Spinal Cord Injury

Dermatome

100

1. What cervical nerves cause the most severe spinal cord injuries that cause paralysis in the arms, hands, trunk, and legs and affect the patient's ability to breathe or cough?

High Cervical Nerves C1-C4

200

. Loss of sensation over the clavicular and suprascapular region indicates damage to:  a) C3  b) C4  c) C5  d) T1

C4

300

A patient has herpes zoster lesions just inferior to the nipple line. Which dermatome is most likely involved? a) T3 b) T4 c) T5 d) T6

T5

400

Numbness over the inguinal crease corresponds to which dermatome? a) T12 b) L1 c) L2 d) L3

L1

500

Sensory loss over the mid-anterior thigh suggests involvement of: a) L1 b) L2 c) L3 d) L4

L2

Shock

100

1. What are the symptoms of spinal shock:

 Signs and sx: flaccid paralysis, anesthesia, absent bowel and bladder control, loss of reflex activity.

200

1. What are the features of neurogenic shock?

Signs and symptoms include hypotension, usually with bradycardia, and hypothermia due to loss of sympathetic tone attributed to interruption of autonomic pathways in the spinal cord causing decreased vascular resistance.

300

1. What is critical to maintaining in patients with a TSCI at risk for neurogenic or spinal shock

Hemodynamics, specifically blood pressure goals (guidelines currently recommend maintaining MAP of at least 85 to 90mmHg.)

Post SCI

100

1. Name four things you must be aware of when getting a para/tetraplegic patient OOB to the chair:

You must know the order for the length of time in the chair; Have all your “wraps in place” (ace wraps on legs, abdominal binder); the chair must be a Rojo chair with padding- no cardiac chairs; adjust the chair every 15 minutes to avoid pressure ulcers

200

Which chair would you use for SCI patient

Roho Chair with physical therapy

300

How often would you change positions on Roho Chair

Every 15 minutes

400

How long can you sit in a Roho chair? 

For 1 hour or as per doctor's order

500

What other things would you require before getting SCI patient from the bed

Abdominal binder, Ace wraps to legs, TLSO belt if needed

Spinal Precautions

100

1. How many nurses are required to turn the patient in full spinal precautions?

4

200

1. True or False: The patient must remain flat in c-spine precautions.

False; HOB can be 30 degrees but always default to MD order

300

1. What is the proper care for c-collar padding?

Have two sets of padding, change padding on night shift, wash with soap and water, and air dry the second set

400

1. True or False: You must maintain cervical spine precautions when turning a patient who is “clear with collar.”

False; it is not necessary to maintain cervical spine precautions when the patient is “clear with collar” unless otherwise noted per MD order.

500

1. In thoracolumbar spine precautions, the patient can sit up at 30 degrees

False; the patient must maintain flat or in reverse Trendelenburg unless they are in a brace and verified by MD order (e.g., TLSO brace)