9. 0 Back and Spinal Cord Injuries.docx

9. 0 Back and Spinal Cord Injuries.docx - 1 N410 Back and...

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1 N410 - Back and Spinal Cord Injuries Please see the additional pages posted under neurological disorders stating the material that needs to be reviewed for the quiz. STUDENT LEARNING OUTCOMES : 1. Discuss risk factors associated with back injury/pain. 2. Identify the clinical manifestations of a disc herniation. 3. Describe appropriate preoperative care of the patient before spinal surgery. 4. Describe appropriate interventions and precautions for the patient after spinal surgery. 5. Describe the demographics of spinal cord injuries and the major targets for prevention. 6. Describe differences between: skeletal injury and neurologic injury; mechanism of injury; primary and secondary spinal injury. 7. Compare the following spinal injury classifications: American Spinal Injury Association extent of injury; spinal cord injury syndromes. 8. Describe the aspects of emergency/acute care for a patient with a spinal cord injury. 9. Compare and contrast the symptoms and treatment of spinal shock and autonomic dysreflexia. 10. Describe the level of injury and functional activities after spinal cord injury. 11. Describe sensory (dermatones) and motor (myotones) function abilities at various levels of spinal cord injury. 12. Describe interventions to prevent/manage complications after spinal cord injury. 13. Identify appropriate sexual counseling and teaching the nurse should provide to patients after a spinal cord injury. READINGS : Lewis, et al. (8 th ed.) a. Spinal Cord Injury, pp. 1546-1564 b. Back Pain, pp. 1626-1632 Back Pain I. Low Back Pain A. Acute low back pain 1. Causes: B. Chronic Low Back Pain 1. Causes: C. Diagnostics – just do a really good history, MRI, CT scan, may not tell you a lot D. Collaborative Management 1. Goals: pain relief (OPIOIDS) , no constipation, learn proper back care techniques, return to previous level of activity 2. Full nursing assessment – Table 64-5 (When you have a cervical injury you want to assess for paresthesia – weakness will be in arms with cervical, in the legs if it is lumbar). Check reflexes because they may have weaker reflexes. 3. Bedrest usually not recommended – if it is it will only be for a day or two at most. Restrict activities: can walk around, but don’t do any bending/lifting. 4. Massage – loosens muscles and increases blood flow. 5. Heat/Cold therapy : (Heat increases blood flow which brings oxygen to the site; cold decreases inflammation – use cold first!!) 6. Pharmacologic management a. Analgesics – may use opioids but only for a short period of time. Give NSAIDS with food, watch with renal failure patients. b. Muscle relaxants – cyclobenzaprine (Flexeril) & Robaxin. i. Become very sleepy. Do not operate heavy equipment. c. Epidural corticosteroid injections – position: curled up in fetal position. i. Have them on an intermittent basis. Does not cure just takes care of pain and inflammation.
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