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Questions and Answers
Which of these symptoms are commonly associated with neurogenic shock?
Which of these symptoms are commonly associated with neurogenic shock?
What is the primary cause of autonomic dysreflexia in individuals with spinal cord injuries?
What is the primary cause of autonomic dysreflexia in individuals with spinal cord injuries?
Which of the following is NOT a characteristic of spinal shock?
Which of the following is NOT a characteristic of spinal shock?
What is the primary concern when managing a patient with a spinal cord tumor?
What is the primary concern when managing a patient with a spinal cord tumor?
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Which of these conditions is characterized by the rapid development of progressive muscle weakness and paralysis?
Which of these conditions is characterized by the rapid development of progressive muscle weakness and paralysis?
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What is the most common cause of death in patients with a primary spinal cord injury?
What is the most common cause of death in patients with a primary spinal cord injury?
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Which of the following is NOT a secondary injury that can occur following a traumatic brain injury?
Which of the following is NOT a secondary injury that can occur following a traumatic brain injury?
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A patient with a spinal cord injury at the level of C1-C3 would be expected to be:
A patient with a spinal cord injury at the level of C1-C3 would be expected to be:
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What is the hallmark symptom of neurogenic shock?
What is the hallmark symptom of neurogenic shock?
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Which of the following is a common mechanism of injury leading to a spinal cord injury?
Which of the following is a common mechanism of injury leading to a spinal cord injury?
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What is the minimum mean arterial pressure (MAP) that should be maintained in a patient with spinal shock?
What is the minimum mean arterial pressure (MAP) that should be maintained in a patient with spinal shock?
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A patient with a spinal cord injury at the level of T2 would be expected to have:
A patient with a spinal cord injury at the level of T2 would be expected to have:
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What is the formula for calculating mean arterial pressure (MAP)?
What is the formula for calculating mean arterial pressure (MAP)?
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Which of the following describes an incomplete spinal cord injury?
Which of the following describes an incomplete spinal cord injury?
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Which of these is NOT a common trigger for Autonomic Dysreflexia (AD)?
Which of these is NOT a common trigger for Autonomic Dysreflexia (AD)?
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What is the primary reason for immediately raising the head of the bed (HOB) in a patient experiencing Autonomic Dysreflexia (AD)?
What is the primary reason for immediately raising the head of the bed (HOB) in a patient experiencing Autonomic Dysreflexia (AD)?
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What type of immobilization is recommended for unstable thoracic or lumbar spine injuries?
What type of immobilization is recommended for unstable thoracic or lumbar spine injuries?
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Which of the following is a potential complication of spinal cord injury (SCI) above T7?
Which of the following is a potential complication of spinal cord injury (SCI) above T7?
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Which of these is NOT a common clinical manifestation of spinal cord injury (SCI)?
Which of these is NOT a common clinical manifestation of spinal cord injury (SCI)?
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What is the primary reason for administering corticosteroids to a patient with a spinal cord injury (SCI) in acute care?
What is the primary reason for administering corticosteroids to a patient with a spinal cord injury (SCI) in acute care?
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What type of shock is typically associated with spinal cord injury (SCI)?
What type of shock is typically associated with spinal cord injury (SCI)?
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Which of the following medications may be given to manage autonomic dysreflexia?
Which of the following medications may be given to manage autonomic dysreflexia?
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Which of the following is a characteristic of the neurogenic bladder that may occur after a spinal cord injury (SCI)?
Which of the following is a characteristic of the neurogenic bladder that may occur after a spinal cord injury (SCI)?
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What is the most appropriate nursing intervention when a patient with a spinal cord injury reports a sudden increase in their blood pressure and headache?
What is the most appropriate nursing intervention when a patient with a spinal cord injury reports a sudden increase in their blood pressure and headache?
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Flashcards
Spinal Cord Injury Classification
Spinal Cord Injury Classification
Categories used to determine the severity and type of spinal cord injuries.
Neurogenic Shock
Neurogenic Shock
A condition resulting from loss of sympathetic tone, leading to hypotension and bradycardia.
Spinal Shock
Spinal Shock
A temporary state of areflexia and loss of sensation below the injury site after spinal cord injury.
Trigeminal Neuralgia
Trigeminal Neuralgia
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Guillain-Barré Syndrome
Guillain-Barré Syndrome
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Hypotension causes in SCI
Hypotension causes in SCI
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Neurogenic bladder
Neurogenic bladder
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Decubitus ulcers
Decubitus ulcers
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Poikilothermia
Poikilothermia
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Autonomic dysreflexia
Autonomic dysreflexia
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Common triggers of AD
Common triggers of AD
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Immediate treatment for AD
Immediate treatment for AD
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Management of respiratory dysfunction
Management of respiratory dysfunction
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Nursing care for immobility
Nursing care for immobility
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Vasopressors
Vasopressors
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Traumatic Brain Injury (TBI)
Traumatic Brain Injury (TBI)
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Primary Injury
Primary Injury
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Secondary Injury
Secondary Injury
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Most common age for TBI
Most common age for TBI
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Spinal Cord Injury (SCI)
Spinal Cord Injury (SCI)
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Classification of SCI - Completeness
Classification of SCI - Completeness
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Mean Arterial Pressure (MAP)
Mean Arterial Pressure (MAP)
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Degrees of SCI Injury
Degrees of SCI Injury
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Respiratory Manifestations in SCI
Respiratory Manifestations in SCI
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Study Notes
Spinal Cord Injury
- Spinal cord injuries (SCI) are most commonly caused by trauma.
- 78% of SCI patients are male.
- Common causes include motor vehicle collisions (MVCs), falls, violence (gunshot wounds, GSWs), and sports injuries.
- Major causes of death in SCI patients are pneumonia, pulmonary embolism (PE), and sepsis.
Traumatic Brain Injury (TBI)
- Falls are the leading cause of TBI (48%).
- Motor vehicle collisions (MVCs) account for 14% of TBI cases.
- Injuries from object strikes and assaults also contribute significantly to TBI.
- Approximately 56,800 people die annually from TBI.
- About 80,000-90,000 individuals experience lasting disability from TBI.
Types of Traumatic Brain Injury (TBI)
- Primary injury: Contusions, lacerations, and skull fractures are initial injury types related to the event.
- Secondary injury: Occurring hours or days after initial injury, secondary impairment includes decreased amount of glucose and/or oxygen to brain tissue, Intracranial hemorrhage, cerebral edema, intracranial hypertension, seizures, vasospasm, and hypoxia.
- Secondary injuries may be reversible (first 4-6 hours).
Types of Spinal Cord Injury (SCI)
- Primary injury: Permanent damage, often due to cord compression, laceration, or transection.
- Secondary injury: Potentially reversible in the first 4-6 hours following a SCI, damage occurs from edema, hypoxia, and ischemia secondary to inflammatory responses.
Spinal and Neurogenic Shock
- Spinal shock: Loss of deep tendon reflexes and sphincter reflexes, usually accompanied by urinary retention, paralytic ileus, loss of sensation, flaccidity, and paralysis below the level of injury.
- Neurogenic shock: Loss of autonomic nervous system function.
- Keep Mean Arterial Pressure (MAP) above 85 mmHg to potentially prevent shock.
Normal Mean Arterial Pressure (MAP)
- Normal MAP range: 70-100 mmHg.
- Recommended MAP for septic or severe sepsis or septic shock patients: ≥ 65 mmHg.
- Maximum recommended MAP: ≤ 160 mmHg.
SCI Classifications
- Mechanism of injury: Nature of the trauma causing the spinal cord lesion.
- Level of injury: Location of the spinal cord lesion. Assessment with imaging (MRI, etc).
- Completeness of injury/impairment: Determined by the level/extent of neurological function lost, including sensory and motor functions.
- American Spinal Injury Association (ASIA): Common scale to classify spinal cord injuries, useful for evaluation of severity involving both sensory and motor function.
Classification of SCI - Mechanism of Injury
- Flexion
- Flexion-Rotation
- Extension-Rotation
- Hyperextension
- Vertical Compression
Classification of SCI - Level of Injury
- C1-C3: ventilator dependent tetraplegia
- C1-T1: tetraplegia
- Below T2: Paraplegia
Classification of SCI - Grade of Injury
- A (complete): No motor or sensory function below the neurological lesion level.
- B (incomplete): Sensory function preserved, but no motor function below the level of injury.
- C (incomplete): Some muscle function (muscle grade <3/5) below the lesion level is preserved.
- D (incomplete): Moderate-to-good muscle function (muscle grade ≥ 3/5) below the lesion level exists.
- E (normal): Normal motor and sensory function exists below the lesion level.
Pediatric Considerations
- Increased incidence of complications and longer hospital stays associated with SCI in older adults.
- Age is a factor that increases frequency of TBI.
- Falls are a major cause of SCI for people >65 years old.
Brain Tumors
- Primary tumors: Arise from brain tissue. Gliomas (astrocytomas and oligodendrogliomas), meningiomas, acoustic neuromas, and pituitary adenomas are examples.
- Secondary tumors: Metastatic tumors of the brain originate from cancer spread from a different part of the body.
Clinical Manifestations of Brain Tumors
- Increased intracranial pressure (ICP)
- Headache
- Visual disturbances
- Vomiting
- Seizures
- Motor abnormalities
- Cognitive deficits
- Language disturbances
Brain Tumor Diagnositcs
- History and physical (H&P) examination
- Neurological exam
- Computed tomography (CT) scan (with contrast)
- Magnetic resonance imaging (MRI)
- Stereotactic brain mapping
- Positron emission tomography (PET) scan
- Electroencephalography (EEG)
- Cytology
Medical Management of Primary Tumors
- Surgery: Used to remove or debulk the tumor..
- Chemotherapy: May be used in conjunction with surgery or radiation to slow or shrink the tumor. Limited by the blood-brain barrier.
- External-beam radiation: A form of radiation therapy for treating brain tumors. Using iodine radioisotopes to protect surrounding brain tissue and stereotactic approaches such as Gamma knife to precisely target radiation exposures.
- Specific medications: Corticosteroids, mannitol, and antiseizure medications are potentially indicated.
Metastatic Brain Tumor Treatment
- Palliative care: Focus is on pain management and symptom relief, not necessarily complete tumor eradication.
- Surgery: Removal or debulking of the brain tumor(s) may improve the patient's symptoms, depending on the tumor characteristics.
- Chemotherapy: May be used in conjunction with other treatments or alone.
- Radiation: May be used as part of the treatment plan.
Spinal Cord Tumors
- Location designations: Intramedullary (within the spinal cord), intradural-extramedullary (between the spinal cord and the dura mater), and extradural (outside of the dura mater).
- Signs and symptoms of spinal cord tumors: Motor and sensory problems, back pain radiating along the nerve root, slow-progressing signs (if untreated, paralysis), and pain that is worsened by a prone position.
- Different approaches to treatment may be indicated depending on location of the spinal tumor, and prognosis varies widely.
Trigeminal Neuralgia
- Sudden, severe, brief, unilateral stabbing pain along the trigeminal nerve.
- Treatment can include supportive medical approaches and surgical intervention.
Bell's Palsy
- One-sided temporary facial paralysis due to inflammation of the facial nerve (CN VII).
- Treatments may include corticosteroids, anti-inflammatory drugs, and symptomatic interventions such as artificial tears, heat, and ocular protection
- Pain management is indicated.
Guillain-Barre Syndrome (GBS)
- An autoimmune condition that attacks the peripheral nerve myelin.
- Weakness and paralysis typically ascend from the legs to the arms.
- May be precipitated by a preceding viral infection.
- Treatments may include intravenous immunoglobulin (IVIG) or plasmapheresis.
Tetanus
- Severe infection of the nervous system.
- Causes muscle rigidity, lockjaw, difficulty swallowing, and spasms.
- Vaccination and post-exposure treatments are important
- Incubation period spans 4-14 days following infection.
Other topics covered
- Neural Tube Defects: Causes, prevention, and treatment of defects in the neural tube including spina bifida occulta, meningoceles, and myelomeningoceles.
- Hydrocephalus: Imbalances in the production and absorption of cerebrospinal fluid (CSF).
- Cerebral Palsy: A range of non-specific clinical symptoms characterized by abnormal motor patterns and postures due to damage during embryonic or fetal development, occurring before, during, or after birth.
- Interprofessional care: Essential aspects of collaborative and comprehensive care provided from different specialities (e.g. pre-hospital, acute care, nursing care) for patients with specific pathologies and/or injuries.
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Description
Test your knowledge on spinal cord injuries, neurogenic shock, and related conditions with this comprehensive quiz. Explore symptoms, causes, and management strategies essential for healthcare professionals dealing with these challenges.
