Final Exam

• characterized clinically as complete loss of motor and sensory function below the level of the traumatic lesion.

  complete cord syndrome
• variable neurologic findings with partial loss of sensory and/or motor function below the level of injury.

  Incomplete cord syndromes
• Injury to the spinal cord in the cervical region, with associated loss of muscle strength in all 4 extremities

  tetraplegia/quadraplegia
• Injury in the spinal cord in the thoracic, lumbar, or sacral segments, including the cauda equina and conus medullaris

  paraplegia
• what is significant about C2-C3 spinal cord injuries


  usually fatal secondary to respiratory death
• C4 innervates the...


  diaphragm
• C5 innervates the...


  shoulders
• C7 innervates the...

  elbows, wrist, and some hand/finger sensation
• what do cervical injuries typically result in?

  injuries think respiratory dysfunction. The higher the injury the more dangerous. They often need respiratory support including intubation/ventilation.
• what is significant about T6 and above?

  T6 and above patients can have autonomic dysreflexia.
• L2 injury affects...


  abdominal muscles
• S3 injury affects...


  bladder control
• S2 injury affects...

  erection problems, no ejaculation
• nursing education for CT scan w contrast

  Ask about allergies...iodine and shellfish! Don't for about renal function.
• nursing education for MRI


  think about metal and claustrophobia.
• priority assessment for spinal cord injuries

  assessing the airway! Then immobilization and stabilization of the head and neck.
• what medications are usually used to treat SCI?

  corticosteroids!!

  others:

  vasopressors

  antispasmotics

  paincontrol

  PPIs

  DVT prevention

  stool softeners
• why are steroids primarily used for SCI treatment?


  the goal is to decrease edema because this can lead to ischemia!!
• steroids should be initiated within how long since injury?

  8 hours
• explain Quad cough


  Assist patient with coughing. Push diaphragm to assist cough to bring up secretions

  o Atelectasis can happen due to poor cough effort. Lots of suctioning
• RotoRest Bed


  proper turning bed for SCI patients
• triad of neurogenic shock (think vitals)

  hypotension, bradycardia, vasodilation
• how long can neurogenic shock last?

  1-6 weeks

  can begin within hour of injury
• s/sx of neurogenic shock

  Flaccid paralysis below level of injury, loss of reflexes, loss of sensations of touch, temperature, pressure and pain, bowel and bladder dysfunction, loss of the ability to perspire
• treat neurogenic shock!

  FLUIDS usually 2 L

  if the fluid resuscitation does not increase the BP, consider vasoconstrictors such as norepi or dopamine
• how do we know neurogenic shock is over?

  when the vital signs have returned to normal and reflexes have returned.
• your SCI patient has a BP of 260/138, headache, and a HR of 50. what are you thinking?

  autonomic dysreflexia
• how to treat autonomic dysreflexia?


  find the cause and remove the perceived noxious stimuli. Raise the head of the bed.

  treat the HTN w agents such as sodium nitropresside, nifedipine, hydralazine.
• what is traction, and explain Gardner-Wells or Crutchfield tongs

  Traction is used to realign the vertebrae and prevent further injury. 4 pins are inserted into the skull, a rope with weights is attached to pull the spinal cord with traction to align the spine. DO NOT move or change the weights once the traction has been applied
• explain Halo external fixation device and how to manage this


  4 pins are inserted into the skull. The metal halo ring may be attached to a plastic vest. This device allows the patient more mobility. No bending at the waist.
• how often to clean pin sites for traction?

  ¼ strength hydrogen peroxide, approximately every 4 hours.
• what population do SCI usually affect?

  young males
• spine is not straight, slight curve vertebrae is slipped out of place

  Subluxation
• what is the preferred analgesic for SCI?

  hydromorphone or morphine
• a patient is complaining of pain from their traction site. What is the nurses priority?


  give pain meds

  remember never move or readjust traction once it is on!
• sedative options for BIPAP/vent

  ketamine (does not decrease BP), etomidate, midazolam
• paralytic options for mechanical ventilation


  o succinylcholine (causes hyperkalemia) short acting

  o rocuronium longer acting
• which burn?

  Only the epidermis is injured. Sunburn, ultraviolet light, mild radiation burns.

  Usually heals in 3-6 days.

  No scar formation

  superficial thickness burn
• which burn?

  The surface appears wound appears waxy and may be moist or dry

  deep partial thickness burn
• which burn?

  The burn is bright red, moist, glistening appearance with blister formation.

  superficial partial thickness burn