Summary
Summary NUR 440 Exam 5 Study Guide
- Course
- NURSING 440
- Institution
- Denver School Of Nursing
This is a comprehensive and detailed study guide on Exam 5 for Nur 440. An Essential Study Resource just for YOU!!
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MedSurgII Exam 5Spinal cord injuries SCI
Spinal cord injuries are most commonly associated with trauma
● Primary injury: initial, direct disruption to spinal cord
● Secondary injury: progressively worsening damage to spinal cord post initial injury
- ischemia, hypoxia, bleeding, edema -no room for swelling causing compression
- Big risk!
Spinal shock
- Pt may actually be fine but spinal shock can cause major loss of function and sensation
below level of injury; may seem Pt has a very bad issue but will go away after time
● Masks post-injury neuro function
- Occurs shortly after injury and can last for days-weeks
S/S: loss of deep tendon and sphincter reflexes, loss of sensation, flaccid paralysis
Neurogenic (vasogenic) shock
● Occurs at T6 or higher
● Sympathetic nervous system no longer has stimulation, leading to parasympathetic
responses to take over
S/S: vasodilation of peripheral vessels … Leading to hypotension and bradycardia causing
decreased cardiac output, venous pooling, decreased perfusion, temp dysregulation
- Medications to give: atropine, vasopressors/vasoconstrictors
Level of injury
- Skeletal level: actual vertebral level with most damage - most commonly used
- Neurologic level: lowest segment of spinal cord with normal sensory and motor function
on both sides of body
- C-spine is highest risk for fracture due to the flexibility
● C1 - T1: tetraplegia -impartiment to all four extremities
● T2 - below: paraplegia -paralysis and loss of sensation in lower extremities
, MedSurgII Exam 5
Motor and sensory effects
● Dermatomes: sensory regions
- In general, sensory levels correlate with motor function at all levels
- When testing dermatomes, start low; test with cold or sharp sensation
Respiratory involvement
● C3 - above: total loss of respiratory muscle function
- MUST be intubated within minutes to avoid respiratory arrest
● C3 - C5: respiratory insufficiency
- Also needs to be intubated in minutes
- Decreased chest/abdominal wall strength
● Complete C5 and above need to be intubated!!
- Incomplete at C5 and higher can be at risk, but do not always need to be
intubated, assess Pt
Always have C-spine precautions with any suspected injuries
Cardiovascular system
● Sympathetic nervous system dysfunction at T6 or higher
- Peripheral vasodilation leads to venous blood pooling leading to relative hypovolemia
- Pt at risk for VTE venous thromboembolism
- VTE prophylaxis: needs SCDs prophylactic anticoags
Urinary system
● Neurogenic bladder: altered or absent bladder stimulation
- High likelihood of requiring foley catheter to avoid bladder rupture
Gastrointestinal system
● Neurogenic bowel: loss of voluntary control of bowel; decreased GI motor activity
- Gastric distension, paralytic ileus -NG or OG tube can be placed to feed
- Pt may be placed on PPI proton pump inhibitors to decrease risk of ulcers
● Bowel regimen/program: scheduled daily, digital stimulation
Integumentary involvement
● Risk for skin breakdown over bony prominences; turn Pts Q2h
- Maintain c-spine precautions with cervical injuries
- Log-roll technique
Thermoregulation
● Poikilothermia: inability to maintain a constant core temperature
- Pt assumes temperature of environment
Nonoperatively stabilization
● Stabilization of injured spinal segment and decompression
- Traction: helps with decompression and realignment
- Halo: long term stabilization; cannot do CPR; know how to remove vest; pin site care
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