Moblity

Meds

Muscle relaxants

Baclofen

Indications: Spasticity r/t spinal cord injury, cerebral palsy, MS

MOA: Enhances GABA in CNS to reduce muscle spasticity

SE: Drowsiness, nausea, constipation

PT: Increase fiber and fluid intake

If you have a back injury that causes spinal cord damage, you might need baclofen for muscle spasms.

Anticonvulsants

Gabapentin

Indications: Neuropathy, fibromyalgia, restless leg syndrome, seizures

MOA: Inhibits excitatory neuron activity

SE: Dizziness, drowiness, dry mouth, edema, potiental for abuse

PT:Avoid alcohol. Discontinue gradually

Antidepressants

Trazodone

Indications: Depression, insomia

MOA: Serotonin antagonist and reuptake inhibitor

SE: Sedation, hypotension, dry mouth

PT: Avoid alcohol, use hard candy or gum for dry mouth

Trazadone helps me get some ZZZ’s.

Amitriptyline

Indications: Depression, neuropathy, fibromyalgia, anxiety, insomnia

MOA: Increases effect of serotonin and norepinephrine in CNS

SE: Sedation, orthostatic hypotension, antichdinergic effects (Urinary retnetion, constipation, dry mouth, increase HR, photophobia) arrhymias, sweating, seizures

Amy tripped over tricycle in the desert. It is dry in the desert, like the anticholinergic effect of the trycyclic amitiptyline

NSAIDS

Ibuprofen

Indications: Mild to moderate pain, fever, inflammation

MOA:Analgesia by decreasing inflammation

Contraindications: Pregnancy, peptic ulcer, disease (PUD), bleeding disorder

SE: GI upset, nephrotoxity

GI bleeding, ulceration, peforation. Increase risk of cardiovascular thrombotic events (MI, stroke)

Interactions: corticosteroids, alchol (concurrent use increase risk of GI bleed)

Naproxen sodium

Indications: Mild to moderate pain, fever, inflammation

MOA:Analgesia by decreasing inflammation

Contraindications: Pregnancy, peptic ulcer disease (PUD), bleeding disorder

SE: GI upset, nephrotoxity

GI bleeding, ulceration, peforation. Increase risk of cardiovascular thrombotic events (MI, stroke)

Interactions: corticosteroids, alchol (concurrent use increase risk of GI bleed)

Narcotics

Indications: Moderate to sever pain, promotion of sedation

MOA: Binds to opioid receptors in the CNS

SE: Sedation, GI upset (especailly constipation), hypotension, urainry retntion

x: Life threatin Respiratory depresion, addiction, avuse, neonatal opiooid withdrawl syndrome

NC: Monitor pain level, VS, respiratory status, adminster naloxone fore overdose. Naloxone reverses analgesia and causes immdeiate withdrawl (increase BP & HR, agiation).

PT: Fluid and fiber intake

You may need to RUSH to give NALOXOMNE to your pt in response to REspiratory depresion, Urinary retention, Sedation, Hypotension

Oxyxodone

Indications: Moderate to sever pain, promotion of sedation

MOA: Binds to opioid receptors in the CNS

SE: Sedation, GI upset (especailly constipation), hypotension, urainry retntion

x: Life threatin Respiratory depresion, addiction, avuse, neonatal opiooid withdrawl syndrome

NC: Monitor pain level, VS, respiratory status, adminster naloxone fore overdose. Naloxone reverses analgesia and causes immdeiate withdrawl (increase BP & HR, agiation).

PT: Fluid and fiber intake

You may need to RUSH to give NALOXOMNE to your pt in response to REspiratory depresion, Urinary retention, Sedation, Hypotension

Morphine

Indications: Moderate to sever pain, promotion of sedation

MOA: Binds to opioid receptors in the CNS

SE: Sedation, GI upset (especailly constipation), hypotension, urainry retntion

x: Life threatin Respiratory depresion, addiction, avuse, neonatal opiooid withdrawl syndrome

NC: Monitor pain level, VS, respiratory status, adminster naloxone fore overdose. Naloxone reverses analgesia and causes immdeiate withdrawl (increase BP & HR, agiation).

PT: Fluid and fiber intake

You may need to RUSH to give NALOXOMNE to your pt in response to REspiratory depresion, Urinary retention, Sedation, Hypotension

Hydrocodone

Indications: Moderate to sever pain, promotion of sedation

MOA: Binds to opioid receptors in the CNS

SE: Sedation, GI upset (especailly constipation), hypotension, urainry retntion

x: Life threatin Respiratory depresion, addiction, avuse, neonatal opiooid withdrawl syndrome

NC: Monitor pain level, VS, respiratory status, adminster naloxone fore overdose. Naloxone reverses analgesia and causes immdeiate withdrawl (increase BP & HR, agiation).

PT: Fluid and fiber intake

You may need to RUSH to give NALOXOMNE to your pt in response to REspiratory depresion, Urinary retention, Sedation, Hypotension

MOA: Binds to opioid receptors in the CNS

Devices

Halo external fixation device

Spinal traction

Physical Therapy

Speech Therapy

Occupational Therapy

Body systems

Perfusion

Gas Exchange

comfort/rest

Nutrition

Tissue integrity

Elimination

Intracranial

Fractures

Tractions

Halo traction: Do NOT apply pressure to rods. Ensure wrench/screwdriver are attached to vest to release pt for emergency

Compartment Syndrome

Spinal Cord Injury (SCI) (Adult)

Complete: Damage results in loss of all innervation below the level of injury

Incomplete: Preservation of some function below the level of injury

Neurogenic shock (above T6): Spinal cord injury causes loss of sympathetic nervous system activity, with unopposed parasympathetic response which leads to Hypotension, bradycardia, flushed/warm skin (instable thermaregulation).

Tx: IV fluids, vasopressors, atropine

Nursing care: Stabilize spine, maintain patent airway, monitor vital signs

Montior for complications: Hemorrhage, neurogenic shock, autonomic dysreflexia

Urinary catheterization, initatiate bowel program (stool softeners, toileting schedule)

Reposition pt regulary to prevent pressure injuries

Spina Bifida (Peds) (Neural tube defect of the spine and spinal cord)

Spina Bifida: Incomplete development and closure of the neural tube, leading to spinal cord and nerve vulnerability/damage cuased by insufficient folic acid intake during pregnancy, maternal diabetes, maternal drug use

Labs

Prenatal: Ultrasound, increase alpha-fetoprotein (its in the yolk sac and kindey) then it means you have spinal bifida

Postnatal: X-ray, CT, MRI

Tx: Early surgical closure of defect

NC: Protect exposed cyst prior to surgery. Cover sax with sterile, saline-moistened, non-adherent dressing. Place infant in prone position with hips flexed. Avoid pressure on sac.

FT: Provide education on complications (hydrocephalus, increase risk of latex allergies, increase risk of pressure injuries and burns due to lack of sensation, bladder dysfunction requiring intermittent catheterization, increase risk of fractures)

Spina Bifida Occulta: No herniation (skin covers malformation). Abnormal tuft of hair, dimple, and/or birthmark at site of defect

Meningocele: Protrusion of cyst with meninges and CSF

Myelomeningocele: Protrusion of cyst with meninges, CSF, and spinal cord

Autonomic Dysreflexia (SCI) (t6)

Autonomic dysreflexia: Stimuli below the level of the SCI (e.g. distended bladder) initiates a sympathetic response, resulting in vasoconstriction and increases BP. Parasympathetic nervous system is unable to compensate

S/S: Extreme hypertension, severe headache, blurred vision, diaphoresis. Flushing above level of injure d/t vasodilation. Cool, pale skin below level of injury d/t vasoconstriction

Tx: Adress underlying cause, antihypertensives

NC: 1st priroty sit the pt up, notfiy provider, loosen restrictive clothing, adress underlying cause (e.g., distended bladder, fecal impaction) Administer antihypertensives, monitor BP.

Monitor BP 2 to 5 minutes

FAT EMBOLSIM (searchup)

Incentive spritometer how to use

Sit up straight

Exhale completly

Put lips completly on mouthpiece

Inhale slowly

Hold breath for 2-3 seconds

Take a resperiods and repeat 10 times per hr

unalateral breathing one lung is collapased one lung is rsing

unsympetircal is frail chest

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