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Dual Dx, Bowel, and AD
Exam 1
55
Medical
Graduate
02/27/2012

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Cards

Term
9 aspects of pre-admission screen
Definition
-Mechanism of injury
-LOC duration
-GCS scores
-PTA duration
-Neurological symptoms
-Seizures
-ETOH or other substance abuse
-Assoc. injuries such as resp insufficiency, hypotension, etc
-History of TBI
Term
Name 7 signs of TBI
Definition
-Impaired attention
-Slurred or incoherent speech
-Gross incoordination
-Disorientation
-Emotional reactions out of proportion
-Memory deficits
-Agitation/aggression
Term
In what tx session would this be placed: SCI without any signs of TBI
Definition
SCI team
Term
In what tx session would this be placed: SCI with signs of mild to od TBI
Definition
Dual Dx Team
Term
In what tx session would this be placed: SCI with signs of severe TBI
Definition
TBI team
Term
Progression is __ if there is a TBI in addition to a SCI
Definition
Slower
Term
The type of bowel program a client had depends on what?
Definition
The presence or absence of rectal (bowel) reflexes. If they have reflexes, they are placed on an UMN program. If not, they are placed on a LMN program.
Term
What is another term used for the UMN bowel?
Definition
Reflex bowel
Term
Because of this, the bowel can be stimulated at the rectum which causes the stool to be passed and emptied. The stimulation can be done in two ways, either by the use of a suppository or with finger stimulation.
Definition
Reflexes
Term
These 2 things contain an active ingredient that acts as a mild irritant directly on the smooth muscle of the bowel. This "irritation" initiates peristaltic activity. The most common side effect is the possibility of intestinal cramping which will subside after the stool and melted suppository have been evacuated.
Definition
Dulcolax Suppository
Enemeeze Enema
Term
Routinely ordered on admission. Vital ingredients in virtually all SCI bowel programs for the prevention of constipation. They do not treat existing constipation, but aid in preventing it from forming. They reduce the surface tension of the stool material promoting a softer mass. They do not stimulate peristalsis, which can cause unscheduled evacuations. Some over the counter brands may contain stimulant additives.
Definition
Stool Softeners such as Surfak and Colace
Term
What type of bowel program is usually performed every other day?
Definition
Stool softeners
Term
What is the LMN bowel also called?
Definition
Non-reflex or flaccid bowel
Term
This client usually is a lower level para and has no rectal reflexes. The use of a stool softener is usually critical with this type of client. Daily bowel programs may be necessary
Definition
LMN bowel
Term
Because there are no reflexes with a LMN bowel, how do you empty?
Definition
Manually (with fingers) usually in conjunction with the use of a glycerin suppository
Term
Draws water from the bowel lining into the feces and thus stimulates evacuation. It is a hyperosmolar laxitive.
Definition
Glycerin Suppository
Term
An important part of the LMN bowel program. Should be done approximately fifteen 'ninnies by rubbing the abdomen in a clockwise direction. Push in as you go up the right side, across, then down on the left side. This helps push fecal material along the intestinal tract. Then put on glove, lubricate finger, and insert it into rectum and take out any stool that can be reached.
Definition
Abdominal Massage
Term
What 2 things can facilitate evacuation during abdominal massage
Definition
Straining or bearing down with abs
Term
What might be used prior to the bowel program and adequate fiber in the diet help made a bowel program successful?
Definition
Hot liquids
Term
Additional bulking agents such at __ can often increase the effectiveness of the bowel program.
Definition
Metamucil
Term
Occasionally spot of blood either on finger, wiping cloth, or on the stool may be observed. This is the result of hard stool, or maybe fingernails are too long or jagged, or hemorrhoids secondary to what?
Definition
The manual evacuation of stool
Term
Name some helpful hints related to bowel care
Definition
-always try to use commode if pt is able
-always wash hands after bowel program
-double glove if fingernails are long
-maintain a schedule to prevent accidents
Term
Name 4 chronic GI complications associated with SCI
Definition
-Elevated incidence of gallstone dz
-Abdominal pain
-Abdominal Distention
-AD, etc
Term
Also known as hyper-reflexia
Definition
Autonomic dysreflexia
Term
Name 10 S&S of AD
Definition
1. HTN (120/50 can be AD if sympomatic)
2. Pounding headache
3. Bradycardia
4. Nasal congestion
5. Bronchospasm
6. Seizures
7. Chills without fever
8. Sweating above injury level
9. Skin flushing above injury level (uni or bilateral)
10. Goose bumps above injury level
Term
If you think your pt could possibly have AD, what 3 things should you do first?
Definition
1. Sit pt up
2. Check BP in BOTH arms
3. Look for noxious stimulus below injury level
- Check for bladder distention
- Check bowels
- Check skin
- Evaluate for gastrocolic irritation
- Gender specific problems
Term
AD can lead to what 3 things?
Definition
Seizures
Stroke
Death
Term
Name the Top 6 causes of AD (most of them can also cause spasticity)
Definition
1. Bladder distention
2. UTI
3. Bladder or kidney stones
4. Cystoscopy, Urodynamics
5. Bowel Distention
6. Bowel Impaction
Term
Bowel and Bladder are the top 2 causes of what?
Definition
AD
Term
Besides the Top 6 causes name the other 23 causes of AD
Definition
1. Gallstones
2. Gastric ulcars or gastritis
3. Invasive testing
4. Hemorrhoids 5. Appendicitis
6. Menstruation 7. Pregnancy
8. Sexual intercourse 9. Ejaculation
10. DVT 11. Pulmonary Emboli
12. Pressure Sores 13. Ingrown toenails
14. Burns and Sunburns 15. Blisters
16. Insect Bites
17. Contact with hard/sharp objects
18. Constrictive clothing/shoes
19. Heterotropic bone 20. Pain
21. Fractures/trauma 22. Sx procedures
23. Temperature fluctuations
Term
Do PTs decide a bowel and bladder program?
Definition
No! Our goal is just mobility
Term
What is the PT's function in bowel and bladder management?
Definition
-Skin precautions and protection
-Mobility, strength, and endurance requirements for technique used
-Equipment needs for technique used
-Time management and daily planning required for the technique
-Goals are directed to transfers and bed mobility
Term
What type of lesion and levels will have reflexic and spastic bladder?
Definition
UMN Lesion
C-spine to T12
Term
What type of lesion and level has areflexic bladder or flaccid?
Definition
LMN Lesion
L1-S spine
Term
Normal voluntary function is at what level?
Definition
Sphincter level
Term
-After a SCI, during this phase, it is very important to not allow the bladder to become over distended
-Keep accurate fluid intake and output records
-Drink a minumum of 3 quarts of fluid every 24 hrs
-Report urine that is not clear in light in color for signs of UTI
-All pts have this at first because of spinal shock
Definition
Flaccid Bladder Program
Term
Bladder fills with urine, the sphincter ms automatically relaxes and the bladder empties itself. Uncertain when the bladder will emplty and if it will empty completely.
Definition
Spastic Bladder Program
Term
What are some techniques to do with the spastic bladder program to trigger emptying?
Definition
-Massaging or tapping abdomen
-Leading forward to change position
-Doing push-ups in w/c
-Pulling pubic hair
-Pinching or stroking inner thigh
-Inserting a gloved finger into rectum
Term
Name 4 bladder program goals
Definition
1. Completely empty bladder
2. Pt to be able to manage bladder program at highest independence level
3. Restore bladder continence (meaning no leakage between program)
4. Bladder program does not interfere with lifestyle
Term
What are 4 methods used in male spastic bladder programs
Definition
1. Foley - indwelling cath (initially)
2. Intermittent cath (every 3-4 hrs during day; every 4-6 hrs during night)
3. External condom cath (texas rig or T drain ;bedside drainage bag at night)
4. Combination of IC and Tx Rig (if pt isn't emptying completely)
Term
Name 3 methods used in flaccid male and femal bladder programs.
Definition
IC typically
Crede
Combination of Crede and IC
Term
What is Crede?
Definition
Tapping on bladder to get it to empty
Term
Name 2 common methods used for femal spastic and flaccid bladder program
Definition
-IC - must be able to see area
-Foley - females use this longer and more often than males
- Comes with high UTI risk
Term
Name 2 alternate methods for bladder management
Definition
Suprapubic
Mitrofanoff
Term
This alternate method of bladder management has a higher infection rate than the other and is located lower than the umbilicus.
Definition
Suprapubic
Term
This procedure uses the appendix to create a channel between the abdominal wall and the bladder. This procedure is particularly useful in pts with limited hand function. In general, it is easier to manipulate clothing and pass the catheter thru the umbilicus than to transfer, remove lower extremity garments, and perform IC
Definition
Mitrofanoff
Term
A major medical concern. Caused by bacteria in the bladder. Most often from IC, foley, or suprapubic methods.
Definition
UTI
Term
A person with a Foley is __ times more likely to get a UTI than someone with IC.
Definition
7
Term
This makes the pt unable to completely empty the bladder especially in external devices. Over 80% of individuals with SCI have bacteria by urine culture but are not symptomatic.
Definition
UTI
Term
Name 9 UTI symptoms
Definition
-Fever
-Chills
-Nausea
-Headache
-Increased spasms
-AD (above T6)
-Milkly urine color; or dark red
-Smelly
-Thick in texture
Term
Name 5 ways to prevent UTIs
Definition
1. Drink plenty of fluids (indwelling - 15 glasses per day; IC or condom - 8-10 glasses per day)
2. Empty the bladder on a schedule
3. Have regular check-ups
4. Keep skin clean
5. Keep personal care supplies clean and use proper technique
Term
Name 4 additional complications of the urinary system in SCI
Definition
1. Urine leakage or incontinence (esp with L1 and below)
2. Bladder cancer (increased risk with indwelling)
3. Kidney and bladder stones
4. Kidney failure (used to be SCI leading cause of death)
Term
Spastic or reflex bowel occurs in UMN injuries above T12. Name 4 methods for emptying the bowel.
Definition
1. Manual Removal
2. Digital Stimulation
3. Suppository
4. Mini-enema
Term
List "The Bowel Program"
Definition
1. Individualized to time of day that fits lifestyle
- Should be done at same time
- At least every 2-3 days
2. Begins with insertion of suppository or mini-enema
3. Program should be done in sitting on a padded toilet seat
4. Digital Stim
- No more than 4X per session is recommended
5. Most require 30-60 min to complete
Term
What bowel program might a person resort to if they have pressure sores?
Definition
Colostomy
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