Question

Learning Objective(s) Written Assignments 1. Briefly describe a spinal reflex. Explain the pathophysiology of muscle spasm and muscle spasticity. 2. You are caring for an 8-year-old child with a diagnosis of cerebral palsy. The child is taking baclofen (Lioresal) for muscle spasticity. Describe special nursing considerations when using baclofen in this patient. 3. A 32-year-old executive has suffered a back injury while doing home improvement projects. The patient is started on carisoprodol (Soma) for relief of muscle spasms. Develop a teaching plan for this patient related to the new medication. 4. A 75-year-old patient suffered a back injury and is experiencing severe muscle spasms of the lower back. Which muscle relaxant would be the drug of choice for this patient and why? What special nursing considerations are appropriate to the older adult taking muscle relaxants? 3,5

Answer 1

1)Spinal reflex act through spinal cord. They carry signals they require immediate attention such as burning or painful sensations. They originate from spine and bypass brain entirely.

Pathophysiology of muscle spasm and muscle spasticity:

A muscle spasm is a violent, involuntary contraction of a muscle or group of muscles. Muscle contractions is triggered by a sudden inflow of calcium ions. Muscle contractions stops when calcium is removed from immediate environment.

Spasticity is a velocity dependent increase in the

muscle tone. It is due to the exaggeration of stretch reflex. In spinal cord lesions bilatera Damage to the pyramidal and reticulospinal pathways can produce severe spasticity reflecting increased tone in the muscle groups.

2) while taking baclofen, if patient persists nausea, insomnia, frequent and painful urination, then symptoms based considerations has to be given because these effects are reversible as soon as the drug is discontinued. Frequent urination and constipation if continues in a severe manner has to be reported.

Hypersensitivity to baclofen has to be checked before starting the prescribed dose of medication.

3) Carisoprodol is a new drug given you to relieve your muscle spasm. You should take your last daily dose at bedtime. If it make stomach upset then have it with food.

If any allergic reaction occurs discontinue the medication and report to the doctor.

Be aware that psychological drug dependence may occur.

Notify the doctor if serious symptoms occurs.

Do not take antacids or steroids with this medication as it may cause interactions.

Avoid alcohol and over the counter drugs while taking this drug.

4) It is better to take non pharmacological treatment for elderly in case of muscle spasm. Short term of muscle relaxant can be recommended for some patients.

In severe case use methocarbamol, cyclobenzaprine or carisoprodol which is safe and effective but prolonged use should be limited.

Skeletal muscle relaxants are sedative class of medication. Special consideration has to be given to geriatric patients while administering these medications. They will increase the risk of falls which has to be monitored by the nurses. They can leav a feeling of groggy and confused.

Problems in urinating, constipation and dry mouth are other problems where the patient feel discomfort.