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LSC-Ch 45 Spinal Cor

Nursing

QuestionAnswer
Factors Contributing to Low Back Pain changes in support structures-spinal stenosis, osteoarthritis, change in vertebrall support & alignment-scoliosis, lordosis, Vascular changes, intervertebral disc generation
Prevetion of Low Back Pain & Injury use proper body mechanics, get assistance, exercise, no high heals, good posture, avoid prolong sitting/standing, keep weight within 10% of ideal body weight, stop smoking
Diagnostics - Low Back Pain CT w or w/o contrast, MRI, EMG & Nerve Conduction
Non Surgical Interventions Back Pain I William's Position-semi-fowler's position pillow under knees to keep flexed, change positions frequently, dont just lie in bed-exercise Firm Mattress/Backboard under soft mattress
Non Surgical Interventions Back Pain II Heat & Ice- Heat Promotes Circulation use for 20-30minutes, Deep Heat uS & Diathermy, Phenophoresis-topical lidocaine &/or hydrocortisone cream f/u with US 10min, Ice-reduces inflammation 10-15min
Extension Exercises Stomach Lying Upper trunk Extension, Prone Pushups
Flexion Exercises Pelvic Tilt, Semi Sit Ups, Knee to chest
Drug Therapy For Back Pain NSAIDS Ibuprofen 800mg rx strength, Muscle relaxants Flexeril-sleepy, Chronic Pain-neurontin, Chronic Neuropathic pain-Oxcarbazepine (Trileptal)
Surgical Interventions For Back Pain Diskectomy, Laminectomy, Spinal Fusion, Interbody cage fusion, Direct Current stimulation:implantable promote bone fusion
Surgical Procedure For Back Pain MIS-home same day, Conventional Open Surgery-VS, Laminectomy checks, cervical movement, sensation in arms, all the functions in legs as well as feet, Voiding, CSF leak, Post Op Bleeding, Pain Control, Log ROll, TCDB, IS
Complications for Back Most Common Complications: CSF Leak & urinary Retention-Men Stand
Care after Back Surgery Firm Mattress, Bed Board, Lifting Restrictions 5# gradually increase, weight reduction, moist heat, Exercise PT-2WEEKS after surgery, conventional surg RTW: 4-6wks, MIS 3wks, proper body mechanics after surgery
Cervical Neck Pain 5th&6th Vertebrae, Neck & Arm Pain, Herniation of nuceus pulposus resulting in spinal nerve root compression
Interventions for Cervical Neck Pain Same as for lower back pain except exercises are related to shoulders/arms: shoulder shrugs, shoulder squeeze, rowing PRIORITY NURSING POST OP: Airway & Breathing
Spinal Cord Injury Hyperflexion, Hyperextension, Axial loading, Vertical Extension, Excessive rotation, 2ndary Injuries: Ischemia, Neurogenic Shock, Hemorrhage,
Anterior Cord Syndrome Loss of pain, tempsensation, motor function, still have touch, position & vibration sensation
Posterior Cord Syndrome Retain Motor Function, Lose touch position, vibration
Brown Sequard Penetrating injuries affecting half of the spinal cord; SAME SIDE: loss of motor function, proprioception & deep touch OPP SIDE: Loss of pain sensation, temp, & light touch
Central Cord Syndrome central of spinal cord is affected, Loss of motor function of UE more than in LE
Dmage to Cauda Equina or Conus Medullaris (Horse's Tail) Variable motor & sensory loss, injuries in this area have potential for recovery and regrowth, no nerve control to B&B
SBAR Situation, Background Assessment Response
Physical Assessments for SCI ABC's, Resp. Impairment-Cervical, note breathing pattern, look for other causes of resp distress, may need to be intubated or vent, SaO2 & PaO2, Abd-hemorrhage signs: low bp, tachycardia, weak pulse, U/O, Glascow Coma Scale: LOC
Level Of Injury Cervical, High Thoracic: Quadriplegia/Tetraplegia, Quadriparesis. Lower Thoracic Lumbar: Paraplegia, Paraparesis
Assessment Sensation (SIC) Light touch/Pin Prick Complete Loss, Hypoesthesia, Hyperesthesia, proprioception- move fingers/toes up or down
Assessment Motor Ability (SCI) Flex, Extend, Joints shoulder to fingers, hips to toes
Assessment Cardiovascul (SCI) above 6th Cervical: Disruption of sympathetic function, bradycardia, hypotension, hypothermia, cardiac dysrhythmias, Keep BP above 90mmHG to perfuse SC
GI/GU Assessment (SCI) Decreased Peristalsis, Note abd distention: paralytic ileus, bleeding, monitor abd pain, firm, Nueruogenic bladder/urine retention, monitor UTI, Foley Cath - Cloudy Urine
Musculoskeletal Assessment (SCI) Muscle wasting/flaccid paralysis, muscle spasticity/contractures, Monitor SKIN, Pressure reducing Mattress, Log roll every 2hrs
LABS and Dx Tests for SCI Urine Analysis, ABG's (risk for pneumonia), Hgb, Hct, WBC, Platlets drop, CT and/or MRI, Leel of SC injury, presence of blood and bone in SC
Nursing Diagnosis SCI: Ineffective Tissue Perfusion Reduce & Immobilize Fx Neuro checks, VS Pulse Oximetry Pain, Neurogenic Shock-life threatening, severe bradycardia & hypertension warm dry skin, POSITIONING: Prevent further cord injury, immobilize cervical spine, cervical tongs w/traction
Cervical Traction Keeps vertebrae from compressing SC (reduce fx) Used until pt is stabilized for surgery, Vertebra stabilized w/surgery, Cervical & upper thoracic injuries-Halo fixator until bone regrows 6mo, pin care-betadine swab or ETOH, Skin Care, Lower Thoracic: TLSO
Drug Therapy for SCI Methylprednisonlone (Solu-Medrol) reduces inflammation at SC Injury, Hope to regain 1-2levels of SC function, Monitor BG, signs of infection, stress ulcers. Dextran: Plasma expander, Atropine: Bradycardia, Dopamine: Hypertension
More Drugs for SCI Muscle relaxants, Intrathecal Baclofen or Dantrium infusion pump: Decreases muscle spasticity w/o severe drowsiness, Celebryx-prevent bony overgrowth
Surgical Mgmt Decompressive Laminectomy-allows cord expansion from edema, spinal usion, steel rods, needs halo/brace during recovery. Post Op Neuro Checks, VS
Ineffective Airway Clearance: Nursing Diagnosis SCI Interventions: TCB, Cough Assist, IS, Level of injury determines if intubation or trach are necessary, risk: PE or Pneumonia
Impaired Physical Mobility: Nursing Diagnosis SCI Intervenions: #1SKIN B/D! Positioning, Teach to reposition self(Lower level injuries), Pressure reducing devices for wc, monitor for hypotension w/position changes
Impaired Urinary Elimination &/OR Constipation Nursing Diagnosis SCI Establish B&B program, Valsalva to empty bladder (Pressing down on bladder), Intermittent self cath (q3-4hrs), Risk: Long Term Kidney Stones, Unaware of infection, need to void, urgency
Interventions continued for Bowel Program SCI Stool Softners, Increased Fluid Intake, Fiber in Diet, COnsistent time to eacuate, digital stim, ducolax suppository
Autonomic Dysreflexia Uncontrolled Sympathetic stim from a noxious stimulus: Full Bladder, Shoes tied too tight, Constipation Neurological EMERGENCY Sudden hypertensive Crisis
Symptoms of Autonomic Dysreflexia Sudden onset severe throbbing HA, Severy rapidly occuring Hypertension, Bradycardia, Flshing above level of lesion (face&chest) Pale extremities below lesion, Nasal Stuffiness, Sweating, Nausea, Blurred Vision, Piloerection, Apprehension
Autonomic Dysreflexia Interventions Place in sitting position*, page/notify physician, loosen tight clothing, assess for & treat the cause, check catheter for kinks, check bladder distention, check for fecal impaction, check room temp, monitor bp q10-15min, give nitrates or hydralazine
Multiple Sclerosis MS Chronic Autoimmune disease afecting mylelin sheath & conduction pathways of CNS, characterized by periods of remissions & exacerbations-most common, mild to mod disease, relapses occur for 1-2 weeks and remission over 4-8mos return to baseline.
Assessment of MS Dx can be difficult due to mimicking of other diseases, thorough hx, vision changes, motor skills, sensations, often vague, aggravating factors: stress, overexertion, temp extremes, personality changes
Motor Assessment of MS weakness clumsy, loss of balance, unsteady gait, poor coordination, fatigue, intenion tremors, flexor spasms at night, dyspagia
sensory Assessment of MS Hypalgesia (decreased sensativity to pain), Paresthesia (pins&needles), Numbness, tingling, and burning, crawling sensations, facial pain, diplopia, blurring, decreased temp recognition, b&b incontinence, sex dysfunction
Cognitive & Psychosocial Assessment of MS Mental status changes usually not seen til late in disease, Decreased Short term memory, Concentration and ability to perform calcuations, inattentiveness, impaired judgment, anxiety, fear apathy depression, lability
Nursing Dx for MS Fatigue, Activity Intolerance, Disturbed Sensory Perception, Impaired Physical Mobility, Impaired Urinary Elimination, Chronic Pain
Drug therapy for MS BRM's Interferon: Avonex IM Inj, Betaseron: SQ Inj, Copaxone SQ Inj, Monoclonal Antibody: Natalizumab (Tysabri) ANticholinergics: bladder dysfunction. MANY SE: Suicide, depression, thrombocytopenia, leukopenia
More Drug Therapy for MS Steroids: Methylprednisolone (Solu-Medrol) IV corticosteroids, nursing considerations: Fluid & Electrolytes, blood glucose, K+, GI Bleeds, Ulcers, Personality changes, decreasing exposure to infectious diseases, steroid rages
More Drug Therapy FOR MS Antispasmodics: Baclofen, Diazepam, or Dantrium for muscle spasms, Adjunctive Therapy meds to treat symptoms including bladder spasms, paresthesia, pain, uncontrolled fatigue (belladonna suppository to decrease bladder spasms
Health Teaching for MS Exacerbations & Remissions, Avoid over exercise, extremes of temps, people w/URI's, PT, use of adaptive equipment, B/B mgmt, need for daily rest/avoid stress
Amyotrophic Lateral Sclerosis (ALS) Progressive & degenerative disease of motor system, atrophy of hands, forearms & legs, results in paralysis & eventually death, no cause, cure, prevention, or standard of tx, no changes in mental status flacid quad, Dvlp Pneumonia, 2-5yrs to live
Clinical Manifestations of ALS Fatigue, especially w/speech, tongue atrophy, dysphagia, muscle weakness & atrophy, nasal quality to voice, dysarthria (slurred speech), resp compromise
Drug Therapy for ALS Riluzone (rilutek) is used to extend survival time. Liver toxic so enzymes must be monitored. Multiple other meds to treat pain, spasms, excessive secretions, and aid in sleep
Created by: ginabeana
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