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SCI Statisti"s
# Mortality rate $ 1%&0's ( )0*
$ +oday ( ,*
# A-erage li.espan .ollo/ing SCI $ 0&0 years
# Highest in"iden"e $ 12000 ne/ "ases per year in 3S
$ 2240)0 $ 00%) li-ing /ith SCI in 3S
$ Males 1,0 years old
$ In"reasing in young .e5ales
$ !0* o. SCIs in-ol-e "er-i"al spine
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Me"hanis5 o. Injury
# Hyper.le:ion $ Sudden de"eleration
$ Cspine "o55on
#Hypere:tension $ Most "o55on type $ ;hiplash
# A:ial loading
$ a
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>re-ention o. SCI
# Sa.e dri-ing
# 3se o. seat ?elts @ "ar seats
# ;ear hel5ets
# Sui"ide @ -iolen"e pre-ention
# >re-ent .alls
# Athleti" prote"tion
# >roper se"urity o. .irear5s
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Anato5y @ >hysiology o. Spinal Cord
# 3pper 5otor
neurons
$ Dri-e -oluntary
5o-e5ent
$ Des"ending 5otor
path/ay
$ ;ithin CNS
$ ead .ro5 ?rain to?rain ste5 or
anterior horn "ell o.
spinal "ord
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3pper Motor Neuron esion
# Injury a?o-e the le-el o. the anterior horn"ell
$ Anterior 6-entral7 horn proje"ts to s
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Anato5y @ >hysiology o. Spinal Cord
# o/er 5otor neurons
$ Be"o5e part o.
peripheral ner-e to
5us"le
$ Condu"t i5pulsesoriginating in upper
5otor neurons
$ =esponsi?le .or
inner-ations and
"ontra"tion o. s
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o/er Motor Neuron esion
# Injury at or ?elo/ the anterior horn "ell
$ Fla""id type paralysis
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Sy5pto5 Co5parison o. esions
# 3pper 5otorneuron
$ Da5age to
des"ending
inhi?itory
ner-es that
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Injury and Fun"tion
# Neurologi" le-el
$ o/est le-el at /hi"h sensory @ 5otor
.un"tion is nor5al
# Co5plete $ Co5plete disruption o. neural tissue
$ +otal loss o. sensory @ 5otor .un"tion ?elo/
le-el o. injury
$ Autono5i" dys.un"tion ?elo/ le-el o. injury
$ Irre-ersi?le
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Injury and Fun"tion
# Con"ussion
$ +ransient lo"alied neurologi" de.i"it
$ Full re"o-ery
# In"o5plete
$ aria?le degrees o. 5otor @or sensory
loss ?elo/ le-el o. injury
$ Certain tra"ts spared
$ >atterns 5ani.ested in syndro5es
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Spinal Cord +ra"ts
# Anterior horn
$ Motor
# >osterior horn
$ Sensory# ateral spinothala5i"
$ >ain @ +e5perature
# Dorsal "olu5ns
$ >osition o. ar5s @ legs
# Corti"ospinal tra"ts
$ Signals to 5o-e 5us"le
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Central Cord Syndro5e
# Central "ord injury
$ Cer-i"al area pri5arily
# 3pper e:tre5ity 5otor loss
# Spasti"ity o. lo/er e:tre5ities
# Sensory loss is -aria?le
# Bo/el?ladder dys.un"tion -aria?le
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Anterior Cord
Syndro5e
# Belo/ le-el o. injury loss o. $ Motor .un"tion
$ +e5perature
$ >ain sensation# =e5ains inta"t
$ >roprio"eption
$ Motion sense
$ +ou"h $ i?ration
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>osterior Cord Syndro5e ~
Rare
# Belo/ le-el o.
injury loss o.
$ >roprio"eption
$ i?ration
# =e5ains inta"t
$ Motor .un"tion o.
e:tre5ities
$ +ou"h $ >ressure
$ +e5perature
$ >ain
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Bro/n Seuard Syndro5e
# Due to he5ise"tion o.
the "ord
$ Northsouth transe"tion
$ Eni.e or 5issile injury $ Fra"turedislo"ation
$ A"ute ruptured dis"
# Ipsilateral loss o.
$ oluntary 5otor
.un"tion
$ Sense o. tou"h $ i?ration
$ >roprio"eption
# Contralateral loss o.
$ >ain sensation
$ +e5perature
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>ri5ary Injury
# Injury that o""urs at i5pa"t
# Asso"iated /ith da5age to -erte?ral
"olu5n
# More 5o?ile areas 5ore .reuently
in-ol-ed
$ Cer-i"al area
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Se"ondary Injury
# Injury that "ontinues hours a.ter trau5a# as"ular pathology
$ In"reased ?lood -essel per5ea?ility
# de5a# De"reased ?lood .lo/ to area
$ Further is"he5ia leads to ne"rosis# as"ular stasis# +hro5?osis
# Further de"rease in ?lood .lo/# +rau5ati" he5orrhagi" ne"rosis o. gray 5atter
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Se"ondary Injury
# Neuronal pathology $ Altered ele"trophysiology o. neurons
# Sodiu5 lea
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5ergen"y Manage5ent o. SCI
# IMMOBILIZEIMMOBILIZE
# Ne"< in neutral position
# +ransport to trau5a "enter or regional
spinal injury "enter
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5ergen"y Manage5ent o. SCI
# Monitor .or
progression o.
neurologi"al
de.i"its
# Highdose"orti"osteroids
$ Contro-ersial
studies
# 9:ygenation
# sta?lish ?aseline
assess5ent
# Sta?iliation o.
-erte?ral "olu5n
$ Cer-i"al
# S
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Cer-i"al +ongs /ith Halo est
# Nursing "are $ >atient "o5.ort
# Balan"e
# oose "lothing
# +u? or sponge ?ath
# Support head /ith s5allpillo/ /hile sleeping
$ >in site "are
# Assess .or redness ordrainage
# Cleanse per proto"ol# +opi"al anti?ioti"s
$ S
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Nursing Manage5ent o. SCI
# =espiratory $ Su"tion /ith "are to a-oid -agal ner-e irritation
$ Chest physiotherapy .or /ea< "ough
$ =outine ?reathing e:er"ises
$ Hydration and hu5idi.ied o:ygen $ For"ed e:piratory "ough
# Cardio-as"ular $ Da5aged sy5patheti"
.un"tion# Flu"tuation in B># Dysrhyth5ias
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Nursing Manage5ent o. SCI
# GI $ Che"< tu?e .eeding residuals @ toleran"e o..eedings a.ter ?o/el sounds return
$ H2 antagonists or anta"ids
$ High "alorie high protein high .i?er
$ Bo/el retraining
$ Stool so.teners
$ Manual re5o-al o. stool on a routine 6i.needed /ith MN injury7
# G3 $ Inter5ittent "atheteriation
$ Assure adeuate .luids
$ +ea"h trigger -oiding te"hniue021!1! 2!
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Nursing Manage5ent o. SCI
# S=9M
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Nursing Manage5ent o. SCI
# >sy"hoso"ial $ 9pen "o55uni"ation
$ n"ourage de"ision 5a
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Co5pli"ations
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Spinal Sho"<
# >athophysiology
$ oss o. autono5i" ner-ous syste5 .un"tion
?elo/ le-el o. injury
$ Sudden depression o. re.le:es ?elo/ le-el o.injury
$ Are.le:ia
$ Fla""id paralysis
$ a"< o. ?ladder and ?o/el .un"tion
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Spinal Sho"<
# Nursing Assess5ents
$ Hypotension
$ Brady"ardia
$ Hypother5ia $ Bo/el distention
$ >aralyti" ileus
$ a"< o. perspiration on paralyed parts
$ =espiratory depression.ailure
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Spinal Sho"<
# NursingMedi"al Manage5ent
$ Sta?iliation o. SCI
$ Support o. -ital organ .un"tion
# >las5a e:pander 6de:tran7# Systoli" B> %0100
# Heart rate ,0100 ?p5
# 3rine output 5ore than 05h
# >re-ent hypother5ia# Intestinal de"o5pression /ith nasogastri" tu?e
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+hro5?ophle?itis
# >athophysiology
$ Stasis
$ I55o?ility
$ De"reaseda?sent
5us"le "ontra"tion
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+hro5?ophle?itis 5?olis5
# Nursing Assess5ents $ D+
# eg s/elling
# =edness
# In"reased te5perature o. a..e"ted e:tre5ity
# Nursing Assess5ents
$ >ul5onary e5?olis5
# >leuriti" "hest pain
# An:iety
# Shortness o. ?reath
# Arterial ?lood gases
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+hro5?ophle?itis 5?olis5
# NursingMedi"al Manage5ent
$ o/ dose anti"oagulants
# Su? heparin
# o-eno:
$ :ternal "o5pression de-i"e
# >neu5ati" seuential "o5pression de-i"e
# +D hose
$ Ind/elling -ena "a-a .ilter
# >re-ent pul5onary e5?olis5
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9rthostati" Hypotension
# >athophysiology
$ Interruption in re.le: ar"s that produ"e
-aso"onstri"tion
$ asodilation $ >ooling in a?do5en @ lo/er e:tre5ities
$ Co55on in lesions a?o-e +4
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9rthostati" Hypotension
# Nursing Assess5ents
$ 2055 Hg de"rease in SB>
$ 1055 Hg de"rease in DB>
$ ;ea
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9rthostati" Hypotension
# NursingMedi"al Manage5ent $ asopressors
$ +D hose
$ A?do5inal ?inders
$ Gradual position "hanges
$ +ilt ta?les
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Autono5i" Dysre.le:ia
# >athophysiology $ A"ute e5ergen"y
# Can pre"ipitate a seiure or stro
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Autono5i" Dysre.le:ia
# Nursing Assess5ents
$ Se-ere pounding heada"he
$ Nasal "ongestion
$ >aro:ys5al hypertension $ Brady"ardia
$ >ro.use diaphoresis a?o-e le-el o. injury
$ >ale "old dry s
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Autono5i" Dysre.le:ia
# +riggers $ Distended ?ladder
$ Distention or "ontra"tion o. -is"eral organs
# >ri5arily ?o/el "onstipation or i5pa"tion $ Sti5ulation o. s
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Autono5i" Dysre.le:ia
# NursingMedi"al Manage5ent
$ =e5o-e trigger
$ +reatpre-ent "o5pli"ations
# Sitting position to de"rease B># =e5o-e "o5pression sto"
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>riority >ro?le5s
# Cer-i"al SCI
$ I55o?iliation o.
"er-i"al spine
$ Cer-i"al "ollar
$ 3se o. ?a"
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>riority >ro?le5s
# u5?ar SCI
$ Mo?ility
# Sa"ral SCI
$ Bo/el
$ Bladder $ Se:ual .un"tioning
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Se:ual =eha?ilitation /ith SCI
# Males $ =e.le: ere"tions 5ay o""ur
# >sy"hogeni" $ =esults .ro5 se:ual thoughts
# =e.le:ogeni" $ =esults .ro5 sti5ulation o. penis
J Changing "atheter J >ulling pu?i" hair
$ 3se.ulness .or se:ual a"ti-ity is -aria?le
# Spontaneous $ =esults .ro5 so5e type o. internal sti5ulation
J Full ?ladder $
Ho/ long ere"tion lasts /ill deter5ine use.ulness .or se:uala"ti-ity
$ 3sually la"< eja"ulation# ja"ulation 5ay "ause autono5i" dysre.le:ia
$ =e.er to urologist .or ne/ ere"tile and .ertilitytreat5ents
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Se:ual =eha?ilitation /ith SCI
# Fe5ales
$ =e5ain "apa?le o. se:ual inter"ourse
# a"< a?ility to a"hie-e orgas5
$ =e5ain "apa?le o. "on"eption $ Menses generally resu5es , 5onths
post injury
$ Monitor pregnan"y "losely due to ris<
.or pre5ature deli-ery and s5all?irth/eight in.ants
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