NUR 405 Exam 4 With Correct Answers (with
Complete Solutions)
Spinal |Cord |Injury |(SCI) |correct |answers |1. |Damage |to |any |part |of |the |spinal |cord |causing |a
|temporary |or |permanent |loss |of |sensory, |motor, |or |autonomic |dysfunction |below |the |level |of |injury
2. |Causes: |
-MVA |(38%) |
-Falls |(30.5%) |
-Violence |(13.5%) |
gun |shot |wounds, |stabbing
-Sport |injuries |(9%) |
diving, |football
-Degenerative |
older |w |osteoporosis
-Cancer, |hemorrhage
3. |Permanent |disability
-don't |know |extent |when |first |occurs
-affects |independence, |economics
-body |image |changes, |possible |wheelchair, |bedridden
-decrease |in |lifespan, |higher |mortality |rate
-affects |all |of |the |body |systems
4. |Psychosocial |issues
Primary |Injury |correct |answers |1. |Initial |disruption |of |spinal |cord
2. |Direct |trauma |to |spinal |cord |d/t |blunt |or |penetrating |trauma
3. |Compression |by |bone |displacement, |interruption |of |blood |supply |or |distraction |from |pulling
-spinal |cord |blood |supply |interrupted, |could |be |breakage |impacting |spinal |cord |and |compressing |it
4. |Penetrating |trauma |causes |tearing |and |transection
-transection: |cut |in |it
Secondary |Injury |correct |answers |1. |Ongoing |progressive |damage
2. |Causes |further |permanent |damage
3. |Results |in |edema, |ischemia |and |inflammation
4. |Blood |brain |barrier |disruption, |neuron |destruction
5. |Spinal |cord |compression
6. |Apoptosis |for |weeks
-cell |death: |apoptosis
7. |Irreversible |nerve |damage |and |permanent |neurological |deficit
Spinal |Shock |correct |answers |1. |Occurs |shortly |after |injury
2. |Loss |of |deep |tendon |and |sphincter |reflexes, |loss |of |sensation |and |flaccid |paralysis |below |level |of
|injury
3. |Lasts |days |to |weeks
-can |have |improvement |after
,4. |Hard |to |determine |extent |of |injury
-cannot |give |prognosis
Neurogenic |Shock |correct |answers |1. |Occurs |with |injuries |T6 |and |above
-T6: |thoracic |(T10 |hip |level)
-cervical, |thoracic, |lumbar
-dermatomes |in |book |different |colors |of |where |sensation |occurs
2. |Causes |peripheral |vasodilation, |venous |pooling, |decreased |cardiac |output
3. |S |& |S |- |hypotension, |bradycardia, |temperature |deregulation
-temp |deregulation: |body |not |regulating |own |temp, |takes |on |temp |of |atmosphere
-want |BP |over |90 |systolic
-also |look |at |MAP
-don't |want |hypotension |so |bad |that |it |lessens |blood |flow |to |spinal |cord
4. |Can |continue |for |1-3 |weeks
Classification |of |Spinal |Cord |Injury |correct |answers |1. |Mechanism |of |injury
2. |Level |of |injury
3. |Degree |of |injury
Degree |of |injury |(pg. |1422) |correct |answers |1. |Complete: |Loss |of |sensory |and |motor |function
|below |level |of |injury
2. |Incomplete: |mixed |loss |of |voluntary |motor |activity |and |sensation
3. |5 |major |syndromes
-Anterior |cord |Syndrome
-Brown-Sequard |Syndrome
-Cauda |Equina |Syndrome
-Central |Cord |Syndrome
-Conus |Medullaris |Syndrome
Incomplete |Spinal |Cord |Injury |correct |answers |1. |Anterior |cord |syndrome: |direct |injury |to |anterior
|spinal |artery |leads |to |compromised |blood |flow |to |anterior |spinal |cord,
~d/t |acute |compression, |common |w/flexion |injury
motor |paralysis |and |loss |of |pain |and |temp |sensation |below
level |of |injury, |intact |touch, |position, |vibration, |and |motion
2. |Brown-Sequard |Syndrome: |damage |to |half |of |spinal |cord
~d/t |penetrating |injury
-opposite |side |of |injury: |loss |of |pain |and |temp |below |level |of
injury
-Same |side |of |injury: |loss |of |motor |function, |light |touch,
pressure, |position, |and |vibration
Incomplete |correct |answers |1. |Cauda |Equina |Syndrome: |damage |to |lumber |and |sacral |nerve |roots,
|asymmetrical |distal |weakness |and |patchy |sensation |to |lower |extremities, |may |have |flaccid
|paralysis |of |lower |extremities, |loss |of |sensation |over |saddle |area |(perineal |area—> |loss |of |bladder
|control), |areflexic |bowel |and |bladder, |pain
,2. |Central |cord |Syndrome: |damage |to |central |spinal |cord, |most |often |in |cervical |region, |seen |with
|older |people
~d/t |hyperextension |in |people |with |DJD |(degenerative |joint |disease)
motor |weakness, |altered |sensation, |and |burning |pain |in |upper
extremities, |lower |not |affected
3. |Conus |Medullaris |Syndrome: |damage |to |lowest |part |of |spinal |cord, |leg |motor |function
|preserved, |weak, |or |flaccid, |loss |of |sensation |to |perianal |area, |areflexic |bowel |and |bladder,
|impotence
4. |older |people: |already |have |degenerative |disease |and |then |fall |forward
Motor |and |Sensory |effects |correct |answers |1. |The |American |Spinal |Injury |Association |(ASIA)
|Scale
2. |Classify |severity |of |impairment
3. |Motor |and |sensory |function
4. |Rehabilitation |potential
Complications |correct |answers |1. |Respiratory |
-Above |C3- |total |loss |of |resp |muscles |
-above |C5 |intubate |stat |
-Aspiration, |atelectasis, |pneumonia
-cannot |take |deep |breaths, |no |chest |expansion, |sats |dropping |rapidly, |cannot |cough/move
|secretions
-can |go |into |pulmonary |edema |d/t |fluid |overload |issues
-want |O2 |over |92%
-if |high |up |may |need |initial |intubation
2. |Cardiovascular: |T6 |or |above |
-bradycardia, |hypotension |(neurogenic |shock)
3. |Urinary: |neurogenic |bladder |
-Overdistension, |incontinence, |reflux |of |urine |into |kidneys
-check |amt |of |volume |w |bladder |scanner |and |then |straight |cath
-one |of |the |reasons |of |renal |failure—>kidney |stones, |pyelonephritis
-bladder |can |happen |at |any |level
Complications
-general |complications |of |any |spinal |cord |injury |correct |answers |1. |GI: |
-Gastric |distension |
-Paralytic |ileus |
-Stress |ulcers |
-Dysphagia
-decreased |GI |motor |activity, |emptying
-produce |more |hydrochloric |acid-> |stress |ulcers-> |PPIs, |histamine |blockers
2. |Bowel: |
-Neurogenic |bowel |
-Stool |retention |and |constipation |
-Impaired |peristalsis |
-Incontinence |
, -Impaction
3. |Integumentary: |Pressure |injuries |leading |to |infection |and |sepsis
-not |getting |out |of |bed, |sitting |for |long |periods |of |time
-sitting |in |incontinence
4. |Thermoregulation: |poikilothermia
-takes |on |ambient |temp |of |room
-cannot |sweat |or |shiver |to |reg |body |temp |esp |higher |cervical |injuries
5. |Metabolic |needs: |increased |nutritional |needs
-try |to |start |TPN/tube |feedings |within |72 |hrs |of |injury
-need |protein |to |heal, |muscles |are |atrophying |and |losing |weight
6. |Lean |body |mass |decreases, |muscles |atrophy
7. |PV |problems: |VTE
-peripheral |vascular |problems |due |to |immobility |and |blood |statuses
8. |Pain: |nociceptive |and |neuropathic
-neuropathic: |nerve |pain |r/t |injury |itself, |pins |and |needles |when |hitting |elbow
-can |be |sensitive |to |someone |touching |them
-nociceptive: |chronic |aching |tissue |pain |due |to |injury
-can |have |combination |of |both |types |of |pain
Emergency |management |correct |answers |1. |ABCs
2. |Preventing |extension |of |spinal |cord |injury |w/ |cervical |collar |and |backboard
-want |to |stabilize |injury, |dont |want |to |get |worse
-log |rolling
-keep |supine |initially |until |know |extent
3. |Intubation?
-intubate |initially
4. |Treat |shock |w/ |IV |fluids |and |vassopressors
5. |Assess |for |other |injuries
6. |Control |bleeding
7. |CT |scan
-MRI |sometimes |used, |but |CT |easier |and |quicker
8. |History/Neuro |assessment/ASIA |tool |
-how |did |injury |occur?
9. |ABGs, |lytes, |glucose, |Coags, |hgb, |hct
Acute |care |correct |answers |1. |Surgery
-can |go |anterior |or |posterior |for |surgery |sometimes |both
-may |put |in |plates, |screws
2. |Methylprednisolone |mixed |recommendations
3. |VTE |prophylaxis
-prevent |VTE |with |lovenox, |heparins, |SCDs
4. |Vassopressors
-phenylephrine |or |norepinephrine |(levophed) |to |maintain |the |MAP |at |greater |than |85 |to |90 |mm |Hg
|to |improve |perfusion |to |the |spinal |cord |
5. |NGT
-don't |want |to |vomit, |will |strain |spinal |cord
Complete Solutions)
Spinal |Cord |Injury |(SCI) |correct |answers |1. |Damage |to |any |part |of |the |spinal |cord |causing |a
|temporary |or |permanent |loss |of |sensory, |motor, |or |autonomic |dysfunction |below |the |level |of |injury
2. |Causes: |
-MVA |(38%) |
-Falls |(30.5%) |
-Violence |(13.5%) |
gun |shot |wounds, |stabbing
-Sport |injuries |(9%) |
diving, |football
-Degenerative |
older |w |osteoporosis
-Cancer, |hemorrhage
3. |Permanent |disability
-don't |know |extent |when |first |occurs
-affects |independence, |economics
-body |image |changes, |possible |wheelchair, |bedridden
-decrease |in |lifespan, |higher |mortality |rate
-affects |all |of |the |body |systems
4. |Psychosocial |issues
Primary |Injury |correct |answers |1. |Initial |disruption |of |spinal |cord
2. |Direct |trauma |to |spinal |cord |d/t |blunt |or |penetrating |trauma
3. |Compression |by |bone |displacement, |interruption |of |blood |supply |or |distraction |from |pulling
-spinal |cord |blood |supply |interrupted, |could |be |breakage |impacting |spinal |cord |and |compressing |it
4. |Penetrating |trauma |causes |tearing |and |transection
-transection: |cut |in |it
Secondary |Injury |correct |answers |1. |Ongoing |progressive |damage
2. |Causes |further |permanent |damage
3. |Results |in |edema, |ischemia |and |inflammation
4. |Blood |brain |barrier |disruption, |neuron |destruction
5. |Spinal |cord |compression
6. |Apoptosis |for |weeks
-cell |death: |apoptosis
7. |Irreversible |nerve |damage |and |permanent |neurological |deficit
Spinal |Shock |correct |answers |1. |Occurs |shortly |after |injury
2. |Loss |of |deep |tendon |and |sphincter |reflexes, |loss |of |sensation |and |flaccid |paralysis |below |level |of
|injury
3. |Lasts |days |to |weeks
-can |have |improvement |after
,4. |Hard |to |determine |extent |of |injury
-cannot |give |prognosis
Neurogenic |Shock |correct |answers |1. |Occurs |with |injuries |T6 |and |above
-T6: |thoracic |(T10 |hip |level)
-cervical, |thoracic, |lumbar
-dermatomes |in |book |different |colors |of |where |sensation |occurs
2. |Causes |peripheral |vasodilation, |venous |pooling, |decreased |cardiac |output
3. |S |& |S |- |hypotension, |bradycardia, |temperature |deregulation
-temp |deregulation: |body |not |regulating |own |temp, |takes |on |temp |of |atmosphere
-want |BP |over |90 |systolic
-also |look |at |MAP
-don't |want |hypotension |so |bad |that |it |lessens |blood |flow |to |spinal |cord
4. |Can |continue |for |1-3 |weeks
Classification |of |Spinal |Cord |Injury |correct |answers |1. |Mechanism |of |injury
2. |Level |of |injury
3. |Degree |of |injury
Degree |of |injury |(pg. |1422) |correct |answers |1. |Complete: |Loss |of |sensory |and |motor |function
|below |level |of |injury
2. |Incomplete: |mixed |loss |of |voluntary |motor |activity |and |sensation
3. |5 |major |syndromes
-Anterior |cord |Syndrome
-Brown-Sequard |Syndrome
-Cauda |Equina |Syndrome
-Central |Cord |Syndrome
-Conus |Medullaris |Syndrome
Incomplete |Spinal |Cord |Injury |correct |answers |1. |Anterior |cord |syndrome: |direct |injury |to |anterior
|spinal |artery |leads |to |compromised |blood |flow |to |anterior |spinal |cord,
~d/t |acute |compression, |common |w/flexion |injury
motor |paralysis |and |loss |of |pain |and |temp |sensation |below
level |of |injury, |intact |touch, |position, |vibration, |and |motion
2. |Brown-Sequard |Syndrome: |damage |to |half |of |spinal |cord
~d/t |penetrating |injury
-opposite |side |of |injury: |loss |of |pain |and |temp |below |level |of
injury
-Same |side |of |injury: |loss |of |motor |function, |light |touch,
pressure, |position, |and |vibration
Incomplete |correct |answers |1. |Cauda |Equina |Syndrome: |damage |to |lumber |and |sacral |nerve |roots,
|asymmetrical |distal |weakness |and |patchy |sensation |to |lower |extremities, |may |have |flaccid
|paralysis |of |lower |extremities, |loss |of |sensation |over |saddle |area |(perineal |area—> |loss |of |bladder
|control), |areflexic |bowel |and |bladder, |pain
,2. |Central |cord |Syndrome: |damage |to |central |spinal |cord, |most |often |in |cervical |region, |seen |with
|older |people
~d/t |hyperextension |in |people |with |DJD |(degenerative |joint |disease)
motor |weakness, |altered |sensation, |and |burning |pain |in |upper
extremities, |lower |not |affected
3. |Conus |Medullaris |Syndrome: |damage |to |lowest |part |of |spinal |cord, |leg |motor |function
|preserved, |weak, |or |flaccid, |loss |of |sensation |to |perianal |area, |areflexic |bowel |and |bladder,
|impotence
4. |older |people: |already |have |degenerative |disease |and |then |fall |forward
Motor |and |Sensory |effects |correct |answers |1. |The |American |Spinal |Injury |Association |(ASIA)
|Scale
2. |Classify |severity |of |impairment
3. |Motor |and |sensory |function
4. |Rehabilitation |potential
Complications |correct |answers |1. |Respiratory |
-Above |C3- |total |loss |of |resp |muscles |
-above |C5 |intubate |stat |
-Aspiration, |atelectasis, |pneumonia
-cannot |take |deep |breaths, |no |chest |expansion, |sats |dropping |rapidly, |cannot |cough/move
|secretions
-can |go |into |pulmonary |edema |d/t |fluid |overload |issues
-want |O2 |over |92%
-if |high |up |may |need |initial |intubation
2. |Cardiovascular: |T6 |or |above |
-bradycardia, |hypotension |(neurogenic |shock)
3. |Urinary: |neurogenic |bladder |
-Overdistension, |incontinence, |reflux |of |urine |into |kidneys
-check |amt |of |volume |w |bladder |scanner |and |then |straight |cath
-one |of |the |reasons |of |renal |failure—>kidney |stones, |pyelonephritis
-bladder |can |happen |at |any |level
Complications
-general |complications |of |any |spinal |cord |injury |correct |answers |1. |GI: |
-Gastric |distension |
-Paralytic |ileus |
-Stress |ulcers |
-Dysphagia
-decreased |GI |motor |activity, |emptying
-produce |more |hydrochloric |acid-> |stress |ulcers-> |PPIs, |histamine |blockers
2. |Bowel: |
-Neurogenic |bowel |
-Stool |retention |and |constipation |
-Impaired |peristalsis |
-Incontinence |
, -Impaction
3. |Integumentary: |Pressure |injuries |leading |to |infection |and |sepsis
-not |getting |out |of |bed, |sitting |for |long |periods |of |time
-sitting |in |incontinence
4. |Thermoregulation: |poikilothermia
-takes |on |ambient |temp |of |room
-cannot |sweat |or |shiver |to |reg |body |temp |esp |higher |cervical |injuries
5. |Metabolic |needs: |increased |nutritional |needs
-try |to |start |TPN/tube |feedings |within |72 |hrs |of |injury
-need |protein |to |heal, |muscles |are |atrophying |and |losing |weight
6. |Lean |body |mass |decreases, |muscles |atrophy
7. |PV |problems: |VTE
-peripheral |vascular |problems |due |to |immobility |and |blood |statuses
8. |Pain: |nociceptive |and |neuropathic
-neuropathic: |nerve |pain |r/t |injury |itself, |pins |and |needles |when |hitting |elbow
-can |be |sensitive |to |someone |touching |them
-nociceptive: |chronic |aching |tissue |pain |due |to |injury
-can |have |combination |of |both |types |of |pain
Emergency |management |correct |answers |1. |ABCs
2. |Preventing |extension |of |spinal |cord |injury |w/ |cervical |collar |and |backboard
-want |to |stabilize |injury, |dont |want |to |get |worse
-log |rolling
-keep |supine |initially |until |know |extent
3. |Intubation?
-intubate |initially
4. |Treat |shock |w/ |IV |fluids |and |vassopressors
5. |Assess |for |other |injuries
6. |Control |bleeding
7. |CT |scan
-MRI |sometimes |used, |but |CT |easier |and |quicker
8. |History/Neuro |assessment/ASIA |tool |
-how |did |injury |occur?
9. |ABGs, |lytes, |glucose, |Coags, |hgb, |hct
Acute |care |correct |answers |1. |Surgery
-can |go |anterior |or |posterior |for |surgery |sometimes |both
-may |put |in |plates, |screws
2. |Methylprednisolone |mixed |recommendations
3. |VTE |prophylaxis
-prevent |VTE |with |lovenox, |heparins, |SCDs
4. |Vassopressors
-phenylephrine |or |norepinephrine |(levophed) |to |maintain |the |MAP |at |greater |than |85 |to |90 |mm |Hg
|to |improve |perfusion |to |the |spinal |cord |
5. |NGT
-don't |want |to |vomit, |will |strain |spinal |cord
