflexia, caused by loss/interruption of sympathetic innervation or hemorrhage.
Secondary Spinal Cord Injury: Due to hypoperfusion, edema, or delayed spinal column stabilization.
Decreased Mobility and Sensory Perception: Resulting from spinal cord damage and edema.

Spinal Cord Injury (SCI)(Planning & Implementation)

Managing the Airway & Improving Breathing: Prioritizes the patient's ability to breathe adequately.
Monitoring for Cardiovascular Instability: Actively monitors the patient's cardiovascular system.
Preventing Secondary Spinal Cord Injury: Minimizes further harm to the spinal cord.
Managing Decreased Mobility: Supports the patient's reduced mobility.

Spinal Cord Injury (SCI)(Care Coordination & Transition Management)

Home Care Management: Supporting the patient's care needs at home.
Self-Management Education: Teaching the patient self-care strategies.
Mobility Skills: Encouraging independent movements.
Pressure Injury Prevention: Protecting the patient from pressure sores.
ADL Skills: Helping with Activities of Daily Living.
Bowel and Bladder Program: Managing the patient's bowel and bladder functions.
Sexuality Education: Discussing the patient's sexual health.
Prevention of Autonomic Dysreflexia: Strategies for avoiding autonomic dysreflexia.
Health Care Resources: Providing resources for additional support.

Spinal Cord Injury (SCI)(Evaluation)

Expected Outcomes:
- No deterioration in neurologic status
- Maintaining a patent airway and adequate breathing.
- No experience of cardiovascular events or receives prompt treatment if a complication occurs.
- No secondary spinal cord injury, no VTE (deep vein thrombosis), and no heterotopic ossification.
- No complications of decreased mobility.
- Performs mobility skills and basic ADLs independently with or without assistive devices.

Low Back Pain (Lumbosacral Back Pain)

Pathophysiology:
- Acute (< 4 weeks): Typically self-limiting.
- Subacute (4-12 weeks)
- Chronic (> 12 weeks): Persistent.

Low Back Pain: Health Promotion and Maintenance

Preventive Measures: Includes proper posture, exercise, and ergonomics.

Low Back Pain (Assessment)

Complete Pain Assessment: Gathering thorough information about the client's pain.
Vertebral Alignment and Tenderness: Evaluating alignment and tenderness in the spine.
Paresthesia: Assessing any numbness or tingling, especially in the limbs.

Low Back Pain (Imaging Assessment)

Plain X-rays: A basic imaging technique to assess the spine.
CT: Computed tomography (CT) scans.
MRI: Magnetic resonance imaging (MRI) scans.
Bone scans: Assessment for bone-related issues, frequently used in combination with other imaging techniques.
Myelogram/post-myelogram CT: Special imaging technique

Low Back Pain: Interventions

Management varies with the severity/chronicity of the pain.
Interprofessional Nonpharmacologic Interventions recommended.
Surgery might be considered if conservative approaches fail.

Low Back Pain: Surgical Management

Minimally Invasive Surgery: Microdiskectomy, laser thermodiskectomy and laser-assisted laparoscopic lumbar diskectomy.
Conventional Open Procedures: Discectomy, laminectomy, and spinal fusion.

Low Back Pain: Post-Operative Care

Depends on the type of surgery performed.
Minimally invasive procedures allow for discharge on the same day or next day.
Post-operative care focuses on the prevention of complications

Low Back Pain: Care Coordination & Transition Management

Home care management: Supporting the patient at home after surgery or for chronic pain management.
Self-management education: Patient education regarding pain management techniques.
Health care resources: Supporting patient access to appropriate health care resources.

Cervical Neck Pain

Causes: Bulging or herniation of the nucleus pulposus in the cervical intervertebral disk, muscle or ligament strain, aging and poor posture.
Treatment Strategy: Usually conservative
- Physical therapy
- Surgery if conservative approaches fail

Case Study (Examples)

Case Study (1): Cervical injury from a car accident, priority assessments.
Case Study (2): Client with unresolved headache, blood pressure of 90/70, pain at 5/10, increase in Glasgow Coma Scale.
Case Study (3): Client with a spinal cord injury and signs of neurogenic shock (Bradycardia, low BP, warm dry skin).
Case Study (4): A client scheduled for discharge to a rehab facility.

Audience Response System Questions (Examples)

Question 1 (Low Back Pain): Which question will the nurse ask first regarding pain management?
Question 2 (Multiple Sclerosis): Which component constitutes a significant risk factor for developing MS?
Question 3 (Spinal Cord Injury): Specific client assessment/intervention necessary in a client experiencing autonomic dysreflexia.

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Description

Test your knowledge on Multiple Sclerosis and spinal cord injuries. This quiz covers symptoms, injury mechanisms, demographics, and care coordination strategies related to these conditions. Challenge yourself with questions that emphasize understanding and management of spinal cord injuries and MS care.