N220 3'1 The Spinal Cord And Peripheral Nervous System

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N220 3.1The Spinal CordAndPeripheral Nervous
System
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Back Pain

• Causes
• Trauma
• support structure
• vertebral support
• vascular changes
• disk degeneration

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Back Pain

• Assessment

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Back Pain

• History and assessment- Posture, gait.
• Paingt where, radiate, quality
• What have you been doing for it?

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Back Pain

• Number 1 Treatment??

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Back Pain - Treatment

• Medications, PT, massage, chiropractor, bed rest,
  braces, heat/ice, traction, .

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Back Pain - Surgery

• Diskectomy
• Laminectomy
• Spinal Fusion
• Chemonucleolysis
• Percutaneous Lumbar Diskectomy
• Microdiskectomy
• Laser-Assisted Laparoscopic Lumbar Diskectomy

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Back Surgery

• Post-op care
• Each patient is different

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Spinal Cord InjuryTypes of Cord Damage

• Concussion
• Contusion
• Lacerations
• Transection

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Spinal Cord Injury

• Mechanism of Injury
• Level of Injury
• Degree of Injury

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C1 nerve exit above C1 Vertebra
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Quadriplegic ?
Paraplegia ?
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Spinal Shock

• Causes
• Loss of motor sensory below lesion. Loss of
  sympathetic intervention

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Spinal Shock- Early

• Peripheral/ Capillary vasodilation
• Sympathetic system inhabited
• Phrenic nerve interrupted
• Ascending/descending pathways interrupted

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Spinal Shock- Early

• Signs Symptoms
• Decrease
• Temperature variation
• Immediate areflexia

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Spinal Shock

• 2 Days
• 7-10 days
• End

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• Autodestruction
• Secondary Injury

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Spinal cord injury - HEMORRHAGE

?Spinal Cord Blood Flow
? Spinal Cord Blood Flow
Tissue Hypoxia
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Autodestruction

• Hypoxia of cord cells
• Necrosis

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Autodestruction(Secondary Injury)

• 2 hours
• 4 hours
• 24 hours compression due to bleeding, vasospasm,
  edema etc. may cause damage above original injury
  site
• 48 hours
• 3-7 days

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Normal
Autonomic Dysreflexia
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Clinical Application

• Pete, 41
• Shot in back at C7-C8 and hit his head on a brick
  wall during his fall and brought in unconscience.

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Neuro Assessment
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Pete, 41 Shot in back at C7-C8 Nicked spinal cord
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Clinical Application

• Emergency Treatment
• Concern??
• Diagnostic tests

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Clinical Application

• Surgical interventions??
• Spinal Shock

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Clinical Application

• Week since injury
• What is my rehabilitation plan
• What is the most he can hope for?

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Degree of Injury
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Functional Mobility

• Transfers
• Weight shifts
• Wheeled mobility
• Sitting posture
• Bed mobility
• Transportation

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Activities of Daily Living

• Feeding
• Dressing
• Bathing/Grooming
• Bowel Bladder Management

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Clinical Application

• Bp 260/118
• P 54
• C/O blurred vision throbbing headache

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Neurogenic Bladder
Reflex bladder gt (upper motor neuron) spastic
bladder (injuries above T-12),
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Neurogenic Bladder
Flaccid bladder gt (Lower motor neuron)
retention and overflow, (in multiple sclerosis
and injury below T-12), problems at reflex arc
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Neurogenic Bladder
Uninhibited bladdergt affect cortical bladder
control center in brain (CVA brain injury),
little sensorimotor control and can not wait
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Spinal Cord Injury - Complications

• Respiratory
• Above C4
• Above T6
• Cardiovascular (Above T5)
• Renal
• Gastrointestinal (Above T-5)
• Musclesketical

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Other Spinal Cord Problems

• Spina Bifida Occulta
• Myelomeningocele
• Meningocele
• Myelocele

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Spinal Tumors
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Multiple Sclerosis
Central Nervous System
400,000 in US 2/3 female. 85 life expectancy.
Start 20-40.
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Multiple Sclerosis

• Autoimmune
• Chronic inflammatory disease with remissions and
  exacerbation

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Multiple SclerosisSymptoms

• Sensory Problems Paresthesias, include tingling,
  crawling sensations, tight-band feelings, and
  feelings of swelling
• Optic Neuritis blurred vision, which is followed
  by vision loss
• Spasticity Most patients complain of heaviness,
  stiffness, or pain in an extremity
• Balance/Coordination Gait and balance

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• Bladder Dysfunction Retention, urinary
  frequency, urgency, hesitancy, and incontinence
• Bowel Dysfunction Constipation
• Heat Sensitivity Heat is a common aggravating
  factor in MS

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• Cognitive and Emotional Dysfunction 40 have
  mild dysfunction, and 10 severe dysfunction
  common cognitive deficits involve memory,
  reasoning, verbal fluency, and speed of
  information processing

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Multiple SclerosisProblems

• Spasticity
• Tremor
• Bladder Dysfunction
• Bowel Dysfunction
• Fatigue
• Mood Alterations
• Chronic Pain

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Multiple SclerosisMedications

• Corticosteroids
• Cholinergic (urinary retention)
• Anticholinergic (urinary
  frequency)
• Muscle relaxants
• Mood elevators

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Multiple SclerosisMedications

• Plasmapheresis
• immunosuppressives
• Chemotherapy
• Corticosteroids
• Interferons

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Multiple Sclerosis MedicationsBiologic Response
Modifiers

• Interferon beta-1a Avonex IM every week or
  Rebif , sq taken 3 times a week
• Interferon beta-1b Betaseron sq every other
  day
• Glatiramer acetate Copaxone sq every day
• Natalizumab (Tysabri) IV Monthly

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Amyotrophic Lateral Sclerosis(Lou Gehrigs
Disease)
No known cause no cure not specific treatment
no standard pattern of progression no method of
prevention
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Amyotrophic Lateral Sclerosis(Lou Gehrigs
Disease)

• Amyotrophic (wasting of nerve cells controlling
  muscles)
• Lateral (at the side of the spinal cord )
• Sclerosis (scarring) and is due to death of nerve
  cells that supply muscles usually for the limbs
  but sometimes in the mouth and throat

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Amyotrophic Lateral Sclerosis(Lou Gehrigs
Disease)

• Motor neuron degeneration in brainstem, Spinal
  cord (Anterior horn cell), and motor cortex
• gtNo

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Amyotrophic Lateral Sclerosis(Lou Gehrigs
Disease)

• Rilutek - neuroprotective drug
• IgF-1, CNTF, etc.

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Amyotrophic Lateral Sclerosis(Lou Gehrigs
Disease)

• Nursing
• Prevent complications of immobility provide
  comfort.

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Clinical Application Guillain-Barré

• Fay, 22

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GBS Peripheral NS -- MS CNS
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Clinical Application Guillain-Barré

• Pathophysiology and Treatment
• Focus of nursing medical management?
• Back to Fay
• S/S Progression may lead to?
• Psychosocial needs
• Rehab

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Myasthenia Gravis (MG)

• Autoimmune disease of neuromuscular junction
• Message not passed

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Antibodies
Myasthenia Gravis
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Myasthenia Gravis
Regional distribution of muscle weakness
95 60 30 10
Percentage by effected areas
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Myasthenia Gravis
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Myasthenia Gravis (MG)

• Types
• Ocular
• Generalized
• Other
• Neonatal
• Congenital

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Myasthenia Gravis (MG)
Give on Time

• Treatment
• Anticholinesterase
• Immunosuppressants
• Corticosteroid Chemotherapeutic
• MUST AVOID MANY DRUGS
• Surgery - Thymectomy

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Myasthenia Gravis (MG) Crisis

• Cholinergic Vs. Myasthenic Crisis
• S/S Difficulty breathing, swallowing, chewing,
  or speaking. Increased salivation, bronchial
  secretions and sweating. Apprehension and
  restlessness

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Myasthenia Gravis (MG) Crisis

• Tensilon Test
• Improvesgt Myasthenic crisis
• Give Cholinergic drugs
• Gets Worstgt Cholinergic Crisis
• Reduce anticholinesterase doses

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Trigeminal NeuralgiaTic Douloureux
5th CN Effects Sensory only
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Trigeminal NeuralgiaTic Douloureux

• Goal
• Tx
• Meds
• Surgery
• Other
• Nursing

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Bells Palsy
CNVII
Cranial Nerve VII
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Bells Palsy

• Goal
• Tests
• Medications
• Nursing

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Polyneuropathy

• Cranial and peripheral nerves
• Muscle weakness with or without atrophy
• Pain, paresthesia, or loss of sensation
• Impaired reflexes

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Polyneuropathy

• Diseased (Diabetes, ETOH, Trauma, etc.)
• Vitamin deficiencies
• Drug use
• Environmental (Heavy metals, industrial solvents)

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Clinical manifestation of peripheral neuropathies
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Peripheral Nerve Trauma

• Assessment
• Surgery
• Rehab

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