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TEST 2 - NSG 252 – Mobility test questions with 100- correct answers.
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TEST 2 - NSG 252 – Mobility test questions with 100- correct answers.
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TEST 2 - NSG 252 – Mobilitytest questions with 100%
correct answers
SPINAL CORD INJURY
Spinal Cord Injury
Pathophysiology
Spinal cord injuries (SCIs) are classified as complete or incomplete
A complete SCI is one in which the spinal cord has been damaged in a way
that eliminates all innervation below the level of the injury
Injuries that allow some function or movement below the level of the
injury are described as an incomplete SCI
Incomplete injuries are more common than complete SCIs
Loss of or impaired motor function (mobility), sensory perception, and
bowel and bladder control often result from an SCI
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Spinal Cord Injury
Pathophysiology
,Mechanisms of Injury
When enough force is applied to the spinal cord, the resulting damage
causes many neurologic deficits
Sources of force include:
- Direct injury to the vertebral column (fracture, dislocation, and
subluxation [partial dislocation])
- Penetrating injury from violence (gunshot or knife wounds)
Although in some cases the cord itself may remain intact, at other times it
undergoes a destructive process caused by
a contusion (bruise), compression, laceration, or transaction (severing of
the cord, either complete or incomplete)
The causes of SCI can be divided into primary and secondary
mechanisms of injury
Five primary mechanisms may result in an SCI:
1. Hyperflexion
2. Hyperextension
3. Axial loading/vertical compression
4. Excessive rotation
5. Penetrating trauma
Secondary injury worsens the primary injury
Secondary injuries include:
• Hemorrhage
• Ischemia (lack of oxygen, typically from reduced/absent blood flow)
• Hypovolemia (decreased circulating blood volume)
• Impaired tissue perfusion from neurogenic shock (a medical emergency)
• Local edema
Hemorrhage into the spinal cord may be manifested by contusion or
petechial leaking into the central gray matter and later into the white
matter
Systemic hemorrhage can result in shock and decrease perfusion to the
spinal cord
Edema occurs with both primary and secondary injuries, contributing to
capillary compression and cord ischemia
,In neurogenic shock, loss of blood vessel tone (dilation) after severe cord
injury may result in hypoperfusion
Hyperflexion
A sudden and forceful acceleration (movement) of the head forward,
causing extreme flexion of the neck
This is often the result of a head-on motor vehicle collision or diving
accident
Flexion injury to the lower thoracic and lumbar spine may occur when the
trunk is suddenly flexed on itself, such as occurs in a fall on the buttocks
Hyperextension
Occurs most often in vehicle collisions in which the vehicle is struck from
behind or during falls when the patient's chin is struck
The head is suddenly accelerated and then decelerated
This stretches or tears the anterior longitudinal ligament, fractures or
subluxates the vertebrae, and perhaps ruptures an intervertebral disk
As with flexion injuries, the spinal cord may easily be damaged
Axial Loading/Vertical Compression
Injuries resulting from diving accidents, falls on the buttocks, or a jump in
which a person lands on the feet can cause many of the injuries
attributable to axial loading (vertical compression)
A blow to the top of the head can cause the vertebrae to shatter
Pieces of bone enter the spinal canal and damage the cord
, Excessive Rotation
Results from injuries that are caused by turning the head beyond the
normal range
Penetrating Traumas
Classified by the speed of the object (e.g., knife, bullet) causing the injury
Low-speed or low-impact injuries cause damage directly at the site or local
damage to the spinal cord or spinal nerves
In contrast, high-speed injuries that occur from gunshot wounds cause
both direct and indirect damage
Spinal Cord Injury
Etiology
Trauma is the leading cause of spinal cord injuries (SCIs), with more than a
third resulting from vehicle crashes
Other leading causes are:
- Falls
- Acts of violence (usually gunshot wounds [GSWs])
- Sport-related accidents
SCIs from falls are particularly likely among older adults
Spinal cord damage in adults can also result from nontraumatic vertebral
fracture and diseases such as benign or malignant tumors
Spinal Cord Injury
History
When obtaining a history from a patient with an acute SCI, gather as much
data as possible about how the accident occurred and the probable
mechanism of injury once the patient is stabilized
Questions include:
• Location and position of the patient immediately after the injury
• Symptoms that occurred immediately with the injury
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