Spinal Nerves & injuries

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created 7 days ago by gagnerkrystal
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1

C4-C5 does which muscle group movement? and how do you assess?

Shoulder abduction

Shoulders shrugged against downward pressure of examiners hand

2

C5 does which muscle group movement? and how do you assess?

Elbow flexion (biceps) (anterior part of arm)

Arm pulled up from resting position against resistance

3

C7 does which muscle group movement? and how do you assess?

Elbow extension (triceps: posterior part of arm)

Assess: from flexed position, arm straightened out against resistance

& thumb-index finger pinch

Assess: Index finger held firmly to thumb against resistance to pull apart

4

C8 does which muscle group movement? and how do you assess?

Hand grasp

Assess: hand grasp strength

5

L2 does which muscle group movement? and how do you assess?

hip flexion

Assess: leg lifted from bed against Resistance

6

L3 does which muscle group movement? and how do you assess?

Knee extension

Assess: Knee extended against resistance

7

L4 does which muscle group movement? and how do you assess?

Foot dorsiflexion

Assess: Foot pulled up toward nose against resistance

8

S1 does which muscle group movement? and how do you assess?

Foot plantar flexion

Assess: foot pushed down against resistance (like stepping on gas)

9

Grading Scale for motor responses

0 is what?

unable to lift arm/leg even w/ painful stimuli

10

1 is what?

Flicker movement felt or seen in muscles

11

2 is what?

Moves limb but unable to raise the extremity off bed

12

3 is what?

Able to lift extremity off the bed briefly but no strength to life body

13

4 is what?

Able to lift extremity but difficulty resisting examiner

14

5 is what?

Able to lift extremity off bed and position against resistance from examiner

15

what motor loss do you have if damage is done to the C1-C4 area of the spinal cord?

Tetraplegia (quadriplegia) Lost: All motor function below the neck

16

C1-C3 damage would cause what complication?

ventilator dependency

17

Spinal shock happneds when?

Spinal shock is a state of areflexia, in which there is a loss of all motor, sensory, and reflex activity at the level of the injury and below. Spinal shock occurs as a result of the primary injury.

18

Secondary injury

...

19

When does neurogenic shock occur?

Neurogenic shock occurs when the normal impulses from the brainstem, which contribute to heart rate and blood pressure, are disrupted, resulting in interruption of normal sympathetic outflow.

bradycardia, peripheral vasodilation below the level of injury (resulting in decreased systemic vascular resistance), hypotension, and decreased cardiac output and hypothermia result.

20

Name a couple of causes for Autonomic dysreflexia?

Distended bladder (most common cause)

constipation

fecal compaction (2nd most common cause)

kinked catheter

tight clothing

irritation from bed linens

21

what are the S&S of autonomic dysreflexia?

elevated uncontrolled BP

bradycardia

blurred vision

diaphoresis

flushing above the level of injury

nasal congestion

22

how do you TX autonomic dysreflexia?

find and remove the cause of stimulation

loosen clothing

elevate HOB

if BP doesnt go down then give vasodilators.

23

what complications can occur from pt who have SCI?

pressure ulcers

bladder distention/loss of bladder control

GI slows and vomit and aspiration becomes a problem

Patients who have sustained an SCI above T12 have the potential for impairment of respiratory function.

24

what assessments should you do on a pt with a SCI?

Respiratory and neuro status (priority)

Airway and ventilation (intubation and vent may be needed)

GCS

and to check level of injury you check

-spinal nerves

-GCS, focal motor, pupils, brainstem

25

what diagnostics would you do for this?

CT myleogram

CT/MRI

LAbs: electrolytes, CBC, PTT, platelet ct, blood gas.

26

what types of complications occur with bowel and bladder in these pts?

spinal shock results in atony of the bowel and bladder so urinary retention happens.

catheter is required

GI decompression occurs: so check for BS and BM. The bowel program is initiated as soon as BS are present.

Skin: at risk for skin breakdown because of decreased circulation.

Psychological assessment: they experience anger and denial so include them in care plan.

27

what types of nursing and medical interventions are there for a pt with SCI?

Stabilization of spinal alignment (PREVENT hyperextension of spine)

cervical collar or halo vest maybe needed.

Halo vest: allows for diagnostics/surgery and early mobilization (perform pin care Q8hrs)

Maintain MAP at 85-90

avoid systolic less then 90

fluid volume & vasopressor may be needed.

Solumedrol: glucocorticoid needed for inflammation (check glucose levels)

preserving airway and resp status

watch for autonomic dysreflexia

first 72hrs NG tube is inserted for gastric decompression until bowels return. also helps with vomiting and aspiration.

skin dry and clean at all times

intermittent compression devices and heparin prophylaxis

if pt is not a candidate for anticoags-> vena cava filter

administer stool softeners to avoid constipation--> leads to autonomic dysreflexia

28

Damage to c$-C5 causes what in pts with SCI?

phrenic nerve impairment that may be tx w pacemaker

29

injury from C5-T6 causes what complications?

intact diaphragmatic breathing with varying impairment of intercostal and abdominal muscle function