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Complex II > Acute Intracranial Disorders > Flashcards

Acute Intracranial Disorders Flashcards

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1
Q

What is a concussion?

A

mild injury
usually resolves w/in 72 hours

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2
Q

What are the s/sx of a concussion?

A

brief loss of consciousness
retrograde amnesia
confusion
memory loss

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3
Q

What is a contusion?

A

bruising of the brain

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4
Q

What are the s/sx of a contusion?

A

Unconsciousness
period of stupor or confusion
postural changes
coup-contrecoup injury

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5
Q

What is a coup-contrecoup injury?

A

an injury that occurs where the head is struck but also on the opposite side of the head that was not struck

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6
Q

What is a open head injury?

A

the skull has been penetrated by an object or blunt force

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7
Q

What is a closed head injury?

A

Blunt force trauma causes acceleration of the head & the deceleration or hits an object

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8
Q

What is a diffuse axonal injury?

A

Widespread injury
severe head injury
results in coma
usually no hemorrhage is involved

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9
Q

What is an intracranial hemorrhage?

A

bleeding in the epidural, subdural, or intracerebral spaces after a trauma

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10
Q

What is a intracerebral hemorrhage?

A

a hemorrhagic stroke

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11
Q

What is an epidural hemorrhage?

A

arterial blood flow
bleeding very fast
decreases ICP fast

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12
Q

What are the s/sx of an epidural hemorrhage?

A

ipsilateral pupillary changes
posturing

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13
Q

What is a subdural hemorrhage?

A

most common
can be acute, subacute or chronic

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14
Q

What is a subdural hematoma?

A

Head hurts on the side of the injury
eyes are slow to react
the eye is bigger on the side of the injury
weakness/paralysis on the opposite side

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15
Q

What are the s/sx of a skull fracture?

A

amnesia
loss of consciousness
CSF leakage from nose (rhinorrhea) or ears (otorrhea) which indicates a basilar fx
the ‘halo’ sign: yellow stain around blood (bullseye) and this fluid will test positive for glucose
Battle’s sign
Raccoon eyes

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16
Q

What is the battle’s sign?

A

bruising/eccyhmosis over the mastoid process

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17
Q

What is raccoon eyes

A

periorbital edema & ecchymosis around the eyes
looks like the patient has black eyes

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18
Q

What diagnostics are used for head injury?

A

GCS
labs (CBC, CMP, drug screen)
CT of head & spine
Lumbar puncture (not done with increased ICP bc it will herniate) Do a CT 1st to R/O increased ICP before LP

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19
Q

What are the priority nursing interventions for head injuries?

A

ALWAYS suspect a cervical spine injury
MUST R/O cervical spine injury w/ CT scan before removing any devices used to stabilize the c-spine
2 large-bore IVs
foley to gravity
neuro checks (assess pupils)
check LOC, VS, I&O, mon for ear/nose leakage

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20
Q

What are the major complications of head injuries?

A

hemorrhage
infection
seizures
death
permanent neuro defects

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21
Q

What surgical intervention can be used to treat head injuries?

A

craniotomy
piece of the skull is removed, allowing access to a hematoma, tumor, etc.
decreases ICP

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22
Q

What are the complications of a craniotomy?

A

permanent neurological deficits
seizure disorders
infection
death

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23
Q

Injuries in the cervical region results in…

A

Quadriplegia

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24
Q

Injuries below T1 result in…

A

paraplegia

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25
C4 injury or above cannot
Spontaneously breathe
26
What should you do for a pt with a C4 or above injury?
Intubate and mechanically ventilate ABCs (C-spine) phrenic nerve C4 (C3-C5 keeps you alive)
27
What are the s/sx of a spinal cord injury?
pt doesn't feel anything below the shoulders hyperflexion/hyperextension flaccid muscles hypoTN loss of thermoregulation = sign of neurogenic shock absent DTRs shallow respirations spinal shock = total temporary loss of all reflexive & autonomic function below the injury
28
What are the priority interventions for a spinal cord injury?
secure airway and apply c-collar (keep body flat) O2 & suction (intubate/ventilate if GCS <8) monitor neuro status & muscle strength/sensation loss of thermoregulation (s/sx of neurogenic shock)
29
What is the life-threatening complication to monitor for with a spinal cord injury?
Autonomic Dysreflexia life-threatening HTN following spinal cord injury usually pts with an injury around T6 & above
30
What are the s/sx of autonomic dysreflexia?
sudden onset of extreme HTN, increased temp, severe HA, pallor, & cold below the level of injury Other symptoms include blurred vision, diaphoresis and have an increased risk for stroke & death
31
What are the causes of autonomic dysreflexia?
distended bladder fecal impaction pt is cold tight clothing
32
How do you treat autonomic dysreflexia?
relieve kink in the cath catheterize the pt remove fecal impaction remove tight clothing sit the patient up to decrease BP!!! admin antiHTN
33
What are the s/sx of neurogenic shock?
Hypotension & bradycardia flushed, warm, dry skin loss of temp regulation
34
What is a complication of neurogenic shock?
postural hypotension when a pt with neurogenic shock is in an upright position, they will have this
35
How do you transfer a pt with postural hypotension?
1. raise HOB (lower if pt becomes dizzy) 2. transfer pt into a reclining wheelchair 3. be ready to lock and lean the wheelchair back if the pt reports dizziness 4. DO NOT attempt to return the pt back to bed
36
What are the priority interventions for a neurogenic shock?
monitor hypoTN & bradycardia IV fluids Atropine (bradycardia) Vasopressors (dopamine for hypoTN) always use 3 people to move the pt
37
What type of meningitis has a vaccine?
bacterial
38
What is meningitis?
inflammation of the meninge's membranes surrounding & protecting the brain & spinal cord
39
What are the diagnostics used for meningitis?
CSF analysis (lumbar puncture) - will have elevated WBCs & protein - bacterial will have decreased glucose - cloudy CSF = bacterial (+ gram) - clear CSF = viral ( - gram) CT/MRI CBC Culture everything!
40
What are the s/sx of meningitis?
excruciating, constant HA Nuchal rigidity (stiff neck) photophobia Positive Kernig's sign Positive Brudzinski's sign fever & chills N/V tachycardia seizures
41
What is Kernig's sign?
Bend the knee at 90 degrees and extend to a completely straight if positive, the pt will report pain while the extension
42
What is the Brudzinski's sign?
pt lays flat on back while flexing the knees and hips into a fetal position while also flexing their neck if positive, the pt will feel pain with the flexion of their neck "Bru, that hurts!"
43
What is the priority for meningitis?
Isolation!
44
When can a patient be removed from isolation?
if test comes back viral OR if its bacterial and the pt has been on antibiotics for 24 hrs
45
What kind of precautions is bacterial meningitis?
droplet
46
What nursing actions are pertinent for meningitis?
HOB @ 30 degrees monitor for increased ICP seizure precautions neuro checks decrease stimuli/bright light
47
What medications are given with meningitis?
Antibiotics Phenytoin for seizures Analgesics (NO opioids)
48
Is meningococcal meningitis reportable?
YES
49
What are risk factors for hemorrhagic stroke?
DM obesity HTN Atherosclerosis A-fib oral contraceptives smoking family hx
50
What are the general s/sx of a hemorrhagic stroke?
slurred speech visual disturbances dizziness weakness to extremities
51
What are the s/sx of a left-sided stroke?
all the A words! inability to speak & understand language memory intact difficulty w/ vision can't do math Frustrated easily depression right unilateral neglect
52
What are the s/sx of a right-sided stroke?
loss of depth perception impairment in creativity poor impulse control left unilateral neglect cannot recognize faces/person's name
53
What medication can we give to help with nerve pain following a hemorrhagic stroke?
gabapentin
54
What is something you should notify the provider of with hemorrhagic strokes?
if the pt has A-fib and is taking warfarin/any blood thinner
55
What are the clinical manifestations of brain tumors?
positive Babinski and romberg sign papilledema (swelling of optic nerve) dysphagia dysarthria (slurred speech)
56
What is the priority when taking care of a patient with a brain tumor?
maintain airway neuro checks seizure precautions/safety give antiepileptics stop aspirin 72 hrs pre-op
57
What should you inform your patient to avoid 5 days before their brain tumor surgery?
NO ETOH tobacco Anticoagulants NSAIDs
58
What diagnostics are used for brain tumors?
CT/MRI EEG Biopsy lumbar puncture should not be done if there is increased ICP Labs
59
What are possible complications of brain tumors?
Syndrome of inappropriate antidiuretic hormone (SIADH) Diabetes Insipidus
60
What is the s/sx of SIADH?
fluid retention Disorientation HA vomiting muscle weakness decreased LOC weight gain no thirst
61
How do you treat SIADH?
vasopressin fluid restriction
62
What are the s/sx of diabetes insipidus?
excessive urination - a complication of a craniotomy
63
How do you treat diabetes insipidus?
massive fluid replacement Electrolyte replacement monitor labs

Complex II (6 decks)

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