SCI & Peripheral Nerves

SCI Primary v. Secondary Injury?

• Primary → initial phase = disruption of spinal cord

• Secondary → ongoing progressive damage following initial injury

  • Starts within minutes, can last for months

Underlying SCI complications patho?

Glial & nerve cells injured → interrupted blood supply to SC → inflammatory cellular responses → additional damage to SC → further inflammation → SC cannot protect itself

SCI secondary injury timeline?

• 24 hours → permanent damage (edema)

• 72 hours → extent of damage determined

• Weeks → apoptosis of increased rate

• 3-6 months → greatest improvement

Define Spinal Shock (study guide)

Loss of reflexes and sensation below the level of the spinal cord injury

Spinal Shock region + characteristics + duration

Region: Any area of SC

Characteristics: Decreased reflexes (motor), loss of sensation (sensory), flaccid paralysis below injury, occurs in predictable stages (can be reversible)

Duration: Normally transient and occurs 30 minutes after injury

Define Neurogenic Shock (study guide)

Loss of SNS innervation

Neurogenic Shock region + characteristics + duration

Region: T6 or higher

Characteristics: Hypotension, bradycardia, temperature dysregulation, loss of vasomotor tone (THINK LOW!)

Duration: Occurs within 30 minutes of injury and can last up to 6 weeks after

3 ways to classify SCI?

• Mechanism of injury

• Level of injury

• Degree of injury

Tetraplegia v. Paraplegia spinal levels?

• Tetraplegia: C1 to T1 → lower = more arm functionality

• Paraplegia: Below T2

Complete v. Incomplete SCI?

• Complete: Total loss of sensory & motor function below injury

• Incomplete: Mixed loss of voluntary motor activity & sensation

What level do respiratory issues occur with SCI?

• C3 & above = total loss respiratory function

  • Below C3 & thoracic = decreased chest & abdominal wall strength → increased pneumonia, aspiration risk

What level do CV injuries occur with SCI?

• T6 & above → SNS dysfunction → neurogenic shock → hypotension & decreased CO

Common urinary system dysfunction with SCI?

Neurogenic bladder →

• Flaccid bladder (utilize foley)

• Spastic bladder (in/out cath, scans)

• Dyssynergia (pyelonephrosis risk)

Underlying cause of poikilothermism with SCI?

• Interruption of SNS + decreased ability to sweat or shiver below injury level

Drug therapy for SCI?

• Low-meolecular-weight-heparin (DVT risk)

  • Muscle spasms → baclofen

  • Bladder spasms → oxybutynin

Bowel & bladder management for SCI?

• Bowels: Toileting schedule, upright positioning, rectal stimulants

• Bladder: Catheters, antispasmodics/anticholongerics/a-adrenergics

Integumentary management for SCI?

• Careful positioning & repositioning

  • Bed Q2

  • Chair Q15-30min

  • Barrier creams/films

Define Trigeminal Neuralgia

Chronic pain condition that causes sudden, severe, electric shock-like or stabbing pain in the face

Define TN1 vs. TN2

TN1: Abrupt onset but brief duration, waves of excruciating pain (Tic Douloureux)
TN2: Constant aching but lower intensity than TN1

Drug therapy for Trigeminal Neuralgia? (3)

• Antiseizure (TN1) → carbamazepine, oxcarbazepine

• Tricyclic antidepressants (TN2)

• Analgesics + opioids (TN2)

Trigeminal Neuralgia percutaneous procedures? (3)

• Glycerol Injection/Rhizotomy

  • Sterile glycerol to block nerve pain

• Balloon Compression

  • Balloon put pressure to block nerve pain

• Radiofrequency Therapy Lesioning

  • Needle w/ electrical current to destroy nerve & block pain

Trigeminal Neuralgia surgical procedures? (2)

• Microvascular Decompression

  • Remove/relocate BVs compressing trigeminal nerve, long-lasting immediate relief

• Gamma Knife Radiosurgery

  • Utilize radiation, months for pain relief

Nursing Management for Trigeminal Neuralgia?

• Know triggering factors

• Protect face against drafts/extreme temps (eye shield)

• Chew on the unaffected side

Define Bell’s Palsy

Acute, temporary unilateral lower facial paralysis/weakness affecting CN VII, often caused by a viral infection

Bell’s Palsy diagnostics?

• No definitive testing

  • MRI/CT scan to rule out other paralysis causes

Bell’s Palsy Medications? (3)

• Corticosteroids

• Acyclovir

• Mild analgesics

Bell’s Palsy management?

• Protect affected eye

  • Eye drops/shield

• Drink from unaffected side

• Good nutrition + oral hygiene

Define Guillain-Barre Syndrome

Acute, rapidly progressive post-infectious polyneuropathy with bilateral upwards paralysis

Key manifestations of Guillain-Barre syndrome

• Muscle weakness + numbness/tingling, incontinence

• Abnormal BP, tachycardia, respiratory complications

• Sweating abnormalities, dysphagia

Key assessments for Guillain-Barre syndrome?

• Neuro

• Respiratory

• Motor + Sensory

• Vital signs