2024 Spinal Cord Injury Summary (PDF)

20241120172905 Thu, Nov 21, 2024 8:51AM 2:01:08 **SUMMARY KEYWORDS** spinal cord injury, exam extension, peer-reviewed article, Thanksgiving break, spinal shock, neurogenic shock, respiratory dysfunction, cardiovascular dysfunction, urinary retention, gastrointestinal dysfunction, skin breakdow...

20241120172905 Thu, Nov 21, 2024 8:51AM 2:01:08 **SUMMARY KEYWORDS** spinal cord injury, exam extension, peer-reviewed article, Thanksgiving break, spinal shock, neurogenic shock, respiratory dysfunction, cardiovascular dysfunction, urinary retention, gastrointestinal dysfunction, skin breakdown, hypothermia, autonomic dysreflexia, rehabilitation challenges, patient teaching Sensitive organ at a certain level. What happens to a brain and aneurysms in this area? You should know kind of the basic functions. Okay, I\'m going to go over them, but I\'m not going to tell you. You have one Epso assignment left. I\'m happy, if people feel that it\'s pressed, I\'m happy to extend that dead time. Dead times, yes, deadline out. You just have to reach out to me. I can\'t read your mind. And then, what was the last thing everybody got? Whenever you get your exam, your love points are added on there. Does anybody have any questions for me? No, so that\'s why it\'s means the first 80s and then enters the last eight weeks. Because if they work, why you\'re not gonna fail? Yeah, I\'m not gonna fail. You can go absolutely not. I do highly encourage you. 27 students to know how much into this exam, I will apologize I did not know about word Bibles, everything really great resource, and make sure that you have the rationale on on why the answer that you picked is either correct or incorrect in the other options as well, right? Because that helps as well. Yeah, yes. Can we extend the EPS, although to like Wednesday instead of next Monday that it\'s due? Yeah, we\'ll extend it till Friday. Okay, it\'s due this upcoming Monday. It\'s day the 25th Yeah, but yes, really, I thought you had Thanksgiving. We heard about some food. That\'s I just it, just, I\'m happy to extend it. Thank you. Yeah, because this week is already, like, we\'re all trying to finish practicum and stuff, and we just got done with this exam. Like, some of us just need a day to breathe and, like, try to focus on it. Sounds good. The other thing is your epslo. I don\'t know if you\'ve opened it, but you need to have a peer reviewed article that\'s been published within the last five years. I need a link or a copy of that article. I can\'t remember who, but somebody has already put it in, has turned it in, and I cannot open the article. So if that\'s you, please send me the article. That\'s fine. Does that need to be attached to be attached the first day of classes in her email and then attached email and I want a barley party, but there needs to be something attached to your CET, be it a copy of a car. I just had my so called read mine, and then she said that was fine. Your CET, just say hey, thanks for the 120 hours. I didn\'t know if they had to do like one page letter, basically just that you acknowledge that. It helps keep the communication simple. Okay, different. No. So do you not eat a bunch of food on Thanksgiving? Everybody\'s asking. So do you not celebrate Thanksgiving? I mean, we do. You. Oh, yeah, you just don\'t forever, it\'s my husband\'s favorite holiday. I don\'t even cook dinner like you go somewhere else. Okay, yeah, well, okay, I don\'t know if Megan Scott, if you do not finish lecture tonight, there\'s a lot of spots. There is, I don\'t know yet, that\'s the or you did it. It\'s got to go back whatever we don\'t put on. Said, I think Kim hasn\'t gotten yet. Either you have. Did you get this here? Okay, so it was just us two, and then we\'ll pass it over. Holly got it, yeah? Carrie, appreciate it. Yeah. Everybody, do you want me to get you finished on this house before we start? No, sorry, go ahead. Spinal cord injury. Spinal cord injury, recording a spinal cord injury isn\'t any damage required to the spinal cord itself, right? It can be a partial or complete disruption of the nerve tracks and neurons, and this results, oftentimes in motor loss, sensory loss, altered activity and autonomic nervous nervous system dysfunction. So there are about 17,000 new spinal cord injuries a year. We have 280,000 people living with a spinal cord injury. This is another one of those. Even though technology has advanced and we know a little bit more about spinal cord injuries and how they work, the rate of people who have a spinal cord injury is actually raising on who does not survive? Does that make sense? People are dying at a higher frequency than before, even still with all the technology. So the most common um people who these happen to are males, ages 16 to 30. Why do you all think that that essentially could be the risky, right? So nasty, sexist, but they\'re more likely motorcycles, right? Football? Anybody watch football? A little concussion, so those final injuries, right? They\'re more visible. That\'s the same females. But 80% of people who have spinal cord injuries are male, and again, this is a pretty young age, right? 16 to 30 spinal cord injury. That\'s a long life. Those who developed a spinal cord injury, you have a spinal cord injury, are at a 30% chance of re hospitalization with an injury. So there is an increased frequency of spinal cord inhale and older adults, why they\'re for allowance? False, false, right? People are living longer, right? So 65 and older is that older group that they pick from? Yeah, false, easy. So here\'s just a quick breakdown again. Fall through that 30.5% of spinal cord injury that\'s really high. You combine that with motor vehicle collisions, that\'s over half of the sports, sports that\'s over half of your percentage, and then violence force injuries. So a quick review right at this final word, it\'s wrapping those hot layers of dura, right? So these are thick membranes, okay, you still want some elasticity with your spinal cord, right? So you can\'t have this big bone protecting your spinal cord, right? So you got these thick layers of membrane tissue that surrounds the spinal cord and up to the brain, right? Because all of that\'s one big connection. So a spinal cord injury can be compressed by bone displacement, an interruption of blood supply to the corn or traction, resulting on so not always squished, right? And then you have your penetrating trauma, right? You\'re tearing your transection. These are often like stab wounds, gunshots. We\'ll come back to that. Is that, yeah, yeah? Is this the next slide that should not be here? We\'ll come back to that. Okay. Anyways, I reorganized. I did Tuesday. Okay, I\'m sorry. We\'ll come back to that. So your etiology and pathophysiology in less than 24 hours, less than 24 hours, right? That\'s not a very big time window. You can have that permanent damage, because you have your initial and then you have that slot, which is your fat, okay? So you have your initial injury, right? Like we talked about, I\'m going to go a little bit further into those in the next slide. So these are your huge mechanisms of injury, right? You\'ve got your collection injury, which you see a lot of car crashes. You have your hyper extension and falls like this great picture, your compression, like we talked about, and then your flexion rotation, so you have that initial injury, and then you have y\'all, I\'m sorry it\'s been a day. So you have your initial injury, okay, which is your gunshot wound, your trauma to the spinal cord, okay? And then you have your secondary injury, which leads into this. This is your events leading to your secondary injury. This is the swelling that happens afterwards, the inflammation of your body trying to repair. Is there a lot of space to adapt to that swelling, or is it more of a closed space? Closed more of a closed space, right? So any kind of swelling, either above or below that injury, is going to cause issues. Okay, so you might have an injury at your seat four, but you\'re seeing things at your seat three. Does that make sense? Because it\'s going to swell above and below. Does that make sense? I\'m sorry I confused myself, and that helps me. Okay, so this is your cascade of events, because this is more what I want you to really be able to focus on is knowing your secondary injury to the spinal cord. Like I said, there\'s that limited space. So you get that edema, you get that swelling, so that\'s going to cut off your blood supply right to anything below it. Does that make sense? It\'s not okay. I do want you to know that scbf on here is spinal cord blood flow. So again, you\'re having this swelling, you\'re going to have a reduction in oxygen, so you\'re going to have a lot of vaso packet substances that can cause vasospasms In your spinal cord. Okay? Patients don\'t always know that they\'re having these which can cause more damage, right? Because they cannot, depending on where it is in the level, they can\'t always feel this okay. And like we said before, the spinal cord has minimal space to be able to adapt to any kind of lesion, swelling, inflammation, anything like that. So this causes cell death, right to anything below, because, if you thought it pop up here, everything below is effective, right? So the higher, the worse. Okay? And then, because of this, in less than 24 hours, permanent damage can occur because of that. HTML. Because edema does not happen in a short time frame. Really no true diagnosis of how bad something is or how bad this kind of cord injury is, and effects are going to happen until after 72 hours, and that edema has basically hit its peak and start to go back down. So talk about this again. I apologize, no slides. So I do want you to know that the flexion rotation is your most instable, unstable, most unstable because the ligaments that stabilize the spine are torn, okay? And this often happens in the cervical region. Where\'s your cervical spine at up here? Right? So everything below? Jeff, is the one that\'s marked is your most sense. Upper Jurassic are your most flexible? All right? So they\'re most like English today, so they are at greater risk of having something happen and having that damage again, just because they do have those 50. Did everybody get this that wants to fill it out tonight? Would you care to look and make sure I put daughter and not mother beside mine? Okay? So again, quick review. Serveable, right? One through seven. Then you have your thoracic, t1, through T 12, your lumbar, l1, to l5 your sacrum and your coccyx. I\'m not going to talk to you a lot about your sacrum and your coccyx, because that\'s not going to have a really big effect on every effect on everything that\'s going on internal Okay, so don\'t you think I\'m just dismissing it, but it does happen. I\'m sorry. You have cereal for breakfast, cervical you have Thanksgiving, typically. Okay, so I do want you to know that tetraplegia is now the new word for quadriplegia. How many limbs are paralyzed, all four limbs, right? I mean four so as well paraplegia, right? So I your spinal injury is classified where skeletal the trauma is. Does that make sense? So if you have a seat for injury, we\'ll go over really kind of what she needs now, as opposed to the thoracic injury, does that make sense? So again, the level of injuries, we\'re really going to focus on our cervical, thoracic and lumbar as we go through bodily systems. As I told you, cervical and lumbar are the most common, because these have the greatest flexibility and movement. I\'m sorry, circle and upper thoracic, you did. That\'s right. Yeah, I\'m on this today, and I apologize. It is no it finally, I\'m not coming back as long as I wrote down the right thing. Go ahead, yes, and it makes sense. Not your lawnmower, right? I\'m sorry, multitasking in my brain. Your cervical and your thoracic are your most flexible. Those are going to be your most prone to injury. You do? I need to review any of the other stuff that I\'ve tripped over somehow. I apologize. I read more than anything. So if the cervical cord is involved, you are going to have more than likely tetraplegia, which makes sense, correct? Like we talked about multiple times. I\'m already trying to hammer in here, your cervical is your upper Okay, so anything below, the higher the level makes sense, right? The more effects you\'re going to have below, if the damage is lower in the cervical vertebrae, okay, so six, seven patients tend to have a little bit of arm movement and sensation. So your degree of injury can be complete or incomplete, and you also hear it called incomplete. You also hear called court complete. Court involvement results in a total loss of sensory and motor function below the level of entry. Makes sense, right? You\'re completely severing that communication system. Okay? Incomplete or that partial, you\'re going to have a mixed loss depending on where, okay, and I\'m talking loss with motor activity and sensation repeated, repeat. Yeah. So for your partial you can have, you\'ll have a mixed loss of muscle and sensory. And we\'re going to go more in depth, because it depends on where that incomplete trauma is on the spinal cord. Which makes sense, right? The pictures in your book, all the pictures, and this is a really great reference to come back to. So we are going to go more in depth with your a little bit more of the incomplete spinal cord injuries. But I also liked this as well, because, again, we\'re going to be into it a little bit more. But your circle nerves, right, your friend curve is controlled by your cervical right, so your diaphragm, and then you got your muscles, your deltas, your biceps, arms, triceps. And then, all right, so you have what is called central cord syndrome, which is your incomplete damage to your spinal cord, and again, most common in your cervical region. And because it is incomplete, you have a mixture of motor function loss and then sensation loss right in this your lower weakness and sensory loss are in both upper and lower extremities, but are seeing more in your upper extremities being affected more than your lower this happens more with older adults. I anterior core syndrome caused by damage to anterior spinal artery. This results in compromised blood flow to two thirds of the spinal cord, so a pretty fair amount. This is often a flexion injury, where you\'ll see motor paralysis right, where you can\'t really move, but you\'re also going to have that loss of pain and temperature sensation, again, below that level of sound. And because this is anterior, your posterior is not effective, right? They\'re not injured. So you are still going to have sensations of touch, position, vibration and motion. You. Is that you said is so is that like all over you\'ll still have all those, or is you said that posterior won\'t be affected, but, okay, still have those temperature, but you can still feel all you still know when you\'re in motion, or something like that, like you can tell us your daughter, more motor with sensory sort that\'s where I\'m like, that\'s where it\'s hard, right? It\'s because you gotta differentiate, because it\'s both right, your spinal cord does motor, it does sensory. So depending on where those injuries are, are going to depend on what you have, do you have your motor, keep out your sensory and wear. So this is like, independent per case. Then that not everyone will always have this specifically, like lose, like the touch, position, vibration, motion, or motor, pain and temp sensation. So it could just be a mixture. It\'s just per person that you encounter. This is pretty typical for this. Okay, right? This isn\'t like a brain injury where, depending on wearing the will and somebody\'s personality, what\'s going to happen. Does that make sense? Yes, it depends on what part of the spinal cord and what\'s impacted in the spinal cord, okay, which is pretty much the same for everybody. So next you have your brown cigar syndrome. And this is damaged to one half of support. This is usually from a penetrating injury, like a so you can have what is called insolateral, which is your same side of the injury, you\'re going to have your loss of motor function, position and that basal map, vasomotor paralysis. Okay, so I get stabbed on the right side. I can\'t move my right side. Okay, for it\'s a lateral if you have contralateral right, which is opposite to where your injury is, you\'re going to have more of that sensory the loss of pain, temperature regulation, and again, that is below the level of injury. I want to reinforce that, because sometimes people just think it\'s full body, but it is just below the level of injury. I those are your incompletes. And why would you know about that? This picture is also in your book, but that was really great. It gives you, again, your summary of what happens again, depending on where your spinal cord injury is c4 you\'re going to have that tetraplegia unless, oh, and then it has c6 right? This is where you\'re still going to have some movement of potentially your arms, depending on where the injury is, is really going to depend on your patient\'s course, obviously, and any potential for any kind of rehab. So the Asia impairment scale, the American Spinal Injury Association, this is still used today to help really kind of classify what kind of spinal cord injury somebody has? Am I going to ask you to tell me if it\'s a, b, c, d, e on an exam? Because you can have this as a reference, but I want you to know what the Asian parent scale is. Okay. I third question, nurse is caring for a client who has a trans section of the spinal cord c7 which of the phone assessment findings should the nurse anticipate? I Is it a some movements, but no sensations, low level of injury. No. Who says yes? No. Sen. Sensation or movement below the level of injury, I don\'t know, some movement and also some sensation below the level of degree or below the level of injury. Who says d some sensation, but no movement below the level of injury? Do so this is where I try to hammer home reading the question slowly, not adding your extra because what is a transaction part of a section? It\'s a complete right? So, a complete injury. We\'re gonna have no sensation or movement below the level of I should have gone that first one. I\'m not trying to trip you up, but these are going to be kind of the questions that you get, okay, where I told you that one word can really make a difference. Okay, so read slow and really maddening, because I know you want to say c7 right? I\'ve told you that too. You\'re going to have potentially, maybe some movement under your arm, in your arms, right? But again, that doesn\'t matter, because it\'s a trans questions on that. So there\'s two big things that can happen. We\'ve talked about shock, but this is spinal shock. You know, spinal shock, or Neurogenic shock. So spinal shock is characterized by that loss of deep tendon and sphincter reflexes. You\'re gonna have a loss of sensation and plastic paralysis. Plastic paralysis in your spinal shock, okay, below that level of injury, and a lot of times this is due to that inflammation. It can last days to weeks, and again, because it can last so long, it can mask, again, any kind of post injury neurologic function. This period of deep of decreased reflexes and sensation is really important to be able to recognize and understand, because, again, you need to understand the complications that it can occur when the spinal shock wears off, and we\'ll talk about that. So next you have your Neurogenic shock, this is characterized by loss of more of your vaso motor tone, so your blood vessels, right? So this is characterized by significant hypotension, which is going to be defined for you, is less than 90 systolic Brady, cardia, what is considered great cardio less than what 60. These people are also going to have warm, dry skin. They\'re going to have that boss sim. Sympathetic Nervous System innervation. So you\'re going to have you\'re going to see peripheral vasodilation, potential, venous pooling and decreased cardiac output. You the neurogenic is seen more again with people who have cervical or high thoracic often seen as t6 or higher. This can occur within 24 hours of injury and last Up to five weeks to last up to last up to five weeks, five weeks. So we\'re going to start with our we\'re. Body systems and go through, okay? So initially, most importantly, you have your respiratory dysfunctions. Okay. Again, this is going to closely correspond to your level of injury, right? And above c4 is your big one, you\'re going to have complete and total loss of respiratory muscle function, because you\'re going to have complete the total loss of your phrenic nerve, which helps control what breathing, your diaphragm, diaphragm. So these people require mechanical ventilation, always at one time, and hopefully makes sense. A lot of these people who had these kind of injuries died on the scene, right? Because we didn\'t know what was going on, but we know a little bit more. They know to stabilize and they can intubate in the feet below the seat floor below seat four, you can still have that diaphragmatic breathing. However, just diaphragmatic breathing is not considered efficient over time, correct. So this can really lead to respiratory insufficiency. So these people may be mechanically vented and end up with a trait and be able to do short periods of time off that ventilator and just kind of on the trait collar, but they\'re not going to have that ability for that vital capacity and tidal volume for the lungs. I\'m Does that make sense? So will they always have, like, a trait, then for the rest of their lives and like, have to carry around? Like, can they still lead any type of life with this to where, like, they still have quality? Yeah, it\'ll be different, right? It\'ll be shipped in because it\'s c4 right? But yes, they have trached events and horrible ventilators now. So, you know, I don\'t know the insurance cost on that kind of thing, but yeah, people are. They\'re able. We have more technology, but we\'re not always able to save them like we would like. They can\'t leave a better quality life. Instead, just get stuck in the bed. So if you take the low c4 are you talking about c4 and then the entire time? So if your injury is like c1, c2 c3 right, you are worried about breathing, right? C5, c6 all of that below your brain and nerve is mostly intact, so you\'re able to have a little bit more of that diaphragmatic breathing, right? But you can have a spinal cord injury. Do not have to do alright? Technology or Yeah, but just not common, no, it is like we have a thoracic that\'s where I was getting confused. Below c4, to one, yeah, I\'m sorry, yeah. So anytime I say below, like, whatever one I give you is everything, right? Because it\'s all one, basically big package, right package, I can\'t even think of like something to compare it to bubble. I\'m sorry, it\'s one big bubble. So if it\'s popped at one spot, then the rest of it below, so what you have whenever I say below, so see for the rest of through c7 all of your lumbar, all of your thoracic, all of that. Does that make sense? I don\'t know why. My head kicking in like a string of lights. You cut one here, so everything below it, you don\'t even one bulb burns out, so everything below it\'s not working. Yeah, that\'s really great. Yes, okay, let me make sense of this. Below c4 I think what we\'re getting to what, what I think might be confusing lumbar, you\'re not going to have diagrammatic issues, no. But that\'s below c4 Yeah. So I guess what I think people may be confused on is you say below c4 but it\'s not really everything below c4 below c4 to a certain point, is going to mess with the diaphragmatic, the diaphragm. So Right? Does that make sense? Event, c4 everything where your injury is, yes, below c4 because lumbar is below c4 Yes, people don\'t like the cut off. The cut off is for where not no longer going to affect and cause diaphragmatic breathing. I\'m not trying to understand. So it\'s not really everything below c4 if the injury is, like, in, like, you know what I\'m saying? Like, you can be in, yes, okay, I just don\'t know how to get the words to make it below c4 so that would mean, like, everything below c4 but not necessarily, because there\'s going to be a cut off to where it doesn\'t mess with your diaphragm anymore. Okay, so where\'s that cut off? Yes, where\'s that cut off with your circle, I apologize. I see what you\'re saying. Okay, where did the diagram? If I have a yes, if I have a lumbar, even if I have a lumbar, right? That\'s not an effect. My printing error, right? Oliver\'s down here. My friend up here. Okay, that right? Yes, okay, um, jeez, I\'m sorry. Um, I\'m sorry. I just didn\'t know how to make it. Yeah, can you put it back all together really quick, just like, from top, like, just start, can you start like at the close medium, what I want you to know really big with your respiratory is C for your patient needs to be mechanically intubated, okay, okay, they are going to be on mechanical ventilation for the rest of their life. Am I? I\'m not getting paid c4 so how about like this with spine at the c4 to the lowest level of the circle is that? Does that sound better? Yes, so c4 to c7 you\'re going to see more impact with your diaphragmatic breather. You\'re going to have a little bit of that, okay, but you\'re still not going to be able to have that big tidal volume and lung capacity that you need for quality deep breaths. Does that help? Yes, okay. I apologize. Thank you guys. Make sense? Okay? Lips. So if you have these, so you can have that paralysis of abdominal muscles, right with thoracic injuries, which makes sense, right? Okay, do we use some abdominal muscles to help us breathe. Yeah, so that too can make an impact. Okay, but it\'s going to be your front end curve, or your Okay, anything like that. It\'s going to be more your abdominal with those thoracic and then, as it has on here, it\'s going to cause an ineffective cough. So if you have an ineffective cough and your diaphragmatic breathing is not on point, right? This can lead to no pneumonia and atelectasis, all that fun stuff, right? So again, those injuries, especially cervical and those upper thoracic you want to make sure you\'re teaching really good quality breathing exercises, right? Incentive, spirometer people, blood throw it, blow it off. But it\'s really important. It can make a huge difference for people, okay, especially if these people can\'t cough effectively. To remove those same kind of mucus or anything that\'s in their lungs. So you really need to be wary when you are doing any kind of oral care, right? If somebody gets intubated, you want to do those facts right? I think it\'s still every two hours, every four you\'re suctioning, you\'re cleaning the mouth, you\'re teaching deep breathing, because, yes, people can be awake on the ventilator, right, even if they\'re integrated orally, not just straight, okay? And you want to watch for any kind of sign of infection, because, again, people are already behind, right? So if they get an infection, they\'re not able to clear it, like you or I said it with a big mic off, or something like that. Okay, so there is a potential for what is called neurogenic pulmonary edema because of a dramatic increase in the cert. The sympathetic nervous system during the time of injury, and what that does is shunt blood to the lungs you and everybody knows the difference between Alexis and a moment correct? So they have developed what is called a chronic nerve stimulator. Obviously, not every patient is a candidate for this, but it does give patients the ability for increased mobility, the ability they also have electronic diaphragmatic pacemakers. Like I said, family teaching is going to be really important, because these people are more than likely going to be paralyzed, right? So you being able to teach family signs and symptoms right of any kind of respiratory infection, teaching them how to encourage and make sure that these people are doing really good coughs, really good respiratory therapy, really is what it is, and deep breathing exercises. And then there are, you may not know, depending on where you work, but social work really has a lot of there\'s a lot of really great community resources for anybody with a spinal cord injury. I like from transportation and to really just kind of like an annual effect on this stuff. So next you have your cardiovascular dysfunction. This is seen often with an injury above the t6 level. I You have a decrease in that sympathetic nervous system, you\'re going to have an imbalance with your sympathetic and your parasympathetic nervous systems, okay, they\'re not going to be able to communicate effectively. This is going to result a lot of times, in bradycardia, and again, because of that imbalance, you\'re often going to see peripheral vasodilation with potential hypotension. You which makes sense that you would have a relative hypovolemia, right? You\'re having vasodilation. It is really important with these patients at A t6 and above, that you are careful with turning or suctioning, because it can result in a cardiac arrest, again, because of that imbalance with the sympathetic nervous system. Can you say that one more time, please? Yeah, you want to be careful with charging or suctioning or initiating that bagel response, because once the body bagels, what does that do? Right? You\'re gonna have that lack of muscle tone to aid in Venus return, which makes you, which would make the patient predisposed for what blood clots, spinal cord injuries and blood clots. These patients who have symptoms show signs and symptoms are often put on another one might have alright. So treatment of your cardiovascular dysfunction, cardiac monitoring, right? So if you get somebody that comes in, they didn\'t order cardiac monitoring, get it right. Why would they? That atrocine order, right? They often to allow the body to adjust a little bit. They won\'t start it until the heart rate is around 40, okay, but in the ICU, it\'s just another day scary. You and you\'re gonna have those frequent, frequent assessments with your vital signs, right you want to make sure, and you are assessing to make sure that they are not having bleeding, and that is the potential for why they are hypertensive. Again, you can assess those thighs and calves for any kind of sign of a DVT. And what are those signs? Hot, red Swan pain, hot red sword. Are they gonna feel pain? Not all the time, but I mean, they won\'t, if they\'ve got this hands on where their injury is, right? I I know. So some of these patients get a temporary or permanent pacemaker, just can\'t live on an action major. It can go live, right? Because of this peripheral vasodilation, you have a reduction in Dan\'s return to the heart correct, which is going to decrease your cardiac output, and again, help with that hypotension that You\'re going to see, hypotension is managed with a vasopressor. You remember what drug we talked about? The scene with cardiac dysfunction? Which one did I say was used a lot, if there\'s I Nori, epinephrine. This is done in IC, right? Yes, please, don\'t ever do this on the floor. So we talked about they\'re at a decrease. They\'re at an increased risk for a DVT. So what are some interventions that we could help with that\'s slap them on there. Yeah, in order, right, yeah, right. Also make sure they don\'t already have a DVT, right? That\'d be bad, right? Somebody has an EBT, you put these SCDS on and what happens? It\'s gonna shoot up. You\'re gonna put that blood clot right in circulation. So please make sure that they are, that you haven\'t ordered and that you\'ve seen that they\'ve been cleared, right? They do use what\'s called gradient stockings. They\'re not tasting and stockings kind of like compression socks. You can get those different stretch levels, yes, yes. Squeeze effect, yes, depending on what the patient needs, right? With those sure you\'re doing your skincare right, completely. Take those off every eight hours. If somebody\'s, you know, having skin breakdown or something like that, you may need to adjust, but those Messies instead, it is also important to do range of motion exercises and stretching with these patients, obviously, once they\'re clear, but there\'s spinal injury and you can and again, these are often going to be passive range of motion. You\'re going to be doing this. PT, OT is going to be doing this. You want to make sure that they are cleared of having a blood clot. Okay, a lot of what you\'ll see is that both adults and. Ordered that low dose, and a lot of times they\'ll be on an oral anti flag event once they go home. What would be a contraindication of the starting or monoxide? I\'m sorry. I It\'s already what it\'s already on a blood thinner, right? Right? You want to make sure that there is no bleeding anywhere at first, right? Because almost anytime anybody gets admitted to the hospital, webinars, bad enough. What\'s the other one? Insulin. Insulin. Nurse is caring for a client who has a c4, spinal cord injury. The nurse should recognize the client is at greatest risk for which of the following complications, B, D, B, same. B, d is in dog right respiratory you stand your right with your face shot, but then we make eye contact, D respiratory compromise. Does anybody have a question about why that\'s right? But that\'d be one. No, you just, I mean, Charlie Thomas, I mean, we get we get serious. We spent what, like 10 minutes. I like these questions, right? Do you have these questions to say? No, no, they\'re not in our PowerPoint. They should come to class. They might one or two might look familiar. So next are your narrative functions these you\'re going to see a little bit more of right in your acute phase. What\'s the acute phase? First 24 those initials, right? So urinary retention is going to be common. I So during this acute phase, oftentimes, with your spinal shock and the bladder is going to be a tonic. What does that mean? Not not doing anything, it\'s going to be flaccid. It\'s like, I don\'t want to do anything right? Because you\'re going through that you\'ve lost all your bladder doesn\'t know, right? So you\'re not going to go to void. You\'re not going to void, right? Because it\'s not saying you\'re full. The functions that it takes to sink together for you to void are not sinking. So these people can get over distended bladders to where it goes back up into the kidney, and then you\'re dealing with other stuff, right kidney infections. A lot of times, every time you should see that these people have an indwelling catheter. It is so important that you are making sure that there are no kinks and no urine is coming out. What would be the first thing that you would think to do? You check for kinks, check for canes. I like it. Irrigate, bladder. Scan platter. Scan before you irrigate, right? And honestly, you never want to irrigate a Foley unless a doctor tells you never know. And the post acute phase, when the bladder is no longer a tonic blasted, it may become hyper irritable as those mechanisms again that need to talk and sync up, start to fry and sync up again. Does that make sense? So you. Have, it\'s called a loss of inhibition from the brain, and you can have that reflexive gain. So they\'re going from complete retention to with the hyper, irritable. They\'re just empty. They can\'t tell. They don\'t know. They can\'t control it. Are we going to keep a catheter in somebody that\'s in a post acute phase? No. I mean, if their skin breakdown, I\'m sorry, well, yes. But also, you want those systems to sync up as much as possible, right? If you have a black if you have a bladder, if you have a catheter in somebody\'s bladder, the splatter. Gonna want to sync those up, or it\'s gonna be like, All right, well, this is working, but we can put a column of cat on right. There are so many new technologies. Females have the pure wick, or whatever they\'re calling them these days, that we can keep them clean. So the big thing with these patients as well, they are going to need three to four liters of fluid just to keep again, keep that catheter in the shock phase, sorry, in that acute phase, to keep from getting an infection or anything like that, keep that urine moving and not just sitting in the water. Does that make sense? Bullies go in with a strict aseptic technique, correct sterile technique. Here. They do put an in dwelling catheter in as soon as possible after the injury, like I said, to keep from that over distension and that reflex back up into the kidney. I is sepsis a common problem with people with these type of spinal injuries, because their body can\'t tell when their bladder is full or anything like that. Like interventions. What hospital utopia? Yes, when everybody has that time, but like, I just didn\'t know if, like, if that was like, if it was common to see people that have had a spinal injury that aren\'t being taken care of appropriately? Like, to see sepsis a lot or not? I wouldn\'t necessarily say a lot, though, okay, right? Because a lot of times the spinal injuries, you\'re not even having an open wound, right? Unless you\'re getting stabbed or shot, which happens a lot more than But does that make sense, though? If you are appropriately taken care of and you know what needs to be managed depending on that injury, there really shouldn\'t be okay, like with the bladder, if you aren\'t taking care of it, you are going to see that back up into the kidney or a rupture of the bladder, right? And then you\'re going to have issues. But that would be on a hospital. Does that make sense? Yes, that\'s more something that could happen at home with, like, that\'s, yeah, that\'s what I was like. It\'s more of like at home. Like, do you see these people that go from like, being fine, and then their bladder fills up too much because their caregivers not paying attention or something, and they\'re not so not to put people in boxes, but like, you\'ll find a lot of people that go home are very well taken care of. Nursing homes. You\'ll see kind of like UTIs. UTIs are really big the respiratory and then again, where that injury is respiratory is going to be a really Big one you want to bring. Yes, please, 542 545. Okay, 545, Purpose. I just have to ask you one more sure. So if somebody has an injury at c4 everything below that is messed up, too, more than likely. So there\'s no way that they could have an injury at c4 and their legs still work. It depends on the injury. Right? Remember, when we\'re going to those incomplete injuries, it is a complete it\'s complete or a transaction, correct? Okay, they\'re gonna see if they\'re not gonna have arms or leg. Because I that\'s what I was trying to, like, distinguish. But I think they were talking about something different. I was like, okay, Christmas lights like you chop one light off, the rest of them don\'t work. I mean, they were thinking more of like the respiratory aspect, and you were going full lives, okay? So as long as it\'s complete, that means that everything below, no matter what it is, is not happening. But if it\'s a partial, they could potentially have with those Okay, since you are very important all of this with this, our Teacher is our teacher, you do Have? You do have also right on tonight, probably not okay, slides and we Will so was the last lecture 50 something. Just knowing slides. Well, I mean, you may have a little more that\'s back, but we will not get I hardly ever get through this entire literature, and I just feel like there\'s a lot so perfect, but we\'ve got that extra because they have spinal cord injury, stroke and then acute injury. Do so we have two more parts of lecture, night, Wednesday, day before Thanksgiving. No, no, okay, so we don\'t have to do the next week. You don\'t have lecture all next week. Wednesday, you don\'t have to come Wednesday is an institutional closing. Very excited. So Monday you have your ATI, yes, and then knock down the recipe, and then have a pick back up that. Oh, we will finish this, and then two weeks off the floor with that, yeah, but that\'s what I was saying. Like you have the longest amount kind of with this material that comes directly from me, because this is the hardest, and I don\'t have any, but we\'ve talked about moving it, but to move it to the beginning of the semester would be, well, I had The hardest material with less time, and now like the first part the speech is not we even talk about it, so we had a group meeting with Some students, and that was tension of doing ATI do is, yeah. This To get it\'s Fine, especially when we especially when you Get work, kids on Top of Everything, I You You. Thank anybody else wish for another break? You Good, Yeah, You ask the question I\'m just put you in, as long as you treat, teach correctly, a patient will often ask, because they do get overwhelmed when you\'re like, pulling on your show and all that stuff. They don\'t have to do it. Sterile, family gifts, right? Your body needs to know before make sense. No, like the reason why I used to do it that way is because I used to work for home health, and there was a chairman that he had to cut himself every few hours. And like, you know, he wouldn\'t wash his hands prior. And he was one of those. He was special needs, and he was with it enough to be able to do it himself. And instead of just like getting a new one or washing it properly, he would just run it under the sink and just throw some limb on it and empty his bladder and be done. So, yeah, yeah, I will tell you, unfortunately, you are going to see with people that are at home that that happens a lot, because insurance, depending on insurance, they don\'t believe that we can give and pay for so many Yeah, so it sucks. But again, that teaching like this is what you need to do if you\'re in the situation, this is what you need to do if you have to reduce your gather. I mean, honestly, I mean, that\'s unfortunately, the reality. And yes, it is the insurance worker. I can slip off that all day, but I\'m not going to. So the other thing with anybody that is on an intermittent PATH program, again, going off of that, you want to make sure, again, anybody involved in treatment is aware of the signs and symptoms of the urinary tract infection. Right? So neurogen bladder is used for any type of bladder dysfunction that is related to abnormal or absent bladder liquidation. Does that mean the bladder? Okay, so we were talking about initially the bladder is classic, correct? That initial shock. It\'s not working at all. We are going to have that. I indwelling catheter like we were talking about before, that person still has an a reflexive or flaccid bladder. That is who you\'re going to be teaching those intermittent cats too, right? This hyper, reflexic or spastic bladder, you\'re going to use a common cap, because, again, their bladder is working, right? There is some of that innovation going on between the brain and the bladder, and you don\'t want to take that away, okay, but you want them to stay clean, and you can use it on the cat a lot of times you don\'t want to use a diaper. Why do you want to use a diaper? Break down, skin breakdown. They often can\'t tell you if they\'re wet, right? It\'s just cleaner, more hygienic. I don\'t even they really were friendly upon diapers, terrible diapers, but in the hospital or at home, we can\'t have them any floor anymore, on our floor, yeah, hyper, intermittent flex use on for the flaccid one, for the flaccid one, you\'re going To teach intermittent cathing, and that\'s the initial stage of for difficulty. So if it seems like somebody is going to obtain that bladder innervation back, you want to, potentially, obviously, if they are cleared with everything else, put them on kind of a bladder training program, if they are able to again, spend level of injury, right and their ability to move, if they can get up and sit on a toilet bedside, or even sit them up in bed on a bedpan, do that. It sounds crazy, but the. What your body used to right? When was the last time you were laying in bed and you\'re like, Yeah, this is a good place to be, right? Can you relax? No, right? And that\'s part of helping to kind of get things coordinating and moving do. Sorry. So clients who have for remote injuries are often the ones that are going to develop that spastic bladder that you\'re going to use, those common calves, those that have lower motor neuron injuries will often develop That flaccid bladder where you\'re doing that intermittent capping. So So other than intermittent hacking, there are a lot of there are some other things that we can do. And along with that, is some drug therapy. Can you teach somebody to in and out cap themselves if they don\'t have upper extremity function? No, right? So there are some various drugs that can be used. Your anticholinergic are going to be your oxybutynin or your Ditra pan. Those are the same generic. That\'s the big one that I want you to know, and that drug suppresses the bladder contractions. Obviously, I will always, I think that that\'s like a little but I\'ll always use the generic and the anchor, and I\'ll oftentimes try and pronounce which I love. So your alpha or alpha alpha adrenergic blockers are going to be your terrorism or your hydrant. And these help relax the uro What do you think one of the anti spasmodic drugs are that are used that we\'ve talked about starts with B humanity facult, that is used as well to help decrease spasticity of those pelvic floor muscles or the bladder. You really want to evaluate any kind of long term indwelling catheters because of the high associated incidence of UTIs, but a lot of times, and why they really shied away from this is people get issuers, and that\'s and again, patients don\'t really know right if they don\'t have the ability To check themselves and they\'re not care. And again, anybody with that in Moline catheter is going to get three to four liters of fluids a day right to really help decrease that chance of any kind of an infection. I before you get out of bladder, you said a lower injury gets the spastic and then a higher injuries of plastic switch it. Your Higher injuries, motor neuron injuries are going to be your spastic and your lower classes. I think I just wrote it down backwards, and that\'s what I\'m supposed to use. I kept looking at it like that doesn\'t make sense. There are urinary diversion surgeries, if that is appropriate for a patient, they have those abdominal suprapubic, has anybody seen one of those super pubic those are used a lot as well, or not used a lot, but those are done as well again, depending on if that is what is. Best for the patient. A lot of the ones that I have seen have been on people who kind of figured around the middle, but with that independence, they can\'t self cast because they can\'t see so they\'ll do that.