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Questions and Answers
What type of stroke results from a blood vessel breaking open and causing blood to leak into the brain?
Which stage of stroke development involves progressive development of stroke symptoms over hours to days?
What is the main nursing intervention during the acute stage of a stroke?
Which diagnostic test can reveal lesion in the brain following a stroke?
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What is the physiopathological consequence of interrupting cerebral blood flow for 5 minutes or more?
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What are the typical signs of spinal shock that may be observed in a patient?
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What is a common cause of spinal cord injury?
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Which technique can help decrease frustration in clients with expressive language deficits?
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In which type of spinal cord injury is visual neglect more common?
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What is a key characteristic of sensory/perceptual deficits in left hemiplegics?
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Which is a common mechanism of spinal cord injury that involves a force exerted straight up or down the spinal column?
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What is the classification for spinal cord injury based on the location of the injury?
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What is the purpose of using cervical tongs (Crutchfield) in the medical management of spinal cord injuries?
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Which nursing intervention is crucial to prevent complications related to immobility in spinal cord injury patients?
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Which of the following best describes a sign of spinal shock in a patient with a spinal cord injury?
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In spinal cord injuries, what level of injury typically results in respiratory paralysis?
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What is the primary cause of autonomic dysreflexia in spinal cord injury patients?
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What difference distinguishes quadriplegia from paraplegia in spinal cord injuries?
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What is the primary purpose of skeletal traction with halo traction in spinal cord injury management?
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What is the main characteristic of a complete cord transection in spinal cord injuries?
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What is the immediate intervention to alleviate autonomic dysreflexia in a patient with a spinal cord lesion above T6?
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What is the rationale behind the immediate removal of fluid from the bladder in autonomic dysreflexia?
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Study Notes
Stroke Pathophysiology
- Ischemic stroke: a blood vessel breaks open, causing blood to leak into the brain
- Hemorrhagic stroke: blood flow is stopped for longer than a few seconds, causing brain cells to die and permanent damage
- Brain cells can die, causing permanent damage, if blood flow is stopped for longer than 5 minutes
Stages of Stroke Development
- Transient ischemic attack (TIA): a brief period of neurologic deficit, lasting less than 24 hours, with complete resolution of symptoms
- Stroke in evolution: progressive development of stroke symptoms over a period of hours to days
- Completed stroke: neurologic deficit remains unchanged for a 2- to 3-day period
Assessment of Stroke
- Generalized signs: headache, vomiting, seizures, confusion, disorientation, decreased LOC, nuchal rigidity, fever, hypertension, slow bounding pulse, Cheyne-Stokes respirations
- Focal signs: hemiplegia, sensory loss, aphasia, homonymous hemianopsia
Diagnostic Tests for Stroke
- CT and brain scan: reveal lesion
- EEG: abnormal changes
- Cerebral arteriography: may show occlusion or malformation of blood vessels
Nursing Interventions for Stroke
- Acute stage:
- Maintain patent airway and adequate ventilation
- Monitor vital signs, neuro checks, and observe for signs of increased ICP, shock, hyperthermia, and seizures
- Provide complete bed rest as ordered
- Maintain F&E balance and ensure adequate nutrition
Fracture Dislocation
- May affect anterior and posterior ligaments, compression of spinal cord, and spinal cord and its roots
- Concussion, contusion, compression, or laceration by fracture/dislocation, penetrating (e.g. GSW, missile)
Axial Loading
- Fall from a height, landing on one's feet, is typical of this fracture
- Axial loading applied to intravertebral disc results in increased pressure and stresses, causing a large central posterior-superior fragment
Pathophysiology of Spinal Cord Injury
- Hemorrhage and edema → ischemia → necrosis and destruction of cord
Medical Management of Spinal Cord Injury
- Immobilization and maintenance of normal spine alignment to promote fracture healing
- Surgery: decompression laminectomy, spinal fusion
Assessment of Spinal Cord Injury
- Spinal shock: temporary condition lasting from several days to 3 months, characterized by absence of reflexes below the level of lesion, flaccid paralysis, lack of temperature control, hypotension with bradycardia, retention of urine and feces
- Level of injury:
- Quadriplegia: cervical injuries (C1-C8) → paralysis of all 4 extremities
- Paraplegia: thoracolumbar injuries (T1-L4) → paralysis of the lower half of the body involving both legs
- Extent of injury:
- Complete cord transection: loss of all voluntary movement and sensation below the level of injury
- Incomplete lesions: varying degrees of motor or sensory loss between the level of the lesion, depending on which neurologic tracts are damaged and which are spared
Nursing Interventions for Spinal Cord Injury
- Emergency care:
- Assess ABC, do not move patient during assessment
- Perform a quick head-to-toe assessment, check for LOC, signs of trauma, and leakage of fluid from ear
- Immobilize client
- Assist in immobilizing head and neck with cervical collar and place on spinal board
- Acute care:
- Maintain optimum respiratory function
- Maintain optimal cardiovascular function
- Maintain fluid and electrolyte balance and nutrition
- Maintain immobilization and spinal alignment
- Prevent complications of immobility
- Maintain urinary elimination
- Maintain bowel elimination
- Monitor temperature control
- Observe for and prevent infection
- Observe for and prevent stress ulcers
Autonomic Dysreflexia
- Rise in blood pressure, sometimes to fatal levels, in response to stimulation of the sympathetic nervous system
- Occurs in clients with cord lesions above T6
- Symptoms: severe headache, hypertension, bradycardia, sweating, goose bumps, nasal congestion, blurred vision, convulsions
- Interventions: raise client to sitting position to decrease BP
Language Deficits
- Left hemisphere dominance for language
- Receptive: give simple, slow directions, give one command at a time, gradually shift topics, use nonverbal techniques of communication
- Expressive: listen and watch carefully, anticipate client's needs, decrease frustration and feelings of helplessness, allow sufficient time for client to answer
Sensory/Perceptual Deficits
- More common in left hemiplegics
- Characterized by impulsiveness, unaware of disabilities, visual neglect
- Interventions:
- Assist with self-care
- Provide safety measures
- Initially arrange objects in environment of unaffected side
- Gradually teach clients to take care of the unaffected side and to turn frequently and look at affected side
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Description
Test your knowledge on spinal cord injuries including fracture dislocation effects, compression, and associated forces. Explore the pathophysiology behind various types of spinal cord injuries.
