MedSurg Mod 6: CNS Disorders Flashcards Preview

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Flashcards in MedSurg Mod 6: CNS Disorders Deck (152)
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How are head injury, Increased ICP, intracranial surgery, seizure and other complications all interrelated?

Head Injury --> ICP, Seizures and Complications, Surgery

Intracranial Surgery Increased ICP and Seizures and other Complications

Increased ICP Seizures and Other complications


What is the one thing independent from most other CNS injury relationships

Spinal Cord Injury


Head Injury

involves trauma to the scalp, skull, and brain

It results in anything from a mild concussion to coma to even death



Traumatic brain injury


What is the most common cause of TBI

falls (any age)


Open TBI

Skull opened


Closed TBI

skull is still closed


Diffuse TBI

widespread damage


Focal TBI

localized damage to one brain area


TBI damage and what you see is dependent on ___ and ___

location and severity


Epidural Hematoma (Hemorrhage)

Above the dura and under the skull

a medical emergency that is usually due to a rupture of a middle meningeal Artery

can cause brain herniation leading to loss of consciousness and focal neuro deficits like pupil dilation and paralysis of an extremity


Subdural Hematoma (Hemorrhage)

Below the dura, Between the Dur and Brain

usually venous in origin - bleeding not as dramatic but this can be both good and bad

may be acute, subacute, chronic (elderly, people on anti coagulants)


Intracerebral Hematoma (Hemorrhage)

withIN the brain tissue

result of focused injury or system issues (focal rather than systemic)

Major risk factor is HTN --> CVA



Global and Microscopic

Widespread homogenous impairment of brain cells (cells under perform)

No visible bleeding occurs

Confusion, irritability, Disorientation, and HA occur

harder to measure and no real fix just cures itself over time



Localized and macroscopic

structural damage to cells (cells die)

effects peak 18-36 hours post injury

coup contrecoup injuries cause this

can increase ICP d/t bleeding

blurred vision, disorientation, unsteady gait, vomiting, slurred speech, and coma can occur


Just because evidence of damage is easier to see with a contusion does not mean...

it will tell what type of injury occurred like hypoxia, impact, foreign body etc - it just tells us there is cellular damage


Can a concussion and contusion occur simultaneously



Damage at the brain cell level is not dependent on...

actual injury


Coup-Contrecoup injury

2 injuries from one impact - a rebound effect

a focal injury

commonly associated with a contusion occurring


Diagnosis for Head Injuries

CT or MRI - identifying and evaluating injuries to brain tissue

Skull X Rays - look at penetrating injuries to the skull and if skull is damaged



What is the number1 concern of head injuries

bleeding and increased ICP


Medical care for Head Injuries

1 - Control ICP

2. Reduce cellular demands

3. Surgical intervention

4. Minimize secondary injury


Intracranial Bolt (ICB)

Bolt put in brain tissue that can monitor ICP


Why may mechanical ventilation and a respiratory be used on a head injury patient

1. To aid if respiratory centers are damaged or at risk and prevent hypoxemia: Lactic Acidosis increased --> increased vasodilation occurs to compensate --> increased ICP will occur!

2. to prevent hypoxemia and hypercapnia as a result of cerebral vessel vasodilation causing increased ICP


Why do head injury patients sometimes undergo medically induced comas?

to decreased CNS activity and reduce too much work in the brain in order to reduce cellular demands


What is the secondary injury to watch for with head trauma that can skyrocket ICP



Goals of Nursing Care of Head Injuryu

1. Address acute issues like respiratory, cerebral circulation, safety

2. Prevent and treat secondary complications like infection, pneumonia, skin integrity, safety, and positioning

3. Prevent treat and minimize consequences via behavior, physical rehab like OT and PT, and education


What to do first for nursing care of head injuries

Assess all systems for direct impact (PRIMARY COMPRIOMISE):

a. Patent Airway and Optimal Breathing pattern --> Monitor O2 sat, respiratory rate, lung sounds, VS

b. Optimal Cerebral tissue perfusion --> monitor mentation

c. Appropriate fluid balance --> monitor labs for H&H and lytes


What to do second for nursing care of head injuries

Assess all symptoms for secondary impact (secondary compromise):

a. s/s of infection

b. complications

c. consequences


What is an important issue to teach patient and family about?

Post concussion syndrome

how difficult it is to measure concussion

when to monitor and notify MD

how changes depend on location and severity