Spinal C ord Injury Herniated Disc Spinal Cord Tumors. Pathophysiology Normal Spinal Cord. Spinal cord begins at the foramen magnum in the cranium Cord ends at the L1-L2 vertebra level Spinal nerves continue to the last sacral vertebra The Human Spine. Spinal Cord.
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Gray matter- cell bodies of voluntary and autonomic motor neurons
White matter axons of ascending and descending motor fibers
Posterior column (Dorsal)- touch, proprioception, and vibration sense
Lateral spinothalamic tract- pain and temperature sensation (only tract that crosses within the cord)
Originate in cerebral cortex
Result in skeletal muscle movement
Injury = SPASTIC paralysis
Lower Motor Neurons
Originate at each vertebral level
Project to specific parts of the body
Result in movement /sensation
Injury = FLACCID paralysis
Bones- vertebral column
Mechanism of Injury
Spinal cord level
Central Cord Syndrome
Upper and Lower Motor Deficits
Quadraparesis means what?
Emergency Care at Scene, ER & ICU
Surgery for SCI
Motor Assessment Upper Extremity
Motor Assessment Lower Extremity
No reflex from S2,3,4
Automatic empting of bladder
Urine fills the bladder and dribbles out
Need Foley or freq intermittent self catheterization
Reflex arc but no connection to or from brain
Reflex fires at will
Bladder training- trigger points to stimulate empting; self catheterization
C5-C6 disc- affects the 6th cervical nerve root
Extramedullary- arise from tissues outside the spinal cord may be benign or malignant
Intradural-from the nerve roots or meninges in subarachnoid space
Extradural- from the epidural tissue or vertebra
and bladder changes, Babinski reflex.
A 30-year-old was admitted to the progressive care unit with a C5 fracture from a motorcycle accident. Which of the following assessments would take priority?
While in the ER, a client with C8 tetraplegia develops a blood pressure of 80/40, pulse 48, and RR of 18. The nurse suspects which of the following conditions?
A 22-year-old client with quadriplegia is apprehensive and flushed, with a blood pressure of 210/100 and a heart rate of 50 bpm. Which of the following nursing interventions should be done first?
The nurse is caring for an elderly client diagnosed with a herniated nucleus pulposus of L4-L5. Which scientific rationale explains the incidence of a ruptured disc in the elderly?
A client is admitted with a spinal cord injury at the level of T12. He has limited movement of his upper extremities. Which of the following medications would be used to control edema of the spinal cord?
A client with a cervical spine injury has Gardner-Wells tongs inserted for which of the following reasons?
Which of the following interventions describes an appropriate bladder program for a client in rehabilitation for spinal cord injury?
A client has a cervical spine injury at the level of C5. Which of the following conditions would the nurse anticipate during the acute phase?
The nurse is evaluating neurological signs of the male client in spinal shock following spinal cord injury. Which of the following observations by the nurse indicates that spinal shock persists?
What can the nurse do to best speed the patients recovery from a laminectomy of L5?
Your patient has a malignant metastatic lesion at T8 and is in for palliative radiation. What is your main goal with this patient?