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65 Cards in this Set
- Front
- Back
What does tetraplegia mean?
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injury that affects all 4 limbs *legs and arms*
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Instead of the word tetraplegia, the USA uses?
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quadraplegia
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Paraplegia means what?
What are the 2 types? |
Loss of function in lower extremities
Complete-loss of all function at level all the way down Parially-nerve level from injury down is partially affected **males more affected, ages 16-30 |
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What are the most common causes of spinal cord injuries?
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Car accidents
falls violence sports |
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What are the first vertebrae to last?
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1st-cervical disk, rests on 2nd-damage at this level is extremely serious
2nd-cervical 12 thoracic 5 lumbar sacrum coccyx |
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What functions a spinal cord injury pt has depends on?
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The level of injury
The nerves that are truly involved is what actually kind of injury a pt has, not the bone structure. |
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An injury at C1-C8 has what type of injury and considered what?
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Tetraplegia- none or impaired use of arms and legs
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What injury does a pt have if it occurs T1-S2?
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Paraplegia- complete use of arms, none/impaired use of legs
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If an injury is at S1-S5, what is impaired?
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Impaired bowel/bladder and sex function
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If a pt has an injury about C4, usually on?
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ventillator, cant use arms hands
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If injury is at C5?
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Deltoid/biceps can be used now
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If injury is at C7?
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Pt can use triceps-arms dont flop
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C8-T1, here a pt can have hands back, so they can?
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push their own wheelchair
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If they have C6 wrist extensors, they can?
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grab things
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a complete injury vs incomplete means?
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Total vs partial loss of muscle control and sensation below level of injury
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What would you use the spinal dermatones for?
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where dr. truly measures functional ability- sensations and motor function
EXACT true level of injury |
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If a pt has a cauda equina injury, what will be the results?
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only the nerves from S1 to S5 are damaged.
Bowel Bladder Sex dysfunction ONLY NO motor deficts |
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Anterior cord syndrome usually leads to ?
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Front of cord is damaged.
Impaired ability to sense pain Temp/touch lost below level of injury Complete paralysis below injury May preserve pressure and joint sensation MOST COMMON W/FLEXION INJURIES |
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What is central cord syndrome?
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Damage to center of spinal cord. More paraylsis in arms than legs-tough.
May preserve bowel/bladder Most common in : hyperextension, spinal stenosis. |
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What is Brown-sequard syndrome?
How might someone get it? |
damage is on 1side of spinal cord.
Impaired loss/movement to innjured side, but can usually feel pain and temperature Opposite side: normal movement, pain and temperature sensations impaired. How? gunshot wound, stabbing, T bone accident |
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What is posterior cord syndrome?
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Damage to back of spinal cord.
Good muscle power, pain, and temperature sensation Problems with coordination of movements Motor weakeness below level of injury |
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What are the most common assessment findings of spinal cord injury pts?
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1. pt will have low BP!!! (60/40, 90/60) This is ok.
2. Bradycardia 3.Dependent edema cause they do not have the muscle tone to bring back the fluid ** when they are supine, fluid is absorbed* 4. Neuropathic pain 5. temperature intolerance -cant constrict and dialate 6. weakened and impaired cough 7. rounded ABD, quad belly-lost muscle tone 8. spasticity- in muscles |
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TEMPERATURE intolerance is a huge problem in spinal cord injury pts. Why?
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SCI pts loose ability to sweat, shiver, vasodilate or vasoconstrict.
If room is cold, they are cold, room is warm, they are warm. They are at constant risk for hypo or hyperthermia! |
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What are the s/s of a Spinal cord injury pt experiencing hyperthermia?
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HA
Confusion nasal congestion |
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What can we do for our hyperthermia pt?
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cold wet towel, wrapped around the back of the neck
Ice to groin and axilla Skin should be damped down to allow water to evaporate (like sweat) Loosen clothing |
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What are the s/s we would see in our spinal cord injury pt experiencing hypothermia?
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Shivering above level of injury, discolored skin, HA, decreased level of conciousness.
More clothes blankets, down comforters, flannel sheets *External heat sources- be careful-- risk for burns is high, so heating pads and blankets is not recommended |
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If pt has spinal cord injury at C3-C5, what is affected respiratory wise?
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Diaphragm-inspiration
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If pt has spinal cord injury at C2-C3, C5-C8 what is affected respiratory wise?
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Accessory muscles -inspiration
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If pt has spinal cord injury at T1-T7, what is affected respiratory wise?
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Intercostal muscles-inspiration, expiration
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If pt has spinal cord injury at T7-T12, what is affected respiratory wise?
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Abdominals -coughing
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A weak/absent diaphragm/intercostals= at risk for?
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hypoventillation
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Weak or absent abdominal muscles =?
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impaired cough
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What is the number one mortality reason of spinal cord injury pts?
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pulmonary complications
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What are the respiration complications seen in spinal cord pts?
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Pneumonia, atelectaisis, PE
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Most pts that have a spinal cord injury need what to bring up secretions?
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Quad cough-like a himlick maneuveur.
Let pt take several deep breaths, place hand below ziphoid process, and forcefully press up and function as a diagphram. 3deep breaths, inhale, then thrust hands up |
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When do spasms and spacicity in spinal cord injury?
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May not occur til weeks, days, months after, or not at all.
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What is going on when a pt has spasms/spacicity?
What does a pt think this is? |
After injury, pt goes into spinal shock.
Complete loss of neuro function, pt is flaccid. When it wears off, spacicity may come back. Pt think it is a recovery. Neurons are starting to wake up, but arent functioning |
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A spinal cord injury blocks? causing the body to?
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Blocks inhibitory signals, body overreacts to stimuli, causing spasm.
If you have a quick stretch, UTI, impaction, infection, pressure ulcer, pain-all cause body to overreact (noxious stimuli) Spasms can be very helpful for transfering, coordinating. Also can be dangerous, and hit ppl. |
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How can we help spinal cord injury pts with spasm/spacicity?
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Stretching
ROM Standing Proning-lay on stomach Medications-Baclofen, Tizanidine, Valium Look for skin breakdown |
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Baclafen and tazanodine should not be?
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not be abruptly stopped
Backlofen-hallucinations, seizures taz-high BP, arrythmias |
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What are the benefits to spasticity?
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maintains muscle bulk
warning sign of infection/painful stimuli Increased circulation (decrease DVT risk) May assist with transfers or walking |
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What is skin breakdown/tissue death from?
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from tissues not receiving blood supply(hypoxia)
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Why must we be really careful skin wise with spinal cord injury pts?
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messages from nerve cells in skin no longer signal discomfort/pain
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How do we prevent skin breakdown spinal cord injury pts?
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weight shifts EVERY 15 MINUTES
in wheelchair turn q2-3 hours skin checks proper bed surface SMOKING CESSATION weight control/nutrition |
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What is the most essential part/area for a spinal cord injury pt?
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skin-we must educate
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What if a spinal cord injury pt develops a stage 3 or 4 wound and cant even get up to the wheelchair anymore?
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Probably get surgical debridement
use wound vac for couple of months get flap surgery put on a special bed for 6-8 weeks on clinitron bed, maybe months. |
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S2- S4 controls?
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bladder function and external spincter
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T10 to T 12 controls?
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Internal spincter
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Over distended bladder and high pressures can cause what?
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kidney damage
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Spinal cord injury pts usually have an annual cycscostopy when they come in for Dr. checkup, why?
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to look at bladder and fuction
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Pts on intermittent caths can?
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reuse them after they wash them out
"clean catheters" |
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What is our bladder goal for spinal cord injury pts?
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keep bladder less than 400 cc
cath every 4-6 hours (different if drinking more, etc) |
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What are common complications bladder wise in SCI pts?
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Autonomic dysreflexia
Stones UTI bladder cancer |
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The S2 to S4 controls?
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Bowel spincter and ability to sense fullness, decreases peristalsis
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What is our bowel goal for SCI pts and how?
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Bowel program!
Diet-fiber Meds-stool softener or metamucil Timing, frequency techniques, equipment goal-get them on a pattern. |
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What are the common problems seen in sci pts regarding bowels?
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constipation
incontinence hemmorrhoids ileus- decreased parastalsis, obstruction |
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The syndrome characterized by an abrupt onset of an excessively high blood pressure cuased by uncontrolled sympathetic nervous system respone in persons with spinal cord injury?
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Autonomic dysreflexia*** medical emergency
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What spinal cord injury pts are at most risk for autonomic dysreflexia?
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T7 level and above
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Why does autonomic dyreflexia occur?
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Noxious stimuli Pain stimuli sent up spinal cord
Attempts to send to brain, but doesnt make it Sympathetic nervous system activated Causes severe vasocontriction in legs and ABD and below injury in response Vasoconstriction causes BP to rise Basoreceptors (carotid arteries, etc) tells brain BP is way too high brain slows does heart rate, vasodilation all above level of injury Messages about and below dont communicate, and BP continues to rise |
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What are the s/s of autonomic dysreflexia?
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High increase in BP
Normal: 90/60, Autonomic dysreflexia 130/80! They arent at risk for stroke or heart attack here yet. Sweating-above injury feeling that "something isnt right" Flushed , warm on top Cool, pale on bottom Goosebumps Vision changes Jitters Anxiety Headache-worse HA of life Tighness felt in chest |
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What are the common causes of Autonomic dysreflexia?
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BLADDER***90%**
stones, distention, catheter, surgery, UTI Bowel 8% Full bowel Constipation hemorrhoids Gallstones/ulcers Colonoscopy Skin- Pressure ulcers, ingrown toenails, lying on something, surgical inscisions, burns Other-tight restricive clothing, cramps, labor, sex |
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Cathing the pt is good to prevent autonomic dyreflexia, but remember?
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Only release 1000 cc at most at a time, so body can adjust
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Lets say we think pt is having autonomic dysreflexia-what do we do!!!??
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1. RAISE HOB 90 DEGREES, LOWER LEGS
2. check kink in catheter, ask pt what triggers for AD are 3. loosen clothes 4. check urinary drainage system, clogs? change? Check ingrown toenail, broken bone, burn Continue to check blood pressure q5min! |
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What must we do if pt is having autonomic dysreflexia and we want to check the bowel?
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use lidocane jelly to numb rectum before checking (decrease stimuli)
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If symptoms of autonomic dysrefleia persist and you cannot find what is causing it, and BP continues to rise, do what?
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careful- give nifedipine 10mg to bring it down-- we want to avoid this really b/c pt can bottom out
If pt bottoms out on this, put pt with head down. (BP goes over 150 systolic-notify MD) |