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NCM 102 A
MEDICAL-SURGICAL NURSING
1. MANAGEMENT OF CLIENTS WITH
DISTURBANCES IN SPINAL CORD FUNCTION2. ANATOMY AND PHYSIOLOGY OF THE EYES
3. ASSESSMENT OF THE VISUAL SYSTEM
Prepared by:
Lilian G. Tumapang, RMT,RN
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MANAGEMENT OF CLIENTS WITH
DISTURBANCES IN SPINAL CORD FUNCTION
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Cross section of a spinal cord
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Picture of the human spinal cordshowing C1 to S5 vertebra and which
vertebra effect what part of body functions
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SPINAL CORD INJURY
result of damage to cells in the spinal cord
and causes a loss of communication betweenthe brain and the parts of the body below the
injury.
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1.Central cord syndrome
2.Posterior cord Injury
3. Brown-Sequards
syndrome
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Research on images of conus medullaris
syndrome and conus equine syndrome
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MRI of an SCI
The white arrow pointsto an a the area in which the spinal
cord
is being
compressed by
a fractured vertebra
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PATHOPHYSIOLOGYOF SCI
Inability of the cell to use energy and perform vital functions
Breakdown of cell membrane Intracellular swelling
Decreased blood circulation
Ischemia and hypoxiaElevated levels of excitatory
neurotransmittersDecreased dopamine
Trauma to the spinal cord
Cellular edema Microhemorrhage
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Neurologic deficits/ damage
Disruption of the nerve transmission pathway
Compromised spinal cord perfusion
a. Structural changes in the gray andwhite matter of the spinal cord
b. scarring of nerve tissue
c. Destruction of the myelin sheath
d. More edema and microhemorrhages
Cellular destruction(myelin / neurons)
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NURSING DIAGNOSES
a. Ineffective airway clearance
b. Ineffective breathing
pattern
c. Disturbed sensoryperception
d. Impaired bed and physical
mobility
e. Risk for impaired skinintegrity
f. Impaired urinary elimination
g. Acute pain
h. Constipation
SCI (Medical
diagnosis)
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NURSING INTERVENTIONS
1. Maintain patent airway
2. Immobilize the client on a spinal backboard withthe head in a neutral position
3. Logroll the client.
4. Supplement oxygen as necessary.
5. Provide ventilator if diaphragm is paralyzed.
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6. Encourage DBE and the use of an incentive
spirometer.
7. Administer medications as prescribed.
8. Use a specialty bed or a turning schedule of
at least every 2 hours.
9. Provide passive ROM exercises.
10. Insert an indwelling catheter to decompress
the bladder
11. Maintain optimal nutrition.
12. Support the psychological/emotional needs
of the client and the significant others.
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Neck or cervical collars
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SURGICALMANAGEMENT
Laminecto
my
Discec
tomy
Foramino
tomy
Spinal
fusion
Decom
pression
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LAMINECTOMY
This is a surgical procedure to remove a
portion of a vertebra, called the lamina. The
lamina is removed to get to a ruptured disc
that is pushing on nerves. The ruptured disc
is then removed. In other cases, the lamina is
removed because of pressure caused by bony
spurs or other problems
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Laminectomy (Lamina Removal; Removal of
the Lamina)
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DISCECTOMY
-surgical removal of herniated disc material
that presses on a nerve root or the spinal
cord. The procedure involves removing the
central portion of an intervertebral disc, the
nucleus pulposus, which causes pain by
stressing the spinal cord or radiating nerves.
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FORAMINOTOMY
medical operation used to relieve pressure on
nerves that are being compressed by the
intervertebral foramina, the passages through
the bones of the vertebrae of the spine that
pass nerve bundles to the body from the
spinal cord
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A foraminotomy is
performed to relieve the
symptoms of nerve root
compression in cases
where the foramen is
being compressed by
bone, disc, scar tissue,
or excessive ligamentdevelopment and results
in a pinched nerve.
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Foraminotomy procedure
1.
Indication: compression ofthe nerve root by a disc
herniation
2.
Client tilted and in facedown position
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3. Posterior cervicalapproach
4. The initial
entrance
5
5. The nerve
course
6. Drilling
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7. Venous cuff
8. Nerve
Root
Freedom
9. Free Fragment
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Spinal fusion
An anterior-posterior X-ray of a case of
adolescent idiopathic scoliosis post-fusion
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Spinal fusion indication
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Spinal fusion series
1. incision 2. Procedure: Posterolateral gutter fusion
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3.Interbody cage fusion 4. Pedicle screw
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HERNIATED INTERVERTEBRAL DISC
*AKA
Herniated nucleus pulposus (HNP)
Ruptured disc
Results from sudden or long-term
compression loads on the spine
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Ruptured Disc in Neck Pushing on Nerves (
Cervical disc herniationP
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SPINALTUMORS
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UNIT 2: ALTERED COGNITIVE-PERCEPTUAL PATTERNS: CLIENT
WITH VISUAL DISORDERS
1. Concept Review Anatomy and
Physiology of the Visual System
2. Assessment of the visual system
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VISUALPATHWAY
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ASSESSMENTOFTHE EYE
(Subjective Data)
Pain Photophobia Blurred vision
Spots, floaters Dryness Diplopia
Ptosis ProptosisVision lossand visualfield loss
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NORMAL VISIONON BOTHFIELDS
bitemporal hemianopsia