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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