Level 3 (Exam 4)- Spinal Cord Injury

Pathophysiology

what vertebra are mostly involved in spinal cord injuries

• C1-C5

• T12

• L1

Pathophysiology

What are the two types of spinal cord injuries

Rationale

• primary

• secondary

Rationale:

Primary- is direct physical trauma to the spinal cord

secondary- after a primary injury, the injury becomes on going and progressive

Manifestation

what are the symptoms of a spinal cord injury that develops into spinal shock

• ↓ DTR

• Spinal reflex and sensation

• flaccid apparency below the level of injury

Nurse intervention

A nurse is caring for a patient who has

HR: 54

TEMP: 97 at 11 am , 99 11:30 am, 100 at 12 pm

BP: systolic of 87

How should should the nurse interpret these findings and what should she do

Rationale:

these are signs of neurogenic shock and should contact the HCP

Pathophysiology

Why is a secondary spinal cord injury dangerous

Rationale:

edema can form within 24 hours and create permeant tissue damage

Which action should the nurse recognize has the highest priority for a patient who was admitted 16 hours earlier with a C5 spinal cord injury?

 

1. Assessment of respiratory rate and effort

2. Cardiac monitoring for bradycardia

3. Administration of low-molecular-weight heparin

4. Application of pneumatic compression devices to legs

Assessment of respiratory rate and effort

Edema around the area of injury may lead to damage above the C4 level, so the highest priority is assessment of the patient’s respiratory function

Manifestations

What type of paralysis can be noted if there is damage C4. C6, T6 areas of the spinal cord

• C4 = complete paralysis below the neck

• C6 = partial paralysis of hand and arms

• T6 = paralysis below the neck

Treatment

What medications can be given to pts who have low HR and low RR and have a spinal cord injury

atropine

Nurse Interventions

A nurse is caring for a spinal cord injury patient and is using a Halo Brace. What should the nurse to reduce the risk of infection

provide pin care everyday

Rationale:

the screws are entering the skull via the skin. Break in skin and bone integrity can lead to infections. Care is needed to prevent this

Pathophysiology

what is autonomic dysreflexia

a life threatening condition that can result from spinal cord injuries that affect T6 or higher

Risk Factor

Why is damage to the T6 area of the spinal cord important to understand the triggers of autonomic dysreflexia

Rationale:

T6 is the area of the CNS the sends and receives info to signal to the body of full bladders or bowel impactions.

Rationale:

Damage to the T6 causes the body to not feel when the bladder is full or the bowels are impacted. Full bladder or bowels is the biggest trigger for autonomic dysreflexia

Nurse Interventions

A nurse is caring for a patient who has a T6 spinal cord injury. The nurse take a BP of 160/ 88, HR of 34 and assess the patients bladder- the bladder is hard and distended upon palpation. What is the primary intervention (3 steps)

Rationale:

1. raise the HOB 45'

2. Contact the HCP

3. Do a straight catherization

Rationale:

Damage to the T6 causes the body to not feel when the bladder is full or the bowels are impacted. Full bladder or bowels is the biggest trigger for autonomic dysreflexia. A straight catherization with remove the built up urine reducing the risk that comes with a full bladder.

A BP of 20-40 mm Hg above the baseline + bradycardia (30-40 bpm) + full bladder = autonomic dysreflexia S/S