Mobility pwrpt study guide

Common Causes of SCI

MVCs, falls, violence, sports injuries, arthritis, tumors, infection, disk degeneration.

Mechanisms of Injury (MOI)

Hyperflexion, hyperextension, axial loading/compression, rotation, penetrating injury.

Complete SCI

No motor or sensory function below level of injury.

Incomplete SCI

Some motor/sensory function remains below injury.

Paraplegia

Paralysis of lower body.

Quadriplegia / Tetraplegia

Paralysis of all four limbs.

Initial Emergency Care

ABCs, immobilize spine, rigid collar/backboard, neuro exam, prevent further injury.

Diagnostic Tests for SCI

X-ray, CT, MRI, ABG, CBC, CMP, UA, full neuro exam.

Common Medications in SCI

Corticosteroids, vasopressors, atropine, PPIs/H2 blockers, anticoagulants, analgesics, baclofen, gabapentin.

Spinal Shock (Primary Injury)

Temporary loss of motor, sensory, and reflex activity below injury. Flaccid paralysis, areflexia, hypotension, ileus.

Neurogenic Shock (Secondary Injury)

Loss of sympathetic tone → hypotension + bradycardia (distinguishes it from hypovolemic shock).

Autonomic Dysreflexia (Emergency)

Sudden HTN, headache, bradycardia due to stimuli (full bladder, fecal impaction, tight clothing).

Autonomic Dysreflexia – Nursing Actions

Sit patient upright, identify/remove cause, empty bladder/bowel, loosen clothes, give hydralazine/nitro, label chart “High Risk.”

Rehabilitation Focus

Maximize independence, prevent pressure injuries, bowel/bladder training, sexuality education.

Mild TBI (Concussion)

Short LOC, confusion, dizziness, headache, may have lasting effects.

Moderate TBI

LOC

Severe TBI

LOC >6 hrs, unequal pupils, seizures, coma, high mortality.

When to Seek Care

Persistent headache, vomiting, slurred speech, seizures, LOC, or symptoms lasting >10 days.

Contusion

Brain bruising; LOC >30 min, edema; caused by blunt trauma or coup-contrecoup injury.

Epidural Hematoma

Arterial bleed between skull & dura; rapid decline; surgical emergency.

Subdural Hematoma

Venous bleed under dura; acute (24–48h) or chronic (weeks).

Subarachnoid Hemorrhage

Bleeding under arachnoid; “worst headache of my life.” Emergency.

Intracerebral Hematoma

Bleeding within brain tissue; caused by HTN, trauma, AV malformation.

Normal ICP

0–15 mmHg.

Increased ICP (IICP)

>20 mmHg = emergency; ↓ perfusion → ischemia.

Cushing’s Triad (Late Sign of IICP)

↑ systolic BP/widened pulse pressure, ↓ HR (bradycardia), irregular respirations.

Nursing Interventions for IICP

HOB 30°, neutral neck, avoid hip flexion, frequent neuro checks, strict I&O, prevent fever, monitor ICP.

Mannitol

Osmotic diuretic; decreases brain swelling by drawing fluid into bloodstream.

Furosemide (Lasix)

Loop diuretic; enhances mannitol’s effect, reduces edema and CSF production.

Nimodipine

Calcium channel blocker; controls BP and prevents vasospasm.

Phenytoin (Dilantin)

Prevents seizures post-TBI.

Barbiturate Coma (Pentobarbital)

Decreases cerebral metabolism and ICP.

Cushing’s Triad Significance

Indicates brainstem compression → herniation risk.

Airway & Oxygenation

Maintain ventilation, suction with caution, monitor ABGs.

ICP Monitoring Contraindications

Anticoagulant use, bleeding disorder, scalp infection, brain abscess.

Prevent Secondary Injury

Avoid hypoxia, hypercarbia, hyperthermia.

Positioning

Head midline, avoid neck flexion, elevate HOB 30°.

Hydration

Strict I&O; avoid hypo/hypervolemia.

Psychosocial Considerations

Depression, anxiety, role change, family stress; encourage support and rehab.

Parkinson’s Pathophysiology

Progressive neurodegenerative disorder caused by loss of dopamine-producing neurons.

Neurotransmitter Imbalance

↓ Dopamine, ↑ Acetylcholine → impaired movement control.

Four Cardinal Symptoms

Tremor, muscle rigidity, bradykinesia, postural instability.

Masklike Face (Hypomimia)

Reduced facial expression; typical of Parkinson’s.

Other Symptoms

Shuffling gait, stooped posture, monotone voice, dysphagia, depression.

Diagnostic Findings

No specific lab; based on symptoms and med response (Levodopa).

Medication Therapy

Levodopa/carbidopa (Sinemet), anticholinergics, dopamine agonists.

Dietary Needs

High fiber, soft foods, ↑ fluids; small frequent meals; avoid protein near med times.

Mobility Support

ROM exercises, PT/OT, assistive devices.

Surgical Treatments

Deep brain stimulation, pallidotomy, thalamotomy to improve movement.

Interprofessional Collaboration

PT, OT, speech therapy, home health, support groups.

Patient Education

Fall prevention, med adherence, energy conservation, coping strategies.

Corticosteroids

Methylprednisolone – reduce inflammation in SCI/TBI.

Vasopressors

Dopamine, norepinephrine – maintain BP.

Anticonvulsants

Phenytoin – prevent seizures.

Antispasmodics

Baclofen – reduce spasticity.

Analgesics/Opioids

Morphine, tramadol – pain control.

PPIs/H2 Blockers

Pantoprazole, famotidine – prevent ulcers.

Anticoagulants

Heparin, warfarin – prevent DVT/PE.

Sedatives

Propofol, lorazepam – control agitation, sedation.

SCI Meds

Corticosteroids, vasopressors, anticholinergics, anticoagulants, muscle relaxants, pain meds.

TBI Meds

Osmotic/loop diuretics, anticonvulsants, sedatives, barbiturates, PPIs, calcium channel blockers.

Parkinson’s Disease Meds

Dopaminergic agents (Levodopa), anticholinergics, MAO-B/COMT inhibitors, dopamine agonists.