Spinal cord injury

Question 1

After injury to the spine weekday is released and how does it make the injury worse?

Answer 1

Glutamate is released and triggers disrupting normal processes and killing neurons and axon protectors

Question 2

sensory information comes in through what root?

Answer 2

Dorsal root

Question 3

motor information goes out through which root?

Answer 3

Ventral root

Question 4

If a patient has a brain stem injury, which cervical area is affected

Answer 4

C 2-3

Question 5

Injury above C4 can cause?

Answer 5

Respiratory difficulty and paralysis of all for extremities

Question 6

If a patient has an injury to T11, what might you expect?

Answer 6

The patient can walk

Question 7

Quadriplegic is also known as? What area of the body is affected? How?

Answer 7

Tetraplegia; there is motor an sensory loss below the neck.

Question 8

Paralegal effects what parts of the body?

Answer 8

The lower limbs

Question 9

This type of spinal injury includes a posterior rupture of ligaments and anterior dislocation of the discs? What activity might have caused this?

Answer 9

Hyper flexion injury; whiplash from an MBA or diving

Question 10

What spinal injury includes an anterior rupture of ligaments? What might this patient have done to have this injury?

Answer 10

Hyper extension injury; chin to table impact

Question 11

Which spinal injury results in compression of the spinal column and bone shattering? What activity could lead to this injury?

Answer 11

Axial loading injury; falling from a ladder or diving

Question 12

What type of spinal injury results in a fractured vertebral body and posterior rupture of ligaments? What activity might cause this?

Answer 12

Rotational injury; skiing

Question 13

Procedure where a balloon is inserted and inflated inside fractured vertebrae and a cement-like material is inserted

Answer 13

Kyphoplasty

Question 14

What is the goal of kyphoplasty?

Answer 14

To restore height to the bone reducing deformity of the spine. Aiding the patient to return to ads and daily activities

Question 15

On the impairment scale, what is an A?

Answer 15

Complete with no motor or sensory in sacral segment

Question 16

On the impairment scale, what is a B?

Answer 16

Incomplete. Sensory but no motor below injury

Question 17

On the impairment scale, what is a C?

Answer 17

Incomplete. Motor present below injury with weakness in more than 1/2 of key muscles

Question 18

On the impairment scale, what is a D?

Answer 18

Incomplete. Motor is present below injury with weakness in at least 1/2 of key muscles

Question 19

On the impairment scale, what is an E?

Answer 19

Normal motor and sensory

Question 20

Bowel, bladder, and reproductive system is innerased by?

Answer 20

Parasympathetic nervous system

Question 21

Thoracic organs and abdominal organs are innervated by?

Answer 21

Parasympathetic nervous system

Question 22

What is immediate response to spinal injury with an interruption of sympathetic pathways?

Answer 22

Spinal shock

Question 23

What does spinal shock look like in a patient?

Answer 23

Loss of skeletal muscle function, bowel and bladder tone, reflex function, sensory function, flaccid paralysis, loss of temperature control, and loss of the ability to perspire

Question 24

Aside from spinal shock, what type of shock can occur with patients suffering from a spinal cord injury?

Answer 24

Neutrogenic shock which is the interference with the nervous system control of blood pressure is causing severe vasodilation

Question 25

What would you expect in neurogenic shock? How would you treat it?

Answer 25

Severe vasodilation, loss of venous return leading to decrease in O2 sats, clots, blood pooling, bradycardia, hypertension - orthostatic. Vasoconstrictors, fluid, compression stockings, air mattress, turn schedule

Question 26

The two main interventions when you find a patient who you suspect has suffered a spinal cord injury

Answer 26

Immobilization and airway

Question 27

What drug therapy can be prescribed for spinal cord inury patient? What does it do?

Answer 27

Solu-medrol. It decreases inflammation and decreases glutamate

Question 28

What are you thinking if you’re patient has absent bowel sounds?

Answer 28

With absent bowel sounds we are concerned is a paralytic ileus due to internal hemorrhage. The blood collects and fills the cavity causing no bowel sounds

Question 29

In this type of cord damage there is a loss of voluntary motor control on the same side as the cord damage and the loss of pain and temperature sensation on the opposite side

Answer 29

Brown-square syndrome aka lateral cord syndrome

Question 30

In this type of cord damage there is a loss of pain, temperature, and motor function below the level of the Legion. Lite Touch, position and vibration sinsation remain intact due to acute disc herniation or hyperflexion injuries

Answer 30

Anterior cord syndrome

Question 31

This type of cord injury result in the loss of motor power and sensation and incomplete laws of the bowel and bladder. Caused by injury or edema usually in the cervical area

Answer 31

Central cord syndrome

Question 32

What is the longest a soft collar should stay on and why?

Answer 32

3 to 4 days only. Prolonged use can lead to weaken the neck muscles and the need for physical therapy

Question 33

This can be used if the patient experiences a sore neck from whiplash and does not need a physician’s order

Answer 33

Soft collar

Question 34

This is used for surgery or for patients just out of a halo and needs a prescription from a physician

Answer 34

Cervical collar aka hard collar

Question 35

Contains rods to lengthen the spine to remove compression. These are surgically implanted

Answer 35

Internal fixator devices

Question 36

Name 8 tips to educate a patient who is using a halo traction

Answer 36

Use a fleece liner under vest, keep shirt on under it, keep liner dry, wash skin under vest with warm water, avoid soap, lotion, or powder, clean pins QD usually with soap and water, keep a wrench available for emergency removal, have a screwdriver available to tighten screws occasionally

Question 37

Sensory nerves detect stimuli and transmit impulses up the cord, but the impulses cannot reach the brain which increases sympathetic responses of autonomic nervous system

Answer 37

Autonomic dysreflexia

Question 38

Hyper reflexive or exaggerated sympathetic response to noxious stimulus leading to severe vasoconstriction

Answer 38

Autonomic dysreflexia

Question 39

Name some causes of autonomic dysreflexia

Answer 39

Full bladder, UTI, fecal impaction, decubitus ulcer, invasive testing, hemorrhoids, gallstones, kidney stones, draft on skin

Question 40

Name the symptoms of autonomic dysreflexia

Answer 40

Severe hypertension, flushing, pounding headache, profuse diaphoresis, piloerection, nasal congestion, bradycardia

Question 41

How is autonomic dysreflexia managed

Answer 41

Have the patience it up right to decrease the blood pressure, administer antihypertensive like nifedipine/ procardia, nitroglycerine/nitropaste, cath as needed, assess for fecal impaction

Question 42

In an injury above t12 what would you expect a patient’s bladder control to be?

Answer 42

This patient has a reflexive bladder aka spastic bladder where no sensation or motor control is present however the bladder empties on reflex. This patient is incontinent

Question 43

For a patient with injury below t12 what would you expect for bladder control?

Answer 43

This patient has a flaccid bladder where once it overflows the patient has incontinence due to an overextended bladder

Question 44

Patients who have injuries above the sacral region lead to what type of BAL control?

Answer 44

This patient has a reflex bowel pattern which means of the bowels work on reflex

Question 45

For patients who have injuries at the sacral region they result in what type of bowel pattern?

Answer 45

These patients have a flaccid bowel pattern which means that they defecate due to overflow. It results in a leaking that can be constant

Question 46

What does rehab focus on for spinal cord injury patients?

Answer 46

Maintaining skin integrity, avoiding DVTs, decreased infection, controlling spastic legs with meds, promoting self care, Council on sexual changes