Chapter 45: Head - PowerPoint PPT Presentation


Title: Chapter 45: Head


1
Chapter 45 Head Spinal Cord Trauma
  • Medical-Surgical II
  • Spring Semester
  • Karyn Mills, RN, BSN

2
(No Transcript)
3
Concussion Pg. 721
  • Violent jarring of brain after a blow to the head
  • temporary loss of cerebral function with no
    damage to cerebral tissue
  • Loss of consciousness, followed by headache,
    irritability, dizzy spells, confusion

4
Concussion
  • Observe for several days for neuro
    symptoms....changes in behavior, speech, gait or
    other abnormality should return to ER
  • Recovery is complete and usually occurs in a
    short time
  • Must monitor vital signs carefully to prevent
    complications

5
Concussion
  • May be sent home
  • instruct family to check LOC and ability to move
    and talk q hour while awake
  • Arouse him q 2 hours during night to determine
    LOC and ability to respond to questions

6
Concussion
  • Observe for changes in behavior, speech, or other
    abnormality for 2 to 3 days

7
Contusion pg 722
  • Is more serious than a concussion, results in
    gross structural injury to the brain

8
Contussion
  • The brain is injured when the head is struck
    directly, a COUP INJURY.
  • Dual bruising can result if the force is strong
    enough to send the brain ricocheting to the
    opposite side of the skull, a CONTRECOUP INJURY.

9
CONTUSION
  • Result in bruising and possibly hemorrhage of
    superficial cerebral tissue.
  • Edema develops at the site of injury or in areas
    opposite to the injury.
  • A skull fracture can accompany a contusion.

10
Contusion S/S
  • Hypotension, rapid weak pulse, shallow resp.,
    loss of consciousness pale cool skin
  • While unconscious, the client generally responds
    to strong stimuli like pressure applied to the
    sternum.
  • On awakening, the client often has temporary
    amnesia (loss of memory) for recent events.
  • Permanent brain damage can cause impaired
    intellect, speech difficulty, seizures,
    paralysis, and impaired gait.

11
Contusion
  • CT or MRI may show bleeding or small hemorrhages,
    a shift in brain tissue edema at injury site
  • Nurse observes LOC for ICP and does neuro
    assessment

12
Cerebral Hematomas pg 723
  • Bleeding within the skull that forms an expanding
    lesion.
  • 1. Epidural hematoma
  • 2. Subdural hematoma
  • 3. Intracerebral hematoma
  • Most hematomas are the result of head trauma or a
    cerebral vascular disorder.

13
Epidural Hematoma pg 723
  • Caused by arterial bleeding and accumulation of
    blood above the dura

14
Subdural Hematoma
  • Occurs as a result of venous bleeding and the
    accumulation of blood in the space below the
    dura.

15
Intracerebral Hematoma
  • Is bleeding within the brain that results from an
    open or closed head injury or from a
    cerbrovascular condition such as a ruptured
    cerebral aneurysm

16
Those at High Risk
  • Receiving anticoagulant therapy
  • Underlying bleeding disorders such as hemophilia,
    thrombocytopenia, leukemia, and aplastic anemia
  • Bleeding increases the volume of brain contents
    and results in IICP.
  • As the ICP increases, cerebral blood flow is
    disrupted and brain becomes hypoxic.

17
Cerebral Hematomas
  • Unrelieved pressure causes the brain to shift to
    the lateral side (uncal herniation) or herniate
    downward through the foramen magnum.
  • The vital centers for respiration, heart rate,
    and blood pressure are affected as well as
    cranial nerve functions.
  • Death occurs if the symptoms are not recognized
    and the bleeding is not stopped.

18
S/S
  • The rapidity and severity of neurologic changes
    depends on the location, the rate of bleeding and
    size of hematoma, and effectiveness of
    autoregulation, the brains ability to provide
    sufficient arterial blood flow despite rising ICP.

19
Medical Management
  • Some subdural hematomas become walled off and
    absorbed by the body with no treatment.
  • However, a rapid change in LOC and signs of
    uncontrolled IICP indicate a surgical emergency.

20
Surgical Management
  • Surgery consists of drilling holes (burr holes)
    in the skull to relieve pressure, removing the
    clot, and stopping the bleeding.
  • If the source of bleeding cannot be located by
    means of burr holes, more invasive surgery is
    performed.
  • Intracranial surgery consists of 3 possible
    procedures craniotomy, craniectomy, and
    cranioplasty. (Read on your own)

21
Nursing Management pg 725
  • Regard a head injury, no matter how mild it
    appears, as an emergency.
  • Obtain a history of the injury and perform a
    neurologic examination with particular attention
    to vital signs, LOC, presence or absence of
    movement in the arms and legs, pupil size,
    equality, and reaction to light for evidence of
    IICP.

22
Preoperative Nursing Management
  • Shave the head in the are where burr holes will
    be drilled (this is sometimes deferred until the
    client is in the operating room)
  • Take V/S
  • Adm. Prescribed medications such as an
    anticonvulsant like dilantin to reduce the risk
    of seizures before, and after surgery, an osmotic
    diuretic, and corticosterioids.
  • Pre-op sedation is generally omitted.

23
Preoperative Nursing
  • Restrict fluids to avoid intraoperative
    complications, reduce cerebral edema, and prevent
    postoperative vomiting
  • Insert indwelling catheter
  • Insert IV line
  • Apply antiembolism stockings to prevent
    thrombophlebitis and deep vein thrombosis, which
    develop from prolonged immobility during
    neurosurgery.

24
Postoperative Nursing Care
  • After surgery, place the client in either a
    supine position or a side-lying position on the
    unaffected side
  • Postoperative assessments are performed at 15 to
    30 minute intervals and include all areas of
    neurologic function.
  • Edema around the eyes (periorbital edema) may
    make examination of the pupils difficult during
    the immediate post-op period

25
Postoperative Nursing Care
  • Ecchymosis can also be present.
  • Maintain a neurologic flow sheet to compare
    assessment findings
  • Administer corticosteroids and restrict fluids as
    ordered to control cerebral edema and to increase
    cerebral perfusion
  • NEVER GIVE D5W TO A NEURO PT!!!

26
Care Plan Family Teaching
  • On your own!!!!

27
Review Table 45-1 Pg. 724
  • Differences in Cerebral Hematomas
  • ON YOUR OWN!!

28
Skull Fractures pg 725
  • A skull fracture is a break in the continuity of
    the cranium.
  • A skull fracture is caused by a blow to the head.

29
Skull Fractures
  • The most common types are simple, depressed, or
    comminuted fractures. (Table 45-2 PG. 730)

30
Skull Fractures Patho
  • The fracture can be associated with an open head
    injury in which the scalp, bony cranium, and dura
    mater (the outer meningeal layer) are exposed.
  • There may be a closed head injury in which the
    fractured skull remains covered by an intact
    layer of scalp.

31
Skull Fractures Patho
  • Open head injuries create a potential for
    infection due to exposure to the environment.
  • They are less likely to produce rapid
    intracranial hypertension (IICP) because the
    opening provides some ability for the brain to
    expand as pressure increases.

32
Basilar Skull Fractures
  • Located at the base of the skull.
  • Trauma in this location is especially dangerous
    because it can cause edema of the brain near the
    origin of the spinal cord (foramen magnum),
    interfere with the circulation of CSF, injure the
    nerves that pass into the spinal cord, or create
    a pathway for infection between the brain and the
    middle ear that can result in meningitis.

33
S/S
  • Simple skull fractures produce few, if any,
    symptoms and heal without complications.
  • May c/o of a localized headache. A bump, bruise,
    or laceration may be found on the scalp.

34
(No Transcript)
35
S/S
  • Because basilar skull fractures tend to TEAR the
    dura, rhinorrhea, leaking of CSF from the nose,
    or ottorrhea, leakage of CSF from the ear, may
    occur.
  • In some cases periorbital ecchymosis, referred to
    as raccoon eyes, or bruising of the mastoid
    process behind the ear, called Battles sign, can
    be present.

36
PG. 730
37
S/S
  • Conjunctival hemorrhages can occur as well.
  • Seizures may occur because of injury to the brain
    tissue.
  • Epilepsy can develop as a sequela of head injury.

38
Medical Management
  • Simple skull fractures require bed rest and close
    observation for signs of IICP.
  • If the scalp is lacerated, the wound is cleaned,
    debrided, and sutured.
  • Depressed skull fractures require a craniotomy to
    remove bone fragments and control bleeding,
    elevation of the depressed fracture, and repair
    of damaged tissues.

39
Medical Management
  • Antibiotics to control infection, an osmotic
    diuretic or corticosteroids to prevent or treat
    cerebral edema, and an anticonvulsant to prevent
    or treat seizures.

40
Nursing Management pg 731
  • Most clients are hospitalized for 24 hours or
    more after a significant head injury
  • Use methods described in Nursing Guidelines 45-1
    PG. to test drainage from the nose or ear.
  • Look for A HALO sign which indicates the
    presence of CSF in drainage. Fig 45-8)

41
Nursing Management
  • Evaluate LOC, assess motor and sensory status,
    and check pupils hourly.
  • Take V/S every 15 to 30 minutes.
  • Prepare for the possibility of seizures

42
Spinal Injury
  • Head, neck, and back must be immobilized by means
    of a cervical collar and back board
  • Spine must be properly aligned at all times to
    prevent further injury to cord
  • IV started to prevent shock
  • Steroids may be given to reduce edema

43
Spinal Injury
  • Cervical collar or cervical traction used
  • Stryker frame used to turn and body cast may be
    used to immobilize
  • Surgery may be done to remove bone fragments or
    repair dislocated vertebrae
  • fusion may be done

44
Spinal Cord Injury
  • Even if no fx has occurred, momentary compression
    of cord because of twisting or severe blow can
    lead to edema and compression
  • neuro symptoms may or may not disappear when
    edema subsides
  • Trauma may cause

45
Spinal Injury
  • The most important nursing task immediately after
    injury is to keep his body and head in alignment
    and limiting all movement

46
Spinal Cord Injury
  • bleeding within cord because it has no place to
    drain, forms a hematoma and compresses cord
  • injury may sever nerve fibers partially or
    completely
  • spinal cord trauma results in paraplegia (both
    legs) or quadriplegia (arms and legs)

47
Symptoms of Spinal Cord Injury
  • There may be pain in affected area, difficulty
    breathing, numbness, and paralysis
  • If high injury resp failure may occur as
    diaphraghm paralyzed
  • Midcervical injury causes paralysis of muscles of
    upper thorax

48
symptoms of Spinal Cord Injury
  • 5th and 6th cervical and 1st and 5th lumbar are
    especially vulnerable to injury
  • If completely severed paralysis occurs
  • If minimal damage may have some function

49
(No Transcript)
50
Care of
  • With any spinal cord injury or surgery the
    patient must be log rolled
  • It is important to support the back with pillows
    and place a pillow between the legs to avoid back
    strain

51
(No Transcript)
52
(No Transcript)
53
Spinal Shock
  • spinal cord injury may result in spinal shock
  • Flaccid paralysis, bradycardia and pronounced
    hypotension are symptoms that should be observed
    for in the first few weeks following the accident

54
Spinal Shock
  • spinal shock, permanent paralysis below level of
    injury, and resp arrest are immediate
    complications of spinal cord injury
  • Degree and location of injury determines symptoms
    that occur immediately after injury

55
Spinal Shock
  • Hypotension, bradycardia, decreased resp rate,
    flaccid paralysis, and warm dry skin
  • Bowel and bladder distention may be seen
  • Does not perspire below injury so hyperthermia
    can occur
  • May persist up to 6 weeks

56
Spinal Shock
  • GI decompression to relieve gastric and bowel
    distention, foley, suctioning and mechanical
    ventilation may be done

57
Autonomic Dysreflexia (Hyperreflexia)
  • Acute emergency seen in cervical or high thoracic
    spinal cord injury.
  • exaggerated response to sympathetic stimuli (full
    bladder, paralytic ileus or impaction)
  • Severe hypertension, bradycardia, pallor, blurred
    vision, or nausea

58
Autonomic Dysreflexia
  • Seizures and death may occur
  • Place in a sitting position to reduce B/P
  • May occur over many years and is life threatening
  • Full bladder is common cause

59
Nursing Care
  • Stryker frame or CircOlectric bed used to turn
  • Monitor vitals, do neuro checks
  • Check for movement below level of injury, look
    for progression of neuro damage and resp distress

60
Nursing Care
  • Give injections above level of paralysis as
    poorly absorbed
  • Rise in temp or accumulation of excessive resp
    secretions may be pneumonia or atelectasis
  • Humidify to aid in raising secretions
  • Turning prevents pneumonia and atelectasis

61
Nursing Care
  • assess for paralytic ilius as common
  • NG tube may be inserted to prevent distention
  • Auscultate bowel sounds, assess urinary and bowel
    function

62
Skin Care
  • Stryker used to turn from supine to prone and
    back q 2 hours
  • Gently massage and give special care to areas
    subject to pressure
  • Use lotion but do not use powder as it cakes

63
(No Transcript)
64
Laminectomy Postop
  • Log roll
  • Cough increases pressure in spinal canal
  • Check dressing for leakage of CSF and bleeding
  • Observe for signs of compression caused by edema
    or hemorrhage (change in sensation or motility)

65
Laminectomy Postop
  • Voiding may be a problem after surg. monitor IO
  • Use Fx pan
  • Keep bed flat and have him lay on back as much as
    possible
  • When allowed up, the head, neck and upper
    shoulders are supported when moving from lying to
    sitting or standing

66
TRACTION
  • Traction may be continuous or intermittent
  • support weights and lower gently so there is not
    a sudden jerking or pulling
  • A pillow may be placed under legs to prevent
    heels from rubbing or sheepskin boots used

67
Traction
  • Roll from side to side to prevent twisting motion
  • when out of bed, stand straight, walk slowly, and
    avoid bending forward
  • Brace or collar worn continuously unless specific
    order
  • avoid hyperextension of neck

68
Traction
  • Cervical spine injury needs to be stabilized with
    cervical collar or traction
  • Crutchfield, Vinke or Gardner-wells tongs or halo
    vest traction used
  • Burr holes used and tongs inserted into skull
  • Traction by means of weights and pulleys is
    applied to keep alignment and increase space
    between vertebrae

69
Traction
  • make sure weights hang free
  • Never lift or remove weights or decrease or
    increase amount without Drs order
  • Ropes must be seated in pulley grooves
  • Position must allow correct pull of traction
    apparatus
  • padding must be correctly applied
  • Check tips of tongs
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Chapter 45: Head

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Title: Chapter 45: Head


1
Chapter 45 Head Spinal Cord Trauma
  • Medical-Surgical II
  • Spring Semester
  • Karyn Mills, RN, BSN

2
(No Transcript)
3
Concussion Pg. 721
  • Violent jarring of brain after a blow to the head
  • temporary loss of cerebral function with no
    damage to cerebral tissue
  • Loss of consciousness, followed by headache,
    irritability, dizzy spells, confusion

4
Concussion
  • Observe for several days for neuro
    symptoms....changes in behavior, speech, gait or
    other abnormality should return to ER
  • Recovery is complete and usually occurs in a
    short time
  • Must monitor vital signs carefully to prevent
    complications

5
Concussion
  • May be sent home
  • instruct family to check LOC and ability to move
    and talk q hour while awake
  • Arouse him q 2 hours during night to determine
    LOC and ability to respond to questions

6
Concussion
  • Observe for changes in behavior, speech, or other
    abnormality for 2 to 3 days

7
Contusion pg 722
  • Is more serious than a concussion, results in
    gross structural injury to the brain

8
Contussion
  • The brain is injured when the head is struck
    directly, a COUP INJURY.
  • Dual bruising can result if the force is strong
    enough to send the brain ricocheting to the
    opposite side of the skull, a CONTRECOUP INJURY.

9
CONTUSION
  • Result in bruising and possibly hemorrhage of
    superficial cerebral tissue.
  • Edema develops at the site of injury or in areas
    opposite to the injury.
  • A skull fracture can accompany a contusion.

10
Contusion S/S
  • Hypotension, rapid weak pulse, shallow resp.,
    loss of consciousness pale cool skin
  • While unconscious, the client generally responds
    to strong stimuli like pressure applied to the
    sternum.
  • On awakening, the client often has temporary
    amnesia (loss of memory) for recent events.
  • Permanent brain damage can cause impaired
    intellect, speech difficulty, seizures,
    paralysis, and impaired gait.

11
Contusion
  • CT or MRI may show bleeding or small hemorrhages,
    a shift in brain tissue edema at injury site
  • Nurse observes LOC for ICP and does neuro
    assessment

12
Cerebral Hematomas pg 723
  • Bleeding within the skull that forms an expanding
    lesion.
  • 1. Epidural hematoma
  • 2. Subdural hematoma
  • 3. Intracerebral hematoma
  • Most hematomas are the result of head trauma or a
    cerebral vascular disorder.

13
Epidural Hematoma pg 723
  • Caused by arterial bleeding and accumulation of
    blood above the dura

14
Subdural Hematoma
  • Occurs as a result of venous bleeding and the
    accumulation of blood in the space below the
    dura.

15
Intracerebral Hematoma
  • Is bleeding within the brain that results from an
    open or closed head injury or from a
    cerbrovascular condition such as a ruptured
    cerebral aneurysm

16
Those at High Risk
  • Receiving anticoagulant therapy
  • Underlying bleeding disorders such as hemophilia,
    thrombocytopenia, leukemia, and aplastic anemia
  • Bleeding increases the volume of brain contents
    and results in IICP.
  • As the ICP increases, cerebral blood flow is
    disrupted and brain becomes hypoxic.

17
Cerebral Hematomas
  • Unrelieved pressure causes the brain to shift to
    the lateral side (uncal herniation) or herniate
    downward through the foramen magnum.
  • The vital centers for respiration, heart rate,
    and blood pressure are affected as well as
    cranial nerve functions.
  • Death occurs if the symptoms are not recognized
    and the bleeding is not stopped.

18
S/S
  • The rapidity and severity of neurologic changes
    depends on the location, the rate of bleeding and
    size of hematoma, and effectiveness of
    autoregulation, the brains ability to provide
    sufficient arterial blood flow despite rising ICP.

19
Medical Management
  • Some subdural hematomas become walled off and
    absorbed by the body with no treatment.
  • However, a rapid change in LOC and signs of
    uncontrolled IICP indicate a surgical emergency.

20
Surgical Management
  • Surgery consists of drilling holes (burr holes)
    in the skull to relieve pressure, removing the
    clot, and stopping the bleeding.
  • If the source of bleeding cannot be located by
    means of burr holes, more invasive surgery is
    performed.
  • Intracranial surgery consists of 3 possible
    procedures craniotomy, craniectomy, and
    cranioplasty. (Read on your own)

21
Nursing Management pg 725
  • Regard a head injury, no matter how mild it
    appears, as an emergency.
  • Obtain a history of the injury and perform a
    neurologic examination with particular attention
    to vital signs, LOC, presence or absence of
    movement in the arms and legs, pupil size,
    equality, and reaction to light for evidence of
    IICP.

22
Preoperative Nursing Management
  • Shave the head in the are where burr holes will
    be drilled (this is sometimes deferred until the
    client is in the operating room)
  • Take V/S
  • Adm. Prescribed medications such as an
    anticonvulsant like dilantin to reduce the risk
    of seizures before, and after surgery, an osmotic
    diuretic, and corticosterioids.
  • Pre-op sedation is generally omitted.

23
Preoperative Nursing
  • Restrict fluids to avoid intraoperative
    complications, reduce cerebral edema, and prevent
    postoperative vomiting
  • Insert indwelling catheter
  • Insert IV line
  • Apply antiembolism stockings to prevent
    thrombophlebitis and deep vein thrombosis, which
    develop from prolonged immobility during
    neurosurgery.

24
Postoperative Nursing Care
  • After surgery, place the client in either a
    supine position or a side-lying position on the
    unaffected side
  • Postoperative assessments are performed at 15 to
    30 minute intervals and include all areas of
    neurologic function.
  • Edema around the eyes (periorbital edema) may
    make examination of the pupils difficult during
    the immediate post-op period

25
Postoperative Nursing Care
  • Ecchymosis can also be present.
  • Maintain a neurologic flow sheet to compare
    assessment findings
  • Administer corticosteroids and restrict fluids as
    ordered to control cerebral edema and to increase
    cerebral perfusion
  • NEVER GIVE D5W TO A NEURO PT!!!

26
Care Plan Family Teaching
  • On your own!!!!

27
Review Table 45-1 Pg. 724
  • Differences in Cerebral Hematomas
  • ON YOUR OWN!!

28
Skull Fractures pg 725
  • A skull fracture is a break in the continuity of
    the cranium.
  • A skull fracture is caused by a blow to the head.

29
Skull Fractures
  • The most common types are simple, depressed, or
    comminuted fractures. (Table 45-2 PG. 730)

30
Skull Fractures Patho
  • The fracture can be associated with an open head
    injury in which the scalp, bony cranium, and dura
    mater (the outer meningeal layer) are exposed.
  • There may be a closed head injury in which the
    fractured skull remains covered by an intact
    layer of scalp.

31
Skull Fractures Patho
  • Open head injuries create a potential for
    infection due to exposure to the environment.
  • They are less likely to produce rapid
    intracranial hypertension (IICP) because the
    opening provides some ability for the brain to
    expand as pressure increases.

32
Basilar Skull Fractures
  • Located at the base of the skull.
  • Trauma in this location is especially dangerous
    because it can cause edema of the brain near the
    origin of the spinal cord (foramen magnum),
    interfere with the circulation of CSF, injure the
    nerves that pass into the spinal cord, or create
    a pathway for infection between the brain and the
    middle ear that can result in meningitis.

33
S/S
  • Simple skull fractures produce few, if any,
    symptoms and heal without complications.
  • May c/o of a localized headache. A bump, bruise,
    or laceration may be found on the scalp.

34
(No Transcript)
35
S/S
  • Because basilar skull fractures tend to TEAR the
    dura, rhinorrhea, leaking of CSF from the nose,
    or ottorrhea, leakage of CSF from the ear, may
    occur.
  • In some cases periorbital ecchymosis, referred to
    as raccoon eyes, or bruising of the mastoid
    process behind the ear, called Battles sign, can
    be present.

36
PG. 730
37
S/S
  • Conjunctival hemorrhages can occur as well.
  • Seizures may occur because of injury to the brain
    tissue.
  • Epilepsy can develop as a sequela of head injury.

38
Medical Management
  • Simple skull fractures require bed rest and close
    observation for signs of IICP.
  • If the scalp is lacerated, the wound is cleaned,
    debrided, and sutured.
  • Depressed skull fractures require a craniotomy to
    remove bone fragments and control bleeding,
    elevation of the depressed fracture, and repair
    of damaged tissues.

39
Medical Management
  • Antibiotics to control infection, an osmotic
    diuretic or corticosteroids to prevent or treat
    cerebral edema, and an anticonvulsant to prevent
    or treat seizures.

40
Nursing Management pg 731
  • Most clients are hospitalized for 24 hours or
    more after a significant head injury
  • Use methods described in Nursing Guidelines 45-1
    PG. to test drainage from the nose or ear.
  • Look for A HALO sign which indicates the
    presence of CSF in drainage. Fig 45-8)

41
Nursing Management
  • Evaluate LOC, assess motor and sensory status,
    and check pupils hourly.
  • Take V/S every 15 to 30 minutes.
  • Prepare for the possibility of seizures

42
Spinal Injury
  • Head, neck, and back must be immobilized by means
    of a cervical collar and back board
  • Spine must be properly aligned at all times to
    prevent further injury to cord
  • IV started to prevent shock
  • Steroids may be given to reduce edema

43
Spinal Injury
  • Cervical collar or cervical traction used
  • Stryker frame used to turn and body cast may be
    used to immobilize
  • Surgery may be done to remove bone fragments or
    repair dislocated vertebrae
  • fusion may be done

44
Spinal Cord Injury
  • Even if no fx has occurred, momentary compression
    of cord because of twisting or severe blow can
    lead to edema and compression
  • neuro symptoms may or may not disappear when
    edema subsides
  • Trauma may cause

45
Spinal Injury
  • The most important nursing task immediately after
    injury is to keep his body and head in alignment
    and limiting all movement

46
Spinal Cord Injury
  • bleeding within cord because it has no place to
    drain, forms a hematoma and compresses cord
  • injury may sever nerve fibers partially or
    completely
  • spinal cord trauma results in paraplegia (both
    legs) or quadriplegia (arms and legs)

47
Symptoms of Spinal Cord Injury
  • There may be pain in affected area, difficulty
    breathing, numbness, and paralysis
  • If high injury resp failure may occur as
    diaphraghm paralyzed
  • Midcervical injury causes paralysis of muscles of
    upper thorax

48
symptoms of Spinal Cord Injury
  • 5th and 6th cervical and 1st and 5th lumbar are
    especially vulnerable to injury
  • If completely severed paralysis occurs
  • If minimal damage may have some function

49
(No Transcript)
50
Care of
  • With any spinal cord injury or surgery the
    patient must be log rolled
  • It is important to support the back with pillows
    and place a pillow between the legs to avoid back
    strain

51
(No Transcript)
52
(No Transcript)
53
Spinal Shock
  • spinal cord injury may result in spinal shock
  • Flaccid paralysis, bradycardia and pronounced
    hypotension are symptoms that should be observed
    for in the first few weeks following the accident

54
Spinal Shock
  • spinal shock, permanent paralysis below level of
    injury, and resp arrest are immediate
    complications of spinal cord injury
  • Degree and location of injury determines symptoms
    that occur immediately after injury

55
Spinal Shock
  • Hypotension, bradycardia, decreased resp rate,
    flaccid paralysis, and warm dry skin
  • Bowel and bladder distention may be seen
  • Does not perspire below injury so hyperthermia
    can occur
  • May persist up to 6 weeks

56
Spinal Shock
  • GI decompression to relieve gastric and bowel
    distention, foley, suctioning and mechanical
    ventilation may be done

57
Autonomic Dysreflexia (Hyperreflexia)
  • Acute emergency seen in cervical or high thoracic
    spinal cord injury.
  • exaggerated response to sympathetic stimuli (full
    bladder, paralytic ileus or impaction)
  • Severe hypertension, bradycardia, pallor, blurred
    vision, or nausea

58
Autonomic Dysreflexia
  • Seizures and death may occur
  • Place in a sitting position to reduce B/P
  • May occur over many years and is life threatening
  • Full bladder is common cause

59
Nursing Care
  • Stryker frame or CircOlectric bed used to turn
  • Monitor vitals, do neuro checks
  • Check for movement below level of injury, look
    for progression of neuro damage and resp distress

60
Nursing Care
  • Give injections above level of paralysis as
    poorly absorbed
  • Rise in temp or accumulation of excessive resp
    secretions may be pneumonia or atelectasis
  • Humidify to aid in raising secretions
  • Turning prevents pneumonia and atelectasis

61
Nursing Care
  • assess for paralytic ilius as common
  • NG tube may be inserted to prevent distention
  • Auscultate bowel sounds, assess urinary and bowel
    function

62
Skin Care
  • Stryker used to turn from supine to prone and
    back q 2 hours
  • Gently massage and give special care to areas
    subject to pressure
  • Use lotion but do not use powder as it cakes

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Laminectomy Postop
  • Log roll
  • Cough increases pressure in spinal canal
  • Check dressing for leakage of CSF and bleeding
  • Observe for signs of compression caused by edema
    or hemorrhage (change in sensation or motility)

65
Laminectomy Postop
  • Voiding may be a problem after surg. monitor IO
  • Use Fx pan
  • Keep bed flat and have him lay on back as much as
    possible
  • When allowed up, the head, neck and upper
    shoulders are supported when moving from lying to
    sitting or standing

66
TRACTION
  • Traction may be continuous or intermittent
  • support weights and lower gently so there is not
    a sudden jerking or pulling
  • A pillow may be placed under legs to prevent
    heels from rubbing or sheepskin boots used

67
Traction
  • Roll from side to side to prevent twisting motion
  • when out of bed, stand straight, walk slowly, and
    avoid bending forward
  • Brace or collar worn continuously unless specific
    order
  • avoid hyperextension of neck

68
Traction
  • Cervical spine injury needs to be stabilized with
    cervical collar or traction
  • Crutchfield, Vinke or Gardner-wells tongs or halo
    vest traction used
  • Burr holes used and tongs inserted into skull
  • Traction by means of weights and pulleys is
    applied to keep alignment and increase space
    between vertebrae

69
Traction
  • make sure weights hang free
  • Never lift or remove weights or decrease or
    increase amount without Drs order
  • Ropes must be seated in pulley grooves
  • Position must allow correct pull of traction
    apparatus
  • padding must be correctly applied
  • Check tips of tongs
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