Title: N220 3'1 The Spinal Cord And Peripheral Nervous System
1N220 3.1The Spinal CordAndPeripheral Nervous
System
2Back Pain
- Causes
- Trauma
- support structure
- vertebral support
- vascular changes
- disk degeneration
3Back Pain
4Back Pain
- History and assessment- Posture, gait.
- Paingt where, radiate, quality
- What have you been doing for it?
5Back Pain
6Back Pain - Treatment
- Medications, PT, massage, chiropractor, bed rest,
braces, heat/ice, traction, .
7Back Pain - Surgery
- Diskectomy
- Laminectomy
- Spinal Fusion
- Chemonucleolysis
- Percutaneous Lumbar Diskectomy
- Microdiskectomy
- Laser-Assisted Laparoscopic Lumbar Diskectomy
8Back Surgery
- Post-op care
- Each patient is different
9Spinal Cord InjuryTypes of Cord Damage
- Concussion
- Contusion
- Lacerations
- Transection
10Spinal Cord Injury
- Mechanism of Injury
- Level of Injury
- Degree of Injury
11C1 nerve exit above C1 Vertebra
12Quadriplegic ?
Paraplegia ?
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15Spinal Shock
- Causes
- Loss of motor sensory below lesion. Loss of
sympathetic intervention
16Spinal Shock- Early
- Peripheral/ Capillary vasodilation
- Sympathetic system inhabited
- Phrenic nerve interrupted
- Ascending/descending pathways interrupted
17Spinal Shock- Early
- Signs Symptoms
- Decrease
- Temperature variation
- Immediate areflexia
18Spinal Shock
19- Autodestruction
- Secondary Injury
20Spinal cord injury - HEMORRHAGE
?Spinal Cord Blood Flow
? Spinal Cord Blood Flow
Tissue Hypoxia
21Autodestruction
- Hypoxia of cord cells
- Necrosis
22Autodestruction(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
23Normal
Autonomic Dysreflexia
24Clinical Application
- Pete, 41
- Shot in back at C7-C8 and hit his head on a brick
wall during his fall and brought in unconscience.
25Neuro Assessment
26Pete, 41 Shot in back at C7-C8 Nicked spinal cord
27Clinical Application
- Emergency Treatment
- Concern??
- Diagnostic tests
28Clinical Application
- Surgical interventions??
- Spinal Shock
29Clinical Application
- Week since injury
- What is my rehabilitation plan
- What is the most he can hope for?
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31Degree of Injury
32Functional Mobility
- Transfers
- Weight shifts
- Wheeled mobility
- Sitting posture
- Bed mobility
- Transportation
33Activities of Daily Living
- Feeding
- Dressing
- Bathing/Grooming
- Bowel Bladder Management
34Clinical Application
- Bp 260/118
- P 54
- C/O blurred vision throbbing headache
35Neurogenic Bladder
Reflex bladder gt (upper motor neuron) spastic
bladder (injuries above T-12),
36Neurogenic Bladder
Flaccid bladder gt (Lower motor neuron)
retention and overflow, (in multiple sclerosis
and injury below T-12), problems at reflex arc
37Neurogenic Bladder
Uninhibited bladdergt affect cortical bladder
control center in brain (CVA brain injury),
little sensorimotor control and can not wait
38Spinal Cord Injury - Complications
- Respiratory
- Above C4
- Above T6
- Cardiovascular (Above T5)
- Renal
- Gastrointestinal (Above T-5)
- Musclesketical
39Other Spinal Cord Problems
- Spina Bifida Occulta
- Myelomeningocele
- Meningocele
- Myelocele
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41Spinal Tumors
42Multiple Sclerosis
Central Nervous System
400,000 in US 2/3 female. 85 life expectancy.
Start 20-40.
43Multiple Sclerosis
- Autoimmune
- Chronic inflammatory disease with remissions and
exacerbation
44Multiple 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
45- Bladder Dysfunction Retention, urinary
frequency, urgency, hesitancy, and incontinence - Bowel Dysfunction Constipation
-
- Heat Sensitivity Heat is a common aggravating
factor in MS
46- 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
47Multiple SclerosisProblems
- Spasticity
- Tremor
- Bladder Dysfunction
- Bowel Dysfunction
- Fatigue
- Mood Alterations
- Chronic Pain
48Multiple SclerosisMedications
- Corticosteroids
- Cholinergic (urinary retention)
- Anticholinergic (urinary
frequency) - Muscle relaxants
- Mood elevators
49Multiple SclerosisMedications
- Plasmapheresis
- immunosuppressives
- Chemotherapy
- Corticosteroids
- Interferons
50Multiple 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
51Amyotrophic Lateral Sclerosis(Lou Gehrigs
Disease)
No known cause no cure not specific treatment
no standard pattern of progression no method of
prevention
52Amyotrophic 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
53Amyotrophic Lateral Sclerosis(Lou Gehrigs
Disease)
- Motor neuron degeneration in brainstem, Spinal
cord (Anterior horn cell), and motor cortex - gtNo
54Amyotrophic Lateral Sclerosis(Lou Gehrigs
Disease)
- Rilutek - neuroprotective drug
- IgF-1, CNTF, etc.
55Amyotrophic Lateral Sclerosis(Lou Gehrigs
Disease)
- Nursing
- Prevent complications of immobility provide
comfort.
56Clinical Application Guillain-Barré
57GBS Peripheral NS -- MS CNS
58Clinical Application Guillain-Barré
- Pathophysiology and Treatment
- Focus of nursing medical management?
- Back to Fay
- S/S Progression may lead to?
- Psychosocial needs
- Rehab
59Myasthenia Gravis (MG)
- Autoimmune disease of neuromuscular junction
- Message not passed
60Antibodies
Myasthenia Gravis
61Myasthenia Gravis
Regional distribution of muscle weakness
95 60 30 10
Percentage by effected areas
62Myasthenia Gravis
63Myasthenia Gravis (MG)
- Types
- Ocular
- Generalized
- Other
- Neonatal
- Congenital
64Myasthenia Gravis (MG)
Give on Time
- Treatment
- Anticholinesterase
- Immunosuppressants
- Corticosteroid Chemotherapeutic
- MUST AVOID MANY DRUGS
- Surgery - Thymectomy
65Myasthenia Gravis (MG) Crisis
- Cholinergic Vs. Myasthenic Crisis
- S/S Difficulty breathing, swallowing, chewing,
or speaking. Increased salivation, bronchial
secretions and sweating. Apprehension and
restlessness
66Myasthenia Gravis (MG) Crisis
- Tensilon Test
- Improvesgt Myasthenic crisis
- Give Cholinergic drugs
- Gets Worstgt Cholinergic Crisis
- Reduce anticholinesterase doses
67Trigeminal NeuralgiaTic Douloureux
5th CN Effects Sensory only
68Trigeminal NeuralgiaTic Douloureux
- Goal
- Tx
- Meds
- Surgery
- Other
- Nursing
69Bells Palsy
CNVII
Cranial Nerve VII
70Bells Palsy
- Goal
- Tests
- Medications
- Nursing
71Polyneuropathy
- Cranial and peripheral nerves
- Muscle weakness with or without atrophy
- Pain, paresthesia, or loss of sensation
- Impaired reflexes
72Polyneuropathy
- Diseased (Diabetes, ETOH, Trauma, etc.)
- Vitamin deficiencies
- Drug use
- Environmental (Heavy metals, industrial solvents)
73Clinical manifestation of peripheral neuropathies
74Peripheral Nerve Trauma
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