Spinal cord dysfunctions Contemp, test I

  1. major causes of spinal cord dysfunctions
    • trauma
    • neoplasms (tumors)
    • viral or bacterial infections (polio)
    • progressive degenerative disorders (MS)
    • vascular accidents (hemorrhage, thrombus, embolus)
    • compressions from arthritic spur
    • congenital anomalies
  2. types of spianl cord injuries
    • Fracture
    • dislocation
    • compression
    • stretching
    • bending
    • severing
  3. characteristics of spinal cord injuries:
    complete: no sensation or motor fxn below level of lesion

    incomplete:some sensation or motor fxn
  4. Possible effects of spinal cord injuries
    • impairment of voluntary bladder/bowel control
    • impairment of sexual fxn
    • impairment of vasomotor and body temp reg
  5. secondary complications that may occur with spinal cord injuries
    • respiratory fxn
    • pressure sores
    • spasticity
    • body temp
    • risk of infection
    • autonomic dysreflexia
  6. decubitis ulcer
    pressure sore
  7. Life threatening
    emergency condition in which the blood pressure increases
    sharply. Problem with pts who have suffered injury at level T6
    and above. Stimuli such as bowel or bladder irritation, pain
    may trigger
    autonomic dysreflexia (hyperreflexia)
  8. Increased BP (may rise to 300/160), decreased
    pulse, pounding headache, flushing, chills, sweating,
    restlessness, increased spasticity
    autonomic dysreflexia (hyperreflexia)
  9. emergancy care for autonomic dysreflexia
    • Gradually position chair upright. DO NOT RECLINE – could cause increased BP to brain.
    • Call for medical
    • help,
    • monitor BP,
    • check bladder distention, straighten catheter if clamped
  10. criteria for mouth-held implements
    • does not harm oral tissues
    • is comfortable and allows pt to talk, swallow, and moisten lips
    • does not cause fatigue
    • can be cleaned easily
    • easy to construct/inexpensive
  11. Primary types of brain injury
    • direct trauma
    • indirect trauma
    • hypoxia or toxi substance exposure
  12. over half the trauma cases to the spinal cord result from?
    motor vehicle accidents
  13. majory of spinal cord injuries affect?
    teenage or adult men
  14. how many people do you need to trasport someone after a spinal cord injury?
    at least 4
  15. immediately after the injury, spinal shock causes?
    complete loss of reflex activity (flaccid paralysis)
  16. how long does fflccid paralysis last?
    several hrs - 3 months
  17. Dental chair implications for a person with a spinal cord injury
    • Patient with urine bag should be sat up at frequent intervals to allow urine to drain
    • empty urine bag
    • don't change chair agnle abrubptly (avoid postural hypotension)
    • change body position (avoid pressure sores)
    • padding for patient (avoid pressure sores)
  18. dh care for spinal cord injuries
    • Monitor vital signs
    • Be aware of patient and body needs/emergencies
    • Suction to prevent aspiration. Use ultrasonic with great caution,
    • if at all.
    • Use rubber dam to prevent aspiration and danger of respiratory
    • complications
    • Keep appt as short as possible
  19. Primary types of brain injruy
    • direct traum
    • indirect trauma
    • hypoxia or toxic substance exposure
  20. secondary types of injury
    • edema
    • hematoma
    • hydrocephalus/hygroma
  21. manifestation of Brain Injury
    • Loss of Consciousness
    • Post Traumatic Amnesia 
    • Concussion
    • Seizures
    • PERL
    • Reflex issues
    • Encephalopathy
  22. process of blood exuding or passing out of vessel into surrounding tissues
  23. Incidence of brain injury
    most often seen in men between the age of 15 and 24

    • 50% vehicle accidents
    • 21% falls
    • 12% violence
    • 10% sports
  24. Congenital defect when the vertebrae fail to enclose the spinal cord
    congenital spinal deformities
  25. how to reduce congenital spinal deformities
    folic acid
  26. Types of congenital spinal deformities
    • myelomenigocele
    • meningocele
    • spina bifida
  27. Protrusion of the spinal cord and its covering (meninges) through
    an opening in the bony spinal column
    Flaccid paralysis of legs and part of trunk
  28. Protrusion of the meninges through a defect in the skull or spinal
    Paralysis uncommon
  29. Congenital cleft in the bony encasement of the spinal cord
    Spina Bifida Occulta(hidden) : no outpouching of meninges or
    spinal cord – no symptoms
    sipna bifida
  30. physical characteristics of a patient with myelomeningocele
    • Bony deformities
    •  Club foot
    •  Dislocation of hip
    •  Spinal curvatures
    •  Kyphosis
    •  Scoliosis
    •  Lordosis
    • Loss of sensation
    • Bladder and bowel paralysis
    • Hydrocephalus – excessive accumulation of fluid
    • on the brain.
    • Seizures
    • Developmental deficit
  31. Medical tx for myelomeningoecele
    • Neurosurgery
    • Closure of the myelomeningocele
    •  Treatment of the hydrocephalus
    • Orthopedic surgery
  32. DH Care for Myelomeningocele
    • General management
    •  Wheelchair transfer may be indicated Assistance for patients with crutches
    • Need for premedication
    •  Ventriculoatrial – YES premed
    •  Ventriculoperitoneal – NO premed
    • Latex allergy
    •  Scheduling early in the day when less contamination from glove powder is in the air
    • Gingival care
    •  Special adaption if cervical or thoracic body levels involved
    • Patient with seizures may present with gingival hyperplasia
  33. Sudden loss of brain function
    changes in motor fxn, communication, perception, as well as possible depression
    death can occur in minutes
    CVA (stroke)
  34. COMMON risk factors for stroke
    • transient ischemic attack (TIA)
    • recent stroke
    • hypertension
    • cigarette smoking
    • cardiac disease
    • diabetes mellitus
  35. POSSIBLE risk factors for stroke
    • oral contraceptives
    • obesity
    • physical inactivity
    • alcohol
    • pregnancy
  36. UNCOMMON risk factors for stroke
    • infalmmatory disorders
    • hematologic disorders
    • coagulation disorders
    • drug abuse
  37. Etiologic factors for stroke
    • Thrombosis
    • intracerebral embolism (seen on pano)
    • Ischemia (A decrease in the blood supply to a bodily organ, tissue, or part caused by constriction or obstruction of the blood vessels)
    • cerebral hemorrhage
    • risks/predisposing factors
  38. signs and symptoms of CVA
    • Transient ischemic attack (TIA)
    • Acute symptoms of a stroke
    •  Dizziness, vertigo, transient paresthesia, transient speech defects, serious headache, labored breathing, chills, paralysis one side of body,
    • nausea, vomiting, convulsions, loss of
    • consciousness
    • Residual or chronic effects
    •  Two thirds have some permanent disability
    • Temporary or permanent loss of thought, memory,
    • speech, sensation, or motion
  39. Right hemiplagia-causes
    • L-CVA
    • speech/vocab problems
    • slow, cautious, disorganized
    • right visual field deficit
  40. left hemiplegia
    • R-CVA
    • Spatial perception problmes
    • over confident and impulsive
    • left visual field deficit
  41. Medical tx for CVA
    • Surgical
    • Physical and occupational therapy
    • Medications
  42. Meds for strokes
    • Anticoagulant – to thin blood
    • Antihypertensive – to lower blood pressure
    • Thrombolytic – to dissolve clots
    • Vasodilator – to relax the blood vessels of the brain
    • Steroid – to control brain swelling
    • Antiepileptic – to help to control seizures
  43. DH care for stroke patients
    • Timing
    •  Elective dental treatment is usually not advised until 6 months or more after a stroke
    • Appointment procedures
    •  Shorter appointments/small increments
    • Four handed dentistry
    • Physician consult if on anticoagulant medication
    • Disease control
    •  Provide complete care
    •  Homecare modifications of devices may be indicated
    •  Paralysis may require caregiver to deliver daily biofilm removal
    •  If facial paralysis is involved, increase in biofilm, leading to
    • demineralization and caries.
    •  Daily fluoride application
    •  Saliva substitutes
    • Disease risk detection
    •  Calcifications in the carotid artery may be seen on panoramic
    • radiograph
Card Set
Spinal cord dysfunctions Contemp, test I
Contemp II