Spinal Cord Injury Overview

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Questions and Answers

What are key signs to monitor for in a client at risk of autonomic dysreflexia?

  • Hypotension and coolness above the injury
  • Bradycardia and anxiety (correct)
  • Warm, flushed skin below the level of injury
  • Increased heart rate and elevated body temperature

Which of the following actions is essential in preventing pressure injuries for your client?

  • Increase fluid intake to prevent dehydration
  • Limit movement to prevent further injury
  • Change the client’s position at least every 2 hours (correct)
  • Encourage the client to remain inactive to build strength

When should the healthcare provider be notified regarding signs of respiratory dysfunction?

  • If lung sounds become clearer
  • When the client reports feeling better
  • If SpO2 decreases to 90% (correct)
  • If tachypnea is observed (correct)

Which symptom indicates the need for immediate action to prevent autonomic dysreflexia?

<p>Symptoms of anxiety (A)</p> Signup and view all the answers

What is an important part of the nutritional support plan for a client recovering from spinal cord injury?

<p>Provide enteral nutrition to maintain positive nitrogen balance (B)</p> Signup and view all the answers

What dietary approach should be encouraged to enhance recovery in patients with spinal cord injuries?

<p>Diet high in fiber, fruits, and vegetables (B)</p> Signup and view all the answers

Which of the following measures is appropriate for emotional support of the client?

<p>Provide opportunities to talk about their self-concept (C)</p> Signup and view all the answers

What intervention should be taken if signs of autonomic dysreflexia are present?

<p>Loosen any constrictive clothing and elevate the head of the bed (A)</p> Signup and view all the answers

What is an effective strategy for preventing pressure injuries in individuals with spinal cord injuries?

<p>Change positions every 2 hours (C)</p> Signup and view all the answers

Which of these medications might be administered for symptomatic bradycardia in this client?

<p>Atropine (B)</p> Signup and view all the answers

How can individuals with spinal cord injuries benefit emotionally from local support groups?

<p>Through social connections with others facing similar challenges (B)</p> Signup and view all the answers

What is a crucial aspect of rehabilitation planning for clients with spinal cord injuries?

<p>Developing a comprehensive self-care routine (C)</p> Signup and view all the answers

What is a critical consideration when planning home care for a client after spinal cord injury?

<p>Coordinate with an interdisciplinary team for comprehensive care (D)</p> Signup and view all the answers

What is one method of managing bowel elimination for someone with a spinal cord injury?

<p>Following a tailored toileting schedule (C)</p> Signup and view all the answers

Which of the following should clients with spinal cord injuries monitor to prevent complications?

<p>Signs of autonomic dysreflexia and skin sores (A)</p> Signup and view all the answers

What key instruction should be provided to clients regarding hydration for recovery?

<p>Drink plenty of fluids to assist in bowel management (B)</p> Signup and view all the answers

What physiological changes arise from neurogenic shock due to sympathetic neuron damage?

<p>Peripheral vasodilation and bradycardia (D)</p> Signup and view all the answers

What is the first step in diagnosing a spinal cord injury?

<p>Assessing muscle function and sensation (C)</p> Signup and view all the answers

When immobilizing a client with a spinal cord injury, which technique should be used for repositioning?

<p>Log-roll technique (D)</p> Signup and view all the answers

Which of the following is a primary nursing goal for a client with a spinal cord injury?

<p>Preventing complications and providing emotional support (A)</p> Signup and view all the answers

What is a significant focus of long-term care for a client recovering from a spinal cord injury?

<p>Preventing and treating complications and promoting functional independence (B)</p> Signup and view all the answers

Which method is effective for managing emotional support and counseling for clients with spinal cord injuries?

<p>Encouraging expression of feelings and concerns (C)</p> Signup and view all the answers

In relation to nutrition and hydration for recovery, which statement is most accurate?

<p>High protein and hydration are crucial for healing (B)</p> Signup and view all the answers

What is an effective strategy for pressure injury prevention in clients with spinal cord injuries?

<p>Regularly changing positions and using support surfaces (B)</p> Signup and view all the answers

Flashcards

Respiratory Dysfunction

Problems with breathing, including ineffective coughing, low blood oxygen (SpO2 < 93%), abnormal lung sounds (diminished, crackles), and rapid breathing (tachypnea).

Intubation and Ventilation

Using a tube to help a person breathe if they cannot breathe on their own.

Neurogenic Shock

A type of shock caused by damage to the nervous system, often seen after spinal cord injuries.

Bradycardia

A slow heart rate.

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Hypotension

Low blood pressure.

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Autonomic Dysreflexia

A serious, potentially life-threatening complication of spinal cord injury, causing severe high blood pressure and other symptoms.

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Paroxysmal Hypertension

Sudden and severe increase in blood pressure.

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Bowel/Bladder Fullness

The need to empty the bowels or bladder, which can trigger autonomic dysreflexia.

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Spinal Cord Injury

Damage to the spinal cord, disrupting the communication between the brain and body.

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Pressure Injuries Prevention

Methods to prevent sores from pressure on the body.

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Client emotional support

Providing emotional support to clients with severe conditions like spinal cord injury.

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Spinal Cord Injury (SCI)

Damage to the spinal cord, caused by trauma, tumors, infections, or diseases, leading to loss of feeling, movement, and function.

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Primary SCI

Initial injury to the spinal cord caused by direct trauma.

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Secondary SCI

Damage to the spinal cord after the initial injury, caused by swelling, bleeding, ischemia, etc.

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Autonomic Dysreflexia

Sudden, serious response to stimulation below the level of injury. Symptoms include headache, anxiety, etc.

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Toileting Schedule

Regular schedule for bowel and bladder emptying to prevent problems like autonomic dysreflexia.

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Self-Catheterization

The process of inserting a tube into the urethra to empty the bladder.

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Clinical Manifestations

Symptoms of a spinal cord injury, which depend on injury severity and location. Loss of sensation and function below injury are common findings

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Risk Factors SCI

Factors that increase the chances of getting a spinal cord injury, like high-risk behaviors and bone/joint diseases, trauma.

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Neuronal Cell Death

Loss of nerve cells in the spinal cord.

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Demyelination

Loss of the protective covering surrounding nerve fibers.

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Scar Tissue

Formation of fibrous tissue in the area of spinal cord damage.

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Neurogenic Shock

A type of shock caused by damage to sympathetic neurons, leading to unopposed parasympathetic activity, resulting in vasodilation, hypotension, and bradycardia.

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Spinal Cord Injury Diagnosis

Begins with client history, physical assessment (muscle function, sensation, proprioception), and using the ASIA scale to determine the severity of injury. Imaging tests can identify the cause of injury.

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ASIA Scale

A scale used to classify spinal cord injuries, ranging from A (complete injury) to E (normal function).

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Spinal Cord Injury Treatment (Initial)

Stabilize the client (immobilize spine), provide ventilatory and cardiovascular support, and manage pain.

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Spinal Cord Injury Treatment (Later)

Address underlying cause (surgery, decompression), stabilize spine, may involve corticosteroids for inflammation reduction. Then focus on rehabilitation.

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Priority Nursing Goals (Spinal Cord)

Prevent further injury (immobilization, log-roll), support respiratory function (oxygen, pulse oximetry, lung sounds), and provide emotional support.

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Log-roll Technique

A method of moving a client with a spinal injury as a unit to prevent further injury; teamwork movement.

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Study Notes

Spinal Cord Injury

  • Spinal cord injury (SCI) is damage to the spinal cord or the cauda equina (bundle of nerves).
  • Anatomy: Spinal column consists of 33 vertebrae (7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccygeal).
  • Spinal cord travels through spinal canal, ending at L2 vertebra (forming conus medullaris).
  • Nerve roots of lower spinal cord (lumbar, sacral, coccygeal) form cauda equina.
  • Spinal cord is a highway for information between brain and body (motor and sensory).

Causes of SCI

  • Younger clients: Motor vehicle accidents, penetrating trauma (e.g., gunshot, stab wound), recreational injuries (e.g., impact sports, diving).
  • Older clients: Falls, tumors, infections, degenerative spinal diseases (e.g., intervertebral disc protrusion, osteophytes).
  • High-risk behaviors: Engaging in risky activities without safety equipment (sports, speeding, diving).
  • Pre-existing conditions: Bone or joint disorders.

Types of SCI

  • Primary Injury: Sudden, traumatic impact causing fractures or dislocations of spine, compressing spinal cord.
  • Secondary Injury: Additional damage (bleeding, ischemia, swelling) that occurs days or weeks after primary injury due to body's response to trauma.

Clinical Manifestations of SCI

  • Depend on severity and location.
  • Partial or complete loss of sensation & motor function below injury.
  • Upper cervical lesions: Quadriplegia (loss of limb/trunk function, ventilator).
  • Lower cervical lesions: Paralysis of lower limbs, but possible upper limb function.
  • Thoracic lesions: Paralysis of lower limbs, functional upper limbs (T1-T12, C5–C7).
  • Lumbar and sacral lesions: Limb dysfunction, possible bladder/bowel dysfunction.
  • Cauda equina lesions: Dysfunction of bowel/bladder, sexual function, saddle anesthesia.

Complication of SCI

  • Spinal shock: Transient condition after injury with flaccid paralysis, loss of sensation & reflex below the level of injury.
  • Autonomic Dysreflexia (AD): Life-threatening complication that happens as a result of a sudden, massive, and inappropriate release of norepinephrine by the autonomic nervous system; it usually happens below the level of the lesion.
  • Neurogenic shock: Damage to sympathetic neurons can lead to vasodilation, hypotension, and bradycardia.

Diagnosis

  • History and physical assessment.
  • Imaging tests (e.g., X-rays, CT scans, MRIs).
  • Muscle function, sensation, and proprioception testing.
  • ASIA scale.

Treatment

  • Stabilize the spine.
  • Supportive measures (e.g., ventilatory and cardiovascular support).
  • Address underlying cause (surgery, decompression).
  • Rehabilitation (physical/occupational therapy).

Nursing Care for SCI

  • Prevention of complications (e.g., pressure injuries, venous thromboembolism).
  • Respiratory support (e.g., high-flow oxygen, pulse oximetry).
  • Immobilization (e.g., cervical collars, log roll technique).
  • Emotional support for client and family.
  • Teaching on self-management and rehabilitation.

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