NUR 222 Exam 4/
Final exam
questions and
answers
What is important to know about spinal cord injury?
Damage to the spinal cord with resulting functional loss of mobility
and/or sensation. Results from concussion, contusion, compression,
tearing, laceration, transection, or ischemia of the spinal cord.
- neurons are killed, demyelinates axons and triggers the
inflammatory response.
- edema causes neurons to dies from blocking blood supply and
causes loss of sensory + motor function
- can be complete or incomplete
Complete: total loss of sensory and motor function below site of
injury
Incomplete: partial loss of sensory and motor function below site or
injury.
What different injuries can occur for the different parts of the back?
- Cervical: C1-C7 paralysis below neck, breathing impaired at this
level (phrenic nerve), sensory loss below C4, quadriplegia.
- Thoracic: T1-T12 paralysis below upper back, paraplegia
- lumbar L1-L5: paralysis below lower back
,- sacral/ coccygeal: Paralysis below hips & tailbone, reflexive bowel
and bladder
What are the clinical manifestations of spinal cord injury?
- bladder/ bowel incontinence, breathing impaired
- limited ROM (tetraplegia)
- Altered LOC
- motor & sensation loss
- extreme pain
What us included in a clients medical diagnosis for someone with
SCI?
- neuro exam and physical exam
- x- ray
- CT scan/ MRI location and extent of damage and reveal problems
such as hematomas.
What may be included in a clients treatment with SCI?
- Acute stage: maintain airway, adequate breathing, preventing
spinal shock, restoring and maintaining BP, preventing further cord
damage, spinal immobilization, avoiding complications. Cervical
injuries need immediate ventilation support.
Pharmacological/ Fluid management
- IV fluids, Vasopressors, inotropes, oxygen (fluid resuscitation,
increase tone, increase cardiac output)
- crystalloids, colloids, blood products or a combination
During an emergency situation: protect the airway, protect c-spine,
lye flat on a board, use a cervical collar
What would be included in the immobilization and stabilization for
someone with a SCI?
HALO Traction
- maintain cervical immobilization for specific types of cervical
fractures
- ring around the patients head held with screws, weights are slowly
added, w/ x-rays between additional weight until spinal allignment
is achieved.
, Complications: pin infections, skin breakdown, loosening/ movement
of the pins, swallowing problems, possible dural tears
- pins are kept clean with cotton tipped applicators w/ NS. must be
done sterile.
- if crusting soak for 15 mins
- pin loosing is the most common complication client may report
being able to move their neck or "vest doesn't fit the same". will
need to be reapplied with new pin sites
-Infection: redness, swelling, drainage, site, pain, areas where the
skin has pulled away from the site
- ointments and hydrogen peroxide should be avoided
- pressure injury r/t improper vest size (prevent w/ Q-2 turn)
- swallowing difficulties may occur, notify the provider
What are some complications that may occur with SCI?
- most common cause of death is respiratory disease and
cardiovascular events
- Spinal shock
- neurogenic shock
- autonomic dysreflexia
What is important to know about spinal shock?
immediately after injury and applies to all phenomena surrounding
spinal cord transection. Results in complete but temporary loss/
depression of all/ most spinal reflexes as well as sensory, motor and
autonomic activity below the injury level.
- the brain is unable to transmit signals to muscles and organs,
resulting in loss of sensation, movement, absence of DTR, impaired
perception, decreased visceral and somatic sensations, penile
reflex, urinary and fecal retention, anhidrosis, and paralytic ileus.
- 24h- 1-6 weeks
What is important to know about neurogenic shock?
disruptive type of shock that occurs in patients with brain, upper
thoracic, and cervical injuries and is caused by the sudden loss of
the autonomic nervous system signals the smooth muscle in the
vessel walls. cardiac output decreases because of vessel tone
Final exam
questions and
answers
What is important to know about spinal cord injury?
Damage to the spinal cord with resulting functional loss of mobility
and/or sensation. Results from concussion, contusion, compression,
tearing, laceration, transection, or ischemia of the spinal cord.
- neurons are killed, demyelinates axons and triggers the
inflammatory response.
- edema causes neurons to dies from blocking blood supply and
causes loss of sensory + motor function
- can be complete or incomplete
Complete: total loss of sensory and motor function below site of
injury
Incomplete: partial loss of sensory and motor function below site or
injury.
What different injuries can occur for the different parts of the back?
- Cervical: C1-C7 paralysis below neck, breathing impaired at this
level (phrenic nerve), sensory loss below C4, quadriplegia.
- Thoracic: T1-T12 paralysis below upper back, paraplegia
- lumbar L1-L5: paralysis below lower back
,- sacral/ coccygeal: Paralysis below hips & tailbone, reflexive bowel
and bladder
What are the clinical manifestations of spinal cord injury?
- bladder/ bowel incontinence, breathing impaired
- limited ROM (tetraplegia)
- Altered LOC
- motor & sensation loss
- extreme pain
What us included in a clients medical diagnosis for someone with
SCI?
- neuro exam and physical exam
- x- ray
- CT scan/ MRI location and extent of damage and reveal problems
such as hematomas.
What may be included in a clients treatment with SCI?
- Acute stage: maintain airway, adequate breathing, preventing
spinal shock, restoring and maintaining BP, preventing further cord
damage, spinal immobilization, avoiding complications. Cervical
injuries need immediate ventilation support.
Pharmacological/ Fluid management
- IV fluids, Vasopressors, inotropes, oxygen (fluid resuscitation,
increase tone, increase cardiac output)
- crystalloids, colloids, blood products or a combination
During an emergency situation: protect the airway, protect c-spine,
lye flat on a board, use a cervical collar
What would be included in the immobilization and stabilization for
someone with a SCI?
HALO Traction
- maintain cervical immobilization for specific types of cervical
fractures
- ring around the patients head held with screws, weights are slowly
added, w/ x-rays between additional weight until spinal allignment
is achieved.
, Complications: pin infections, skin breakdown, loosening/ movement
of the pins, swallowing problems, possible dural tears
- pins are kept clean with cotton tipped applicators w/ NS. must be
done sterile.
- if crusting soak for 15 mins
- pin loosing is the most common complication client may report
being able to move their neck or "vest doesn't fit the same". will
need to be reapplied with new pin sites
-Infection: redness, swelling, drainage, site, pain, areas where the
skin has pulled away from the site
- ointments and hydrogen peroxide should be avoided
- pressure injury r/t improper vest size (prevent w/ Q-2 turn)
- swallowing difficulties may occur, notify the provider
What are some complications that may occur with SCI?
- most common cause of death is respiratory disease and
cardiovascular events
- Spinal shock
- neurogenic shock
- autonomic dysreflexia
What is important to know about spinal shock?
immediately after injury and applies to all phenomena surrounding
spinal cord transection. Results in complete but temporary loss/
depression of all/ most spinal reflexes as well as sensory, motor and
autonomic activity below the injury level.
- the brain is unable to transmit signals to muscles and organs,
resulting in loss of sensation, movement, absence of DTR, impaired
perception, decreased visceral and somatic sensations, penile
reflex, urinary and fecal retention, anhidrosis, and paralytic ileus.
- 24h- 1-6 weeks
What is important to know about neurogenic shock?
disruptive type of shock that occurs in patients with brain, upper
thoracic, and cervical injuries and is caused by the sudden loss of
the autonomic nervous system signals the smooth muscle in the
vessel walls. cardiac output decreases because of vessel tone
