neuro stressors ii student ppt
TRANSCRIPT
Neurologic Stressors II
Victoria Siegel, RN, CNS, MSNJoy Borrero, RN, MSN
12/10
Spinal Cord Injury Incidence- 10-12,000/year 50-60% are cervical Cervical spine injury- C5, C6, C7 most
common Damage range is from concussion (with full
recovery, to contusion, laceration and compression to complete transection
Early tx prevents total and permanent damage
Spinal Cord Injury Stressors: Congenital – Spina bifida,meningomyelocele. Physical Trauma – Sports injuries, car
accidents, gunshot wounds, diving. Microbiological – Polio, meningitits. Physiological- neoplasms, herniated disc,
scoliosis.http://www.spinalcord.org/
Spinal Cord Injury Extent of alteration in function depends on: Degree and Location of injury Quadriplegia, tetraplegia- above C4 Paraplegia= lesion thoracic or lumbar region Spinal cord compression- function may be
preserved with prompt surgical intervention.
Spinal cord injury Hyperflexion – forward cervical injury Hyperextension – backward cervical injury Axial loading – vertical compression Rotation – rotate head beyond it’s range Penetration – GSW ,knife
Initial Assessment Assessment of the respiratory pattern
and ensuring an adequate airway Assessment for indications of intra-
abdominal hemorrhage or hemorrhage or bleeding around fracture sites
Assessment of level of consciousness using Glasgow Coma Scale
Establishment of level of injury: tetraplegia, quadraplegia, quadriparesis, paraplegia, and paraparesis
Cardiovascular Assessment Cardiovascular dysfunction is usually the result of
disruption of the autonomic nervous system. Bradycardia, hypotension, and hypothermia result
from a loss of sympathetic input and may lead to cardiac dysrhythmias.
Systolic blood pressure lower than 90 mm Hg requires treatment because lack of perfusion to the spinal cord worsens the condition.
Spinal Cord Injury Complete- spinal cord has been severed Incomplete- cord not completely severed C2 or C3 fractures- complete respiratory
paralysis, complete flaccidity and loss of reflexes, death
C1-C3 needs mechanical ventilation C4- may need CPAP or BiPAP for nocturnal
hypoventilation C5,C6,C7- most common injury
Effects of injury can be reversed depending on level of injury Loss of: 1. Motor function 2. Sensation 3. Reflex activity 4. Bowel/bladder control Behavior/emotional problems 1. Changes in body image 2. Role performance 3. Self-concept
Spinal Cord Injury- management Scene of accident- maintain proper
alignment. Pt kept on back board until x –rays are taken. Diagnostic tests – X-ray, CT, cardiac
monitoring- cervical injuries. Pharmacotherapy- high dose corticosteroids
to decrease edema. Dextran –plasma volume expander, maintain
BP and capillary flow.
Autonomic dysreflexia Commonly seen in clients with upper spinal
cord injury Occurs after spinal shock Cause is some noxious stimuli such as … s/s include severe hypertension,
bradycardia,,severe headache ,nasal stuffiness, flushing above site of SCI, piloerection
Spinal Cord Injury- Autonomic DysreflexiaEmergency: Severe, pounding headache Paroxysmal hypertension, flushing Profuse diaphoresis, bradycardiaInterventions: Remove stimulus – e.g., empty bladder… Sit patient up to decrease BP Apresoline may be given IVP.
Spinal Cord Injury Teaching Plan for pt. with SCI:
Physical mobility and activity skills ADL skills Bowel and bladder retraining Skin Care Medication regimen Sexuality education
Spinal Cord Injury-Outcomes Evaluation of Nursing Interventions:
Attain highest level of mobility Maintain healthy, intact skin Bladder control, free of infection Bowel control Reduction in spasticity Free of complications.
Spinal Shock
Condition characterized by: Flaccid paralysis Loss or reflex activity below injury. Bradycardia Paralytic ileus (occasionally) Hypotension
Immobilization for Cervical Injuries to prevent Ineffective Tissue Perfusion
Fixed skeletal traction to realign the vertebrae, facilitate bone healing, and prevent further injury
Halo fixation and cervical tongs Stryker frame, rotational bed, kinetic
treatment table Pin site care and monitoring of traction
ropes
Immobilization of Thoracic and Lumbosacral Injuries For clients with thoracic injuries: bedrest
and possible immobilization with a fiberglass or plastic body cast
For clients with lumbar and sacral injuries: immobilization of the spine with a brace or corset worn when the client is out of bed; custom-fit thoracic lumbar sacral orthoses preferred
Drug Therapy for SCI Corticosteroids - Methylprednisolone ,
solumedrol Plasma expanders - Dextran Atropine sulfate Vasopressor - Dopamine hydrochloride Analgesics – opiods /NSAIDS Antispasmodics-Dantrolene, Baclafen DVT prophylactics –
Surgical Management Emergency surgery necessary for spinal
cord decompression Decompressive laminectomy Spinal fusion Harrington rods to stabilize thoracic
spinal injuries
Spinal Cord Tumors Surgical management: goal of removing as
much of the tumor as possible Nonsurgical management: radiation therapy,
chemotherapy, pain control Nonsurgical management- RT, CT, pain control Diagnosis – Neuro exam, CT, MRI. Assess- Pain,sensory & motor loss, sphinctor
disturbances
Spinal Cord Tumors Post –op nursing care: Neuro assessment – motor and sensory Resp compromise- assess with cervical
tumors Bladder and bowel functioning Pain management Observe dressing for possible leakage of
CSF
Back Pain Low back pain Herniated nucleus pulposus Physical assessment: continuous acute
pain, altered gait, vertebral alignment, paresthesia
Diagnostic assessment using MRI, CT, and electromyography
Conservative Management Positioning Firm mattress Exercise and physical therapy Pharmacology Heat and Ice Diet therapy Complementary and alternative tx
Herniated disc Herniated disc – The nucleus of the disc
protrudes out, causing nerve compression. Diagnostic tests – Neuro exam and history, Xrays, CT and MRI, myelogram, EMG.
Herniated discNursing Diagnoses; Pain related to surgical procedure Impaired physical mobility Knowledge deficit related to procedure or home care
management.Nursing Interventions: Relieve pain Monitor for complications Improve mobility Pt. education and home care management
Herniation of Cervical Disc
Immobilization – collar, traction or brace Pain relief – hot, moist compresses, meds MIS cervical diskectomy with/without fusion Postop care
Herniation of a Lumbar Disc L4 or l5 – S1 Sciatic pain, straight leg raise
test. Neuro exam and history. MRI, CT, and myelogram.
Management- Bed rest, not supported by research Anti inflammatory and muscle relaxants Moist heat and massage, Heat/Ice Epidural corticosteroids.
Surgical Management Preop care Diskectomy Laminectomy Spinal fusion (arthrodesis) Minimally invasive lumbar procedures,
such as percutaneous lumbar diskectomy, microdiskectomy, laser-assisted laparoscopic lumbar diskectomyhttp://www.youtube.com/watch?v=EvQPZxXr3Rs
Post –op care Neurovascular checks Log rolling Muscle relaxants, pain management Bowel and bladder function Prevent infection, assess CSF leakage Prevent complicationsPatient Teaching: Body mechanics, avoid strain, maintain alignment Sit with knees higher than hips Maintain appropriate weight Exercise 15 min BID. Avoid standing long periods,
foot stool. Sleep on side with pillow between knees.