Central Nervous System: Spinal Cord - Flashcards

Flashcards covering concepts of care for patients with problems of the central nervous system, including Multiple Sclerosis, Spinal Cord Injury, Low Back Pain, and Cervical Neck Pain, based on lecture notes.

What is Multiple Sclerosis (MS)?

A chronic autoimmune inflammatory disease with no cure that progresses over time.

What are the key pathological processes occurring in MS?

Demyelination and axonal injury.

What forms in the white matter of the CNS in MS?

Plaques.

What effect do MS plaques have on electrochemical transmission?

Slowed or stopped electrochemical transmission of impulses between the brain to the spinal cord and body.

How does MS typically progress in terms of symptoms?

It goes in exacerbations and remissions that get shorter over time.

What is a potential ultimate outcome of severe MS?

Quadriplegia.

Which type of MS is the most common?

Relapsing-remitting MS.

How is Relapsing-remitting MS characterized?

By relapses (exacerbation) and periods of remission back to baseline.

How is Primary progressive MS described?

Gradual progression with no remissions.

How is Secondary progressive MS described?

Initial relapsing-remitting course followed by gradual worsening of the disease.

How is Progressive-relapsing MS described?

Progressive with gradual worsening of signs and symptoms, and relapses may or may not have recoveries (not back to baseline).

What neurological condition can MS symptoms resemble, making diagnosis difficult?

ALS (Amyotrophic Lateral Sclerosis).

What are the three components of Charcot's Neurologic Triad in MS?

Intention tremor, dysarthria, and nystagmus.

What is dysarthria?

Difficulty speaking.

What specific brain areas, when affected by plaques, can lead to dysarthria and dysphagia in MS?

Plaques on the brainstem.

What are intention tremors?

Tremors that occur during movement (not resting).

What causes intention tremors, muscle weakness, spasms, and ataxia in MS?

Plaques along motor pathways.

What is ataxia?

Decreased motor coordination.

What is nystagmus?

Involuntary rapid eye movements.

What causes nystagmus, vision loss, optic neuritis, and diplopia in MS?

Plaques in optic nerves.

What is diplopia?

Double vision.

List some mental or cognitive changes associated with MS.

Decreased concentration, attention deficit, memory loss, impaired judgment, inability to perform calculations, inattentiveness.

What psychological symptoms are commonly observed in MS patients?

Depression and unstable mood.

What sensory changes can occur in MS?

Loss of sensation, numbness, tingling, and prickling pain.

What common bladder and bowel dysfunctions are observed in MS?

Bladder and bowel dysfunction.

What CSF findings are indicative of MS?

Elevated proteins (oligoclonal bands) and increased WBCs.

What specific proteins and immunoglobulins are increased in CSF electrophoresis for MS diagnosis?

Myelin basic protein and immunoglobulins, especially immunoglobulin G (IgG).

What diagnostic imaging is used to show plaques in at least two areas of the brain and spinal cord for MS diagnosis?

MRI of the brain and spinal cord.

What evoked potential test is used to assess for issues along visual pathways due to MS?

Visual evoked response (VER).

What is a priority problem for an MS patient related to drug therapy and immune function?

Impaired immunity due to MS and drug therapy for disease management.

What is a priority problem for an MS patient related to physical function?

Decreased or impaired mobility due to muscle spasticity, intention tremors, and fatigue.

What is a priority problem for an MS patient related to neurological function?

Decreased visual acuity and cognition due to dysfunctional brain neurons.

What class of medications reduces inflammation and modulates immunity in MS, posing a risk for infection?

Immunomodulators or anti-inflammatories.

Name a common immunomodulator medication used for MS.

Interferons (e.g., Interferon beta-1a, Interferon beta-1b).

What is glatiramer acetate used for in MS?

It is a myelin-similar synthetic protein used as an immunomodulator.

What is mitoxantrone used for in MS?

An antineoplastic anti-inflammatory drug.

What is a serious risk associated with Natalizumab, an IV monoclonal antibody used for MS?

Progressive multifocal leukoencephalopathy (PML), which can lead to brain death or severe disability.

Name two oral immunomodulators for MS mentioned.

Fingolimod, teriflunomide, or dimethyl fumarate.

What complementary therapy for MS can reduce pain, muscle stiffness, and spasticity but may negatively affect cognitive symptoms?

Medical marijuana.

What therapies are recommended to improve mobility in MS patients?

Physical Therapy (PT), Occupational Therapy (OT), and Speech-Language Pathology (SLP).

What medications are commonly used to treat muscle spasticity in MS?

Baclofen or tizanidine.

What strategy helps manage fatigue for MS patients who combine group care with individual activities?

Allow for rest periods.

How can diplopia be managed in an MS patient?

Using an eye patch.

How can patients with peripheral vision issues due to MS compensate for them?

By turning their head side to side to scan.

How can cognition issues in MS be managed at home?

Using single date calendars, lists, recorded messages, technology for reminders and cues, and keeping frequently used items close by.

List some complementary therapies for MS symptom management.

Reflexology, massage, yoga, relaxation and meditation, acupuncture, aromatherapy.

What environmental or behavioral triggers should MS patients avoid?

Overexertion, stress, hot temperatures (fever, hot tubs, chills), humidity, crowds, people who are sick.

What is an expected outcome for an MS patient regarding immunity?

Remains free of infection as a result of drug therapy affecting immunity or disease process.

What is an expected outcome for an MS patient regarding mobility?

Maintains optimal mobility and function as a result of managing fatigue and pain.

What is an expected outcome for an MS patient regarding visual acuity and cognition?

Maintains adequate visual acuity and cognition to function independently.

What is a complete spinal cord injury?

Total loss of sensory and motor function below the level of the injury.

What is an incomplete spinal cord injury?

Mixed functions of sensory and motor are still working below the level of the injury.

What age group and gender have the highest risk factors for SCI?

Males aged 16-18.

What is the leading cause of spinal cord injuries, accounting for 56%?

Automobile accidents.

What type of injury mechanism causes sudden and forceful acceleration of the head forward, leading to extreme neck flexion?

Hyperflexion.

What type of SCI mechanism occurs when the head suddenly accelerates and then decelerates, stretching or tearing anterior ligaments?

Hyperextension.

What SCI mechanism involves a blow to the top of the head or landing directly on the buttocks or feet from a height?

Axial loading or vertical compression.

What type of SCI mechanism is caused by injuries that involve turning the head beyond the normal range?

Excessive rotation.

How do low-impact penetrating traumas (e.g., knife wounds) differ from high-impact ones (e.g., gunshot wounds) in terms of damage?

Low-impact causes local damage, while high-impact causes both direct and indirect damage.

What is a secondary spinal cord injury?

An injury that worsens the primary injury through mechanisms like hemorrhage, ischemia, hypovolemia, impaired tissue perfusion from neurogenic shock, or local edema.

What are the clinical manifestations of a high cervical spinal cord injury (e.g., C3-5)?

Partial or complete quadriplegia (tetraplegia), ventilator dependence, loss of all four extremities, loss of bowel and bladder control, alteration in sexual function, and autonomic dysreflexia.

Why do C3-5 spinal cord injuries often require ventilator support?

These injury levels innervate the phrenic nerve controlling the diaphragm.

What are the clinical manifestations of a thoracic spinal cord injury?

Partial or complete paraplegia, loss of bowel and bladder control, alteration in sexual function, and loss of control of lower extremities and/or lower trunk.

At what thoracic level or above can autonomic dysreflexia occur in SCI patients?

T6 or above.

What is the priority assessment for any trauma patient, including those with SCI?

Assessing airway, breathing, and circulation (ABC).

What is spinal shock?

A temporary condition immediately after SCI characterized by loss of sensation, flaccid paralysis, absent DTRs, and loss of reflexes below the injury level.

How does spinal shock differ from neurogenic shock?

Spinal shock is a temporary loss of reflexes and motor/sensory function, whereas neurogenic shock is a distributive shock due to ANS disruption, causing hypotension, bradycardia, and temperature instability.

How is the end of spinal shock indicated?

Return of reflex activity below the level of injury.

What specific neurological assessment confirms the level of sensory function in an SCI patient?

Evaluation of the dermatomes.

What vital sign control is crucial after SCI to prevent secondary injury?

Blood pressure control.

What cardiovascular symptoms might occur with injuries at T6 and above due to autonomic nervous system disruption?

Low pulse, temperature, blood pressure, and dysrhythmias; reduced cardiac output.

What combination of signs could indicate neurogenic shock requiring immediate action?

SPO2 < 95%, symptoms of aspiration (stridor, inability to clear airway), symptomatic bradycardia, reduced LOC, decreased urine output, SBP < 90 mmHg, or MAP < 65 mmHg.

How is neurogenic shock typically treated?

Intubation, IV fluids (isotonic crystalloids), and IV vasopressors (e.g., norepinephrine, dopamine, dobutamine); IV colloids.

What are common GI complications after SCI, specifically regarding bowel function?

Ileus to the gut and hypotonic bowel (never fully empty).

What GU complication is common after SCI due to an areflexic bladder?

Urinary retention.

What is a Halofixator with a hard vest used for in SCI management?

Immobilization of the patient.

What technique is crucial for maintaining body alignment during repositioning of an SCI patient?

Log rolling.

What are Gardner-Wells tongs used for in SCI?

Skeletal traction for cervical spine immobilization.

What are Harrington rods commonly used for in SCI surgery?

Spinal fusion to stabilize the spine.

What is a critical safety rule for moving a patient with a Halo device?

NEVER hold onto the device to move the patient!

What should the nurse do if screws on a Halo device appear loose?

NEVER adjust the screws; report any sign of loosening to the provider immediately.

What emergency item should always be taped to the patient's vest with a Halo device?

The emergency wrench for easy access.

What is the significant risk of neglecting pin site infections with a Halo device?

Osteomyelitis of the skull.

What is autonomic dysreflexia?

A life-threatening syndrome affecting the sympathetic nervous system without a compensatory response by the parasympathetic nervous system.

What is the primary concern if autonomic dysreflexia is left untreated?

Hypertensive stroke.

At what level of injury does autonomic dysreflexia commonly occur?

At or above T5-T6.

What are common causes of autonomic dysreflexia?

GI or GU origin, such as urinary retention, kinked catheter, UTI, renal stone, fecal impaction, or pressure injuries.

What are key features or signs and symptoms of autonomic dysreflexia?

Sudden rise in BP with low pulse rate, sweating, flushing, goosebumps above the level of injury, blurred vision, severe headache, anxiety, and apprehension.

What is the #1 priority nursing action for a patient experiencing autonomic dysreflexia?

Put the patient in a sitting position or raise the head of the bed to help reduce pressure to the brain.

Beyond positioning, what is the next critical step in managing autonomic dysreflexia?

Find and remove the cause (e.g., check for urinary retention, kinked catheter, fecal impaction, or pressure injuries).

What medications may be given to help lower blood pressure during an autonomic dysreflexia event?

Nifedipine or nitrates.

What is an expected outcome for an SCI patient regarding cardiovascular events?

Does not experience a cardiovascular event (shock, hemorrhage, autonomic dysreflexia) or receives prompt treatment if an event occurs.

What is an expected outcome for an SCI patient regarding mobility?

Performs mobility skills and basic ADLs as independently as possible with or without the use of assistive/adaptive devices.

What are common causes of acute low back pain?

Muscle strain or spasm, ligament sprain, osteoarthritis, disk herniation, or spinal stenosis.

What is considered the #1 treatment for low back pain?

Prevention.

What are some nonpharmacological methods for treating low back pain?

Massage, spinal manipulation, acupuncture, heat, and the Williams position.

What traditional pain reliever is generally preferred over acetaminophen for low back pain if not contraindicated?

NSAIDs.

What is Ziconotide, and how is it administered for severe low back pain as a last resort?

It is an intrathecal spinal infusion with an implanted pump.

What post-operative care technique is crucial after back surgery like a laminectomy or fusion to maintain spinal alignment?

Logrolling.

What are general post-operative precautions for a patient after back surgery?

Limit stair climbing, restrict or limit driving, no lifting anything over 5 lbs, avoid bending and twisting at the waist, take daily walks, and do PT exercises.