RNSG 2432 - Spinal cord injury/ spinal tumors/ herniated
disks Questions With Complete Solutions
Contrast the difference between extradural, intradural
extramedullary, and intradural intrameduallary spinal cord
tumors. Which one has the worst prognosis? Correct Answer
Intraspinal Extradural Tumors = located within the Spinal Canal
& outside the Dura Mater. Most are metastatic tumors
(cancerous tumors which have spread from another organ),
which arise within the vertebrae themselves. (can be seen early
on xray)
Intradural-Extramedullary Tumors = arising inside the dura
mater, but outside the actual substance of the spinal cord. The
majority of these tumors are Neurofibromas (nerve sheath
tumors) or Meningiomas
- mostly benign; require MRI/CT for detection
Intradural intramedullary tumors = arising within the substance
of the spinal cord itself. These are usually Astrocytomas or
Ependymomas.
- Least frequent; require MRI/CT for detection *(worst
prognosis)*
Describe emergency care (on the scene/in ED) for the spinal
cord injured- Why might an NG tube to drainage and a Foley
catheter used in the acute SCI individual? Correct Answer Find
out the mechanism of injury
Do not remove helmet at scene
NEVER put a pt on a backboard without a C collar
Transport with cervical collar and logroll!!!
,Assess ABC's
IV x2 large bore
Foley - for flaccid bladder from spinal shock
NG tube to suction - may have paralytic shock
CMS (circulation, movement, sensation) circulation - pulse and
capillary refill
Describe the clinical manifestations expected from each of the
following spinal cord injuries. Why do they occur?
a) Complete (transaction) spinal cord injury Correct Answer
totally damaged cord horizontally & post spinal shock the
individual will have:
a. Motor deficits: hyperreflexia, spastic paralysis below the level
of injury.
b. Sensory deficits: loss of touch pressure, temp, pain, vibration
& proprioception from below the level of injury.
c. Autonomic deficits: vasomotor failure resulting in orthostatic
hypotension, poikilothermic (take on the temp of the
environment) & parasympathetic spastic bladder
Describe the clinical manifestations expected from each of the
following spinal cord injuries. Why do they occur?
b) Incomplete- Brown-Sequard Syndrome Correct Answer
result of damage to one half on the spinal cord, usually the result
of penetrating injury; characterized by:
- loss of motor function, sensation, vibration, position on the
same side as injury (ipsilateral)
- opposite side has loss of pain and temp sensation below the
level of the injury (contralateral)
, Describe the clinical manifestations expected from each of the
following spinal cord injuries. Why do they occur?
c) Incomplete- Anterior Cord Syndrome Correct Answer -
Injury to the anterior part of the cord; loss of motor (Pyramidal
track), loss of pain and temperature below the level of injury
-Posterior tract not injured, touch, position, vibration, motion
stay intact
Describe the clinical manifestations expected from each of the
following spinal cord injuries. Why do they occur?
d) Incomplete - Posterior Correct Answer *****Least frequent
syndrome
Injury to the posterior (dorsal) columns
Loss of proprioception
Pain, temp, sensation & motor function below the level of the
lesion remain INTACT.
Describe the clinical manifestations expected from each of the
following spinal cord injuries. Why do they occur?
e) Incomplete- Central Cord Syndrome Correct Answer injury
to the center of the cord by edema and hemorrhage; usually cord
is compressed between vertebra
- weakness in both upper extremities
- legs are spared; varied loss of sensation
Describe what you can expect to see/functional goals and
nursing concerns with complete spinal cord lesion of:
a) C1 - C3
b) C6
disks Questions With Complete Solutions
Contrast the difference between extradural, intradural
extramedullary, and intradural intrameduallary spinal cord
tumors. Which one has the worst prognosis? Correct Answer
Intraspinal Extradural Tumors = located within the Spinal Canal
& outside the Dura Mater. Most are metastatic tumors
(cancerous tumors which have spread from another organ),
which arise within the vertebrae themselves. (can be seen early
on xray)
Intradural-Extramedullary Tumors = arising inside the dura
mater, but outside the actual substance of the spinal cord. The
majority of these tumors are Neurofibromas (nerve sheath
tumors) or Meningiomas
- mostly benign; require MRI/CT for detection
Intradural intramedullary tumors = arising within the substance
of the spinal cord itself. These are usually Astrocytomas or
Ependymomas.
- Least frequent; require MRI/CT for detection *(worst
prognosis)*
Describe emergency care (on the scene/in ED) for the spinal
cord injured- Why might an NG tube to drainage and a Foley
catheter used in the acute SCI individual? Correct Answer Find
out the mechanism of injury
Do not remove helmet at scene
NEVER put a pt on a backboard without a C collar
Transport with cervical collar and logroll!!!
,Assess ABC's
IV x2 large bore
Foley - for flaccid bladder from spinal shock
NG tube to suction - may have paralytic shock
CMS (circulation, movement, sensation) circulation - pulse and
capillary refill
Describe the clinical manifestations expected from each of the
following spinal cord injuries. Why do they occur?
a) Complete (transaction) spinal cord injury Correct Answer
totally damaged cord horizontally & post spinal shock the
individual will have:
a. Motor deficits: hyperreflexia, spastic paralysis below the level
of injury.
b. Sensory deficits: loss of touch pressure, temp, pain, vibration
& proprioception from below the level of injury.
c. Autonomic deficits: vasomotor failure resulting in orthostatic
hypotension, poikilothermic (take on the temp of the
environment) & parasympathetic spastic bladder
Describe the clinical manifestations expected from each of the
following spinal cord injuries. Why do they occur?
b) Incomplete- Brown-Sequard Syndrome Correct Answer
result of damage to one half on the spinal cord, usually the result
of penetrating injury; characterized by:
- loss of motor function, sensation, vibration, position on the
same side as injury (ipsilateral)
- opposite side has loss of pain and temp sensation below the
level of the injury (contralateral)
, Describe the clinical manifestations expected from each of the
following spinal cord injuries. Why do they occur?
c) Incomplete- Anterior Cord Syndrome Correct Answer -
Injury to the anterior part of the cord; loss of motor (Pyramidal
track), loss of pain and temperature below the level of injury
-Posterior tract not injured, touch, position, vibration, motion
stay intact
Describe the clinical manifestations expected from each of the
following spinal cord injuries. Why do they occur?
d) Incomplete - Posterior Correct Answer *****Least frequent
syndrome
Injury to the posterior (dorsal) columns
Loss of proprioception
Pain, temp, sensation & motor function below the level of the
lesion remain INTACT.
Describe the clinical manifestations expected from each of the
following spinal cord injuries. Why do they occur?
e) Incomplete- Central Cord Syndrome Correct Answer injury
to the center of the cord by edema and hemorrhage; usually cord
is compressed between vertebra
- weakness in both upper extremities
- legs are spared; varied loss of sensation
Describe what you can expect to see/functional goals and
nursing concerns with complete spinal cord lesion of:
a) C1 - C3
b) C6
