Spinal Nerves & injuries
C4-C5 does which muscle group movement? and how do you assess?
Shoulders shrugged against downward pressure of examiners hand
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
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
C8 does which muscle group movement? and how do you assess?
Assess: hand grasp strength
L2 does which muscle group movement? and how do you assess?
Assess: leg lifted from bed against Resistance
L3 does which muscle group movement? and how do you assess?
Assess: Knee extended against resistance
L4 does which muscle group movement? and how do you assess?
Assess: Foot pulled up toward nose against resistance
S1 does which muscle group movement? and how do you assess?
Foot plantar flexion
Assess: foot pushed down against resistance (like stepping on gas)
Grading Scale for motor responses
0 is what?
unable to lift arm/leg even w/ painful stimuli
1 is what?
Flicker movement felt or seen in muscles
2 is what?
Moves limb but unable to raise the extremity off bed
3 is what?
Able to lift extremity off the bed briefly but no strength to life body
4 is what?
Able to lift extremity but difficulty resisting examiner
5 is what?
Able to lift extremity off bed and position against resistance from examiner
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
C1-C3 damage would cause what complication?
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.
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.
Name a couple of causes for Autonomic dysreflexia?
Distended bladder (most common cause)
fecal compaction (2nd most common cause)
irritation from bed linens
what are the S&S of autonomic dysreflexia?
elevated uncontrolled BP
flushing above the level of injury
how do you TX autonomic dysreflexia?
find and remove the cause of stimulation
if BP doesnt go down then give vasodilators.
what complications can occur from pt who have SCI?
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.
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)
and to check level of injury you check
-GCS, focal motor, pupils, brainstem
what diagnostics would you do for this?
LAbs: electrolytes, CBC, PTT, platelet ct, blood gas.
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.
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
Damage to c$-C5 causes what in pts with SCI?
phrenic nerve impairment that may be tx w pacemaker
injury from C5-T6 causes what complications?
intact diaphragmatic breathing with varying impairment of intercostal and abdominal muscle function