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NCM 116 Lecture > Midterms_ CARE OF PATIENTS WITH HEAD AND SPINAL CORD INJURIES CARE OF PATIENTS WITH HEAD AND SPINAL CORD INJURIES > Flashcards

Midterms_ CARE OF PATIENTS WITH HEAD AND SPINAL CORD INJURIES CARE OF PATIENTS WITH HEAD AND SPINAL CORD INJURIES Flashcards

1
Q

s any trauma that leads to injury of the scalp, skull, or brain. The injuries can range from a minor bump on the skull to serious brain injury.

A

Head injury

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2
Q

Two Types of Brain Injury

A
  1. Acquired Brain Injury
  2. Traumatic Brain Injury
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3
Q

injury to the brain that occurs after birth. Many different factors can cause an ABI, including:

A

ACQUIRED BRAIN INJURY (ABI)

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4
Q
A

Anoxic injuries (a prolonged lack of oxygen)
- Hypoxia (decreased oxygen flow)
- Epilepsy or other seizure disorders
Strokes
- Cerebral ischemia (restricted blood flow)
- Infections, such as encephalitis or
meningitis
- Neurotoxic events (exposure to toxic
chemicals or drugs)
- Hydrocephalus

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5
Q

most common types of ABI is a

A

traumatic brain injury, or TBI

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6
Q

means an acquired injury to the brain caused by external physical force. The injury occurs when a blow to the head or body causes the brain to move rapidly inside the skull. The impact and movement can injure brain cells, nerves and blood vessels.

A

traumatic brain injury, or TBI

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7
Q

Classifications of TBI

A
  1. Epidural Hematoma
    2.Subdural Hematoma
  2. Subarachnoid Bleed
    4.Intracerebral Bleed
    5.Shear Injury
  3. Edema
  4. Skull Fracture
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8
Q

bleeding is located between the dura mater and the skull.

A

Epidural Hematoma

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9
Q

located
beneath the dura mater (sub-below), between it and the arachnoid mater

A

subdural hematoma

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10
Q

bleeding occurs in the
space beneath the arachnoid layer where the CSF is located. Often there is intense headache and vomiting with subarachnoid bleeding.

A

Subarachnoid Bleed

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11
Q

bleeding occurs within the
brain tissue itself.

A

Intracerebral Bleed

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12
Q

Sometimes, the damage is due to shear
injury, where there is no obvious bleeding in the brain, but instead the nerve fibers within the brain are stretched and torn.

A

Shear Injury

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13
Q

All injuries to the brain may also cause
swelling or edema, no different than the swelling that surrounds a bruise on an arm or leg.

A

Edema

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14
Q

The bones of the skull are classified as
flat bones, meaning that they do not have an inside marrow. It takes a significant amount of force to break the skull, and the skull does not absorb any of that impact. It is often transmitted directly to the brain.

A

Skull fracture

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15
Q

Skull fractures- Location:

A

Skull Vault Fractures:

Skull base fractures: serious prognosis

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16
Q

Risks/complications: neuroinfection (purulent meningitis, brain abscess), CSF fistula, IC hypotension syndrome (CFS), n. I and n.II. injury, deafness, n.VII. damage

A

Eyeglasses-like“ hematoma – Processus mastoideus ecchymosis Battle sign –

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17
Q

SKULL FRACTURES: DIAGNOSIS

A

Clinical physical evaluation
- palpation
- local pain, edema, or decline
- Skull X-ray or brain/skull CT (bone window)
- Liquorrhea nasalis (CSF leakage through broken
meninges)
- Otorrhea

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18
Q

Ecchymosis over mastoid area

A

(Battle’s sign) MAIN SYMPTOM

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19
Q

S/Sx

PERSISTENT LOCALIZED PAIN

A

SKULL FRACTURE)

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20
Q

S/Sx

TEMPORARY LOSS OF NEUROLOGIC FUNCTION WITH NO STRUCTURAL DAMAGE)

A

CONCUSSION

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21
Q

MODERATE BRAIN INJURY IN WHICH BRAIN IS BRUISED AND DAMAGED IN SPECIFIC AREA)

A

CONTUSION

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22
Q

HEADACHE,DIZZINESS, ANXIETY,IRRITABILITY AND LETHARGY

A

POST CONCUSSION SYNDROME SYMPTOMS LIK

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23
Q

is a condition that refers to bruises around both eyes.
● These bruises look like the dark patches around the eyes that are characteristic of raccoons.
● The pooling of blood around the eyes is most commonly associated with fractures of the base of the anterior cranial fossa

A

RACCOON SIGN
● Raccoon eyes

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24
Q

temporary,usually caused by blow to the head, eg. Falls and sports

A

CONCUSSION

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25
Q

S/Sx of Concussion

A

headache, loss of memory (amnesia)and confusion. The amnesia usually involves forgetting the event that caused the concussion.

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26
Q

Concussions are categorized based on severity:

A

Grade 1
Grade 2
Grade 3

27
Q

This type involves no loss of consciousness and resolution of any other symptoms within 15 minutes.

A

Grade 1

28
Q

There’s no loss of consciousness with this type of concussion, but the symptoms last longer than 15 minutes.

A

Grade 2

29
Q

This type involves loss of consciousness and other symptoms lasting more than 15 minutes.

A

Grade 3

30
Q

concussion can lead to longer-term or chronic symptoms,a condition called

A

post-concussive syndrome (PCS).

31
Q

refers to bruising and bleeding in the brain, typically arising in areas where the cerebral cortex of the brain strikes the skull or dura mater, the tough membrane surrounding the brain and spinal cord.

A

CONTUSION

32
Q

are two other hallmarks not necessarily seen in contusion cases

A

Nausea and vomiting

33
Q

S/ Sx Contusion

A
  • Lower pulse
  • High blood pressure
  • Dilation in one or both pupils
  • Affected breathing
  • Tingling in the limbs
34
Q

DIAGNOSIS

A

❖ PHYSICAL EXAMINATION (GLASCOW COMA SCALE)
❖ NEUROLOGICAL EXAMINATION
❖ CT SCAN,PET
❖ XRAYS

35
Q

COMPLICATIONS

A

● BRAIN DEATH (IRREVERSIBLE END OF BRAIN ACTIVITY)
● POST TRAUMATIC AMNESIA
● DEMENTIA (LOSS OF BRAIN FUNCTION)
● APHASIA
● TINNITUS
● MENINGITIS
● POST TRAUMATIC SEIZURES
● ATAXIA
● COMA

36
Q

Medications

A

Mannitol
Furosemide
Barbiturates
Phenytoin

37
Q

NURSING DIAGNOSIS

A

A. Ineffective airway clearance and impaired gas exchange related to brain injury
B. Ineffective cerebral tissue perfusion related to increased icp and decreased CPP
C. Deficient fluid volume related to LOC and hormonal dysfunction
D. Imbalanced nutrition less than body requirement related to metabolic changes,fluid restriction and inadequate intake
E. Risk for injury related to seizures, disorientation or brain damage
F. Potential for impaired skin integrity related to bed rest.hemiparesis hemiplegia and immobility
G. Potential for disturbed sleep pattern related to brain injury and frequent neurological checks

38
Q

injury damage to any part of the spinal cord or nerves at the end of the spinal canal often causes permanent changes in strength, sensation and other body functions below the site of the injury

A

spinal cord injury

39
Q

transmits nerve signals from the brain to the rest of the body. It is enclosed and safeguarded by layers of tissue known as the meninges and a column of vertebrae (spinal bones).

A

spinal cord

40
Q

3 layers of meninges

A

Dura mater
Arachnoid mater
Pia mater

41
Q

Most Frequently involved parts of the vertebrae are the_____

A
  • Cervical—C5, C6, and C7
  • Thoracic—T12
  • Lumbar—L1
42
Q

Most common vertebrae involved are (SCI)

A

C5, C6, C7, T12, and L1 because they have the greatest ROM

43
Q

Risk factors SCI gender and age

A

Male age 16-30

44
Q

Emergency signs and symptoms

A

Extreme back pain or pressure in your neck, head or back
Weakness, incoordination or paralysis in any part of your body
Numbness, tingling or loss of sensation in your hands, fingers, feet or toes
Loss of bladder or bowel control
Difficulty with balance and walking Impaired breathing after injury
An oddly positioned or twisted neck or back
OTHER SYMPTOMS

45
Q

Tetraplegia with total loss of muscular/respiratory function.

A

C-1 to C-3:

46
Q

Tetraplegia with impairment, reduced pulmonary capacity,complete dependency for ADLs.

A

C-4 to C-5

47
Q

Tetraplegia with some arm/hand movement allowing some independence in ADLs.

A

C-6 to C-7:

48
Q

Tetraplegia with limited use of thumb/fingers, increasing independence.

A

C-7 to T-1

49
Q

Paraplegia with intact arm function and varying function of intercostal and abdominal muscles.

A

T-2 to L-1

50
Q

Mixed motor-sensory loss; bowel and bladder dysfunction.

A

L-1 to L-2 or below:

51
Q

SCI 2 Categories

A

Complete and Incomplete

52
Q

SCI Test and Diagnosis

A

History
Physical examination (inspection, testing for
sensory function and movement, and asking some questions about the accident, neurological examination)
X Rays
Computerized tomography (CT) scan Magnetic resonance imaging (MRI)

53
Q

is a treatment option for an acute spinal cord injury

A

Methylprednisolone (Medrol)

54
Q

SCI - MEDICAL MANAGEMENT

A
  1. High dose corticosteroids (Methylprednisolone) - Mannitol Dextran
  2. Naloxone
55
Q

SURGICAL MANAGEMENT

A

Diskectomy
Laminectomy
taminotor
Diskectomy with fusion
Fixation and Fusion
REDUCTION

56
Q

damage above the reflex defecation
center in the sacral cord,

A

Upper Motor Neuron lesion

57
Q

damage within the reflex defecation center

A

Lower Motor Neuron lesion

58
Q

An over-activity of the autonomic nervous system causing abrupt onset of excessively high blood pressure

A

HEALTH RISKS - AUTONOMIC DYSREFLEXIA

59
Q

is the presence of bone in soft tissue where one normally does not exist. The acquired form is most frequently seen with either musculoskeletal trauma, spinal cord injury, or central nervous system injury.

A

HETEROTOPIC OSSIFICATION

60
Q

Damage to spinal column
Acute traumatic injuries
Overuse
Treatment
Nsaids
Acetaminophen
Muscle relaxants
Tramadol
Narcotics

A

MUSCULOSKELETAL PAIN

61
Q

Damage to the central nervous system
Compression neuropathies
Segmental pain
Treatment
- Anti Seizure medications
Antidepressants
-
Therapy PT/OT, cold, heat, massage Modalities
- TENS,
acupuncture
Adaptive equipment

A

NEUROPATHIC PAIN

62
Q

Steroidal injections, blocks, biofeedback
Relaxation, hypnotism, vibration,
Surgery - if compression
neuropathies are unresponsive to conservative
measures, surgery may be necessary

A

NEUROPATHIC PAIN CONTRAINDICATION

63
Q

Poorly localized and defined
Treatment
Above the level of injury
nociceptive pain due to visceral injury or
inflammation-treatment is identifying the
cause and then treating the injury or
inflammation.
Below the level of injury may be
nociceptive or neuropathic
celiac plexus block can be diagnostic if

A

VISCERAL PAIN

NCM 116 Lecture (11 decks)

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