Neuro Trauma Flashcards
(121 cards)
1
Q
What are they two categories of brain injuries
A
Primary
Secondary
2
Q
Define Primary injury
A
Primary injury occurs at the time of the trauma
3
Q
Define Secondary injury
A
The indirect additional complications that occur later on that plays a large role in brain damage and death
- hours or even days later
4
Q
Primary injury examples (5)
A
Contusion
Epidural Hematoma
Subdural Hematoma
Traumatic Subarachnoid Hemorrhage
Diffuse Axonal Injury
5
Q
Define Diffuse Axonal Injury
A
Brain rapidly shifts inside the skull and causes shearing of axons
6
Q
What state are those with Diffuse Axonal Injury left in typically?
A
Coma
7
Q
Doctor recommends to do a CT and MRI for diffuse axonal injury. What do you know about this and what does that mean for the nruse?
A
Diffuse axonal injury is hard to detect on MRI and CT - which means nurse assessment has to be really good.
8
Q
Symptoms of diffuse axonal injury?
A
Coma
Confusion
N/V
9
Q
T/F
Secondary brain injury is not preventable
A
False. We can prevent this
10
Q
What is the focus of care when it comes to minimizing secondary injury?
A
Increasing oxygen blood to brain
Decreasing metabolic demands
11
Q
Why do we want to prevent hypoxemia in a patient who has a primary head injury?
A
If there isn’t enough oxygen in the blood, it increases chance of secondary head injury.
12
Q
Why avoid hypotension to avoid a secondary brain injury?
A
We don’t want there to be hypotension because that can affect how well we perfuse the brain and thus cause the secondary injury.
13
Q
Why do we need to focus on the blood sugar needs after a patient has a primary head injury?
A
Focus on controlling blood sugar to avoid a secondary head injury
14
Q
What is meant “respond to loss of auto regulatory mechanisms” if a patient has a primary head injury?
A
Sometimes people’s compensation skills don’t work, and so it is our job to use medications like pressors, diuretics, hypertonics, etc to try to manipulate it
- loss of compensation like temp, BP, Hr changes
15
Q
Why do we want to avoid increased ICP after having a primary brain injury?
A
Increased ICP can cause a secondary injury to occur
16
Q
Why do we want to control the Co2 levels after a patient has a primary head injury?
A
The CO2 dictates the constriction/dilation of the vessels and can cause a secondary head injury if not monitored.
17
Q
What is the most important indicator of neuro severity and how do we assess it?
A
LOC changes - which we assess for with the Glasgow Coma Scale
18
Q
Mild Traumatic Brain Injury GCS score
A
13-15 = mild
19
Q
Moderate Traumatic Brain Injury GCS score
A
9-12 = moderate
20
Q
Severe Traumatic Brain Injury GCS score
A
Less than 8
21
Q
What is the nature of deficits for a mild TBI?
A
Functional deficits that lasts weeks or months but usually come back
22
Q
Diagnostic testing for Hematomas
A
Blood pooling bruise. CT
23
Q
Diagnostic testing for Hemorrhage/Bleeding
A
CT
24
Q
Diagnostic testing for fractures
A
CT
25
Diagnostic testing for cerebral edema
**CT**
26
Diagnostic testing for *_severe_* _diffuse axonal injury_
**MRI** - but only if the **DAI** is **severe.** A lot of times they don't show up.
27
Diagnostic testing for _brain stem injury and hernation_
MRI
28
Diagnostic testing for _aneurysm_
MRI - due to the vessel bulging
29
What is the danger of an aneurysm?
As the bulge grows, it can hemorrhage and then you have a stroke on your hands.
30
What other injuries do we use diagnostic testing for that can be related to the cause of the TBI?
Other bone fractures. Or really anything.
31
What nursing care will you provide to a patient with a TBI that address respiratory needs?
Airway Management
Oxygenation
Ventilation
32
Explain why you will be managing the patients airway for a TBI
Brain injuries can affect the patients ability to maintain their own airway - so again, we want to avoid secondary injury.
33
Why would you be giving a patient oxygen for a TBI?
The TBI may affect their ability to oxygenate themselves but also, the brain needs oxygen to avoid a secondary injury.
34
Why might a patient with a TBI be on a vent?
The TBI can affect someone's ability to oxygenate themselves and it could be so bad that they need the vent to breathe but also avoid secondary injury.
35
What nursing care will you provide to a TBI patient that addresses the needs of the brain related to volume?
Manage fluids
Manage ICP
Support cerebral perfusion
36
TBI patient asks why they need to be on fluids. What do you tell them?
The fluids can be contributing to either their perfusion or it can be taking volume off.
* depends on what the brain needs atm
37
Why do you do ICP management on a TBI patient?
Increased ICP can contribute to injury and even death.
38
Why do we manage the cerebral perfusion?
Manage cerebral perfusion because it is what keeps the brain oxygenated and full of blood.
39
What med can support CPP?
Dopamine etc / pressors
40
Why will we want to prevent an increase in oxygen demand in an ICP patient?
Prevent the need for more oxygen because the brain is already working hard to keep itself oxygenated after a TBI
41
How can we prevent increased cerebral oxygen demand?
Sedation meds
42
What is a secondary complication that can come with any head injury - primary or secondary - related to care?
Pneumonia, PE, DVT, skin integrity
* just because they will be immobile
43
How do check for the pneumonia & PE?
Anticoagulation
Lung sound assessments
* especially if they're sedated. Diminished lung sounds are bad
44
How often do we turn patients?
q2hrs
45
Why do we have to educate the family and be there for them with a TBI?
Brain injuries are often acute because of an accident
46
Linear fracture
Generally not displaced. More like a hairline fx that heals on its own
47
Depressed fracture
Inward depression of the bone which needs surgical removal
48
Basilar fracture
Symptom?
Back Base of the skull is involved.
49
Kiddo who hit the back of their head is complaining of runny nose and ears. What could this mean?
Basilar fracture - the runny nose and ears is cerebral spinal fluid from a dural tear.
50
If a kid is having CSF coming out of their nose and ear, what do you need to do?
Call the doctor so you can get a pH test for glucose
51
Little kid has bruising behind the ears. What is this and what do you need to be aware of?
Battles sign related to basilar fracture.
Caused by shaken baby syndrome.
52
Most common causes of Spinal Cord Injury?
Motor vehicle accidents (MVA)
Falls
Acts of violence
Sports-related injuries
53
Which gender has mores spinal cord injuries?
80% are males due to reckless behaviors
54
Who is the major population that gets spinal injuries from falls?
23% elderly
55
What is meant by acts of violence causing spinal cord injury?
Domestic abuse towards females
56
What mechanisms of injury are there for spinal cord injuries?
Hyperflexion
Hyperextension
Axial loading/compression
Rotation
Penetrating trauma
57
What causes the _hyperflexion and hyperextension_ of a spinal cord injury?
**Whiplash** - it compresses the spine and causes bruises
58
What mechanism of injury causes _axial loading_?
**Diving** action
59
What action causes _rotation_ related to the spinal cord injury?
From **rolling**
60
What causes the _penetration_ spinal cord injury?
Knife or gunshot wound
61
What happens to the synapse if the spinal cord is pushed, bruised, or compressed from edema?
Whatever the case - it **blocks the synapse** from traveling and you have **paralysis**.
62
Concussion effects
Temporary loss of function
63
Symptoms of Concussion
Headache
Vomiting
Decrease LOC
Sensitive to light and sound
* common in athletes; guardian cap
64
Contusion Effecgts
Bruising and bleeding goes into spinal cord causing **edema** and ***possible*** **neuronal death**
65
Laceration effects
The tear in the cord causes a permanent injury
66
What are lacerations caused by?
What do laceration injuries usually involve in addition?
Stabbing wound
Can involve contusion, edema, & compression
67
Transection effects
Severing of whole cord w complete loss function below the injury
68
Explain how hemorrhage and blood vessel damage can occur with a spinal cord injury and its effects
Any injury can cause internal bleeding. Both issues involve bleeding/rupture which can create volume issues.
69
What is the secondary injury caused by in a spinal cord injury?
Vascular damage from the initial injury which decreases blood flow
70
Due to a decrease in blood flow often associated with cell and vascular damage with spinal cord injuries , what happens? (2)
Metabolic function changes
Cell membrane destruction therefore synapse not functioning
71
What symptoms do you see for a secondary injury to the spinal cord?
Respiratory changes
Headaches
72
What happens in the Neurogenic shock?
Spinal injury of some sort causes complete loss of autonomic nervous system; parasympathetic and sympathetic
73
What is the blood pressure and HR you see with Neurogenic shock?
How do we treat?
Hypotension + Bradycardia
Try fluid challenge
Use pressors; levophed
74
What measurements do we use to assess the Neurogenic shock?
CVP
MAP
CPP
75
What to assess with a spinal injury
Airway & Breathing
Circulation
Motor and sensory function q4hrs
76
When assessing someone with a spinal cord injury, what do you do position wise?
Immobilize spine with C spinal collar
77
Why is baseline assessment so important?
You need to be able to compare your findings.
78
What are the main 3 issues that cause decreased functioning related to the spinal cord injury?
Edema
Loss of vertebral alignment
Intrathecal hematoma
79
What is _spinal shock_?
Acute injury where there is temporary suppression of the reflexes
80
Is spinal shock caused by something that is repairable or permanent?
Repairable
81
What needs to be evaluated in spinal shock?
Degree of injury so keep your assessment up
82
Define Complete Spinal Cord injury
Total loss of sensory and motor functions caused by a complete interruption
83
Define Incomplete Spinal Cord Injury
Varying degree of sensory and motor function disruption due to some tracts being intact
84
Which types of spinal cord injuries are the most common ? (2)
Cervical
Lumbar
85
What level of spinal cord injury affects respiratory function?
The higher up the insult, the more likely respiratory is involved.
86
What diagnositic tests are there for spinal cord injuries?
Xray
CT
MRI
87
What does a CT diagnostic test exam for in relation to spinal cord injury?
Bone injury and cord compression
88
What does MRI diagnostic test exam for in relation to a spinal cord injury?
Soft tissue involvement
* can identify ligamentous injury without bone abnormality
89
What steps do we take to manage a spinal cord injury and avoid the secondary injury?
Immobilize them
Manage the airway
Add on Respiratory management
Hemodynamic support
Neuroprotection
90
How do we immobilize the patient for an SCI?
Hard cervical collar
Bed rest
Log roll
91
How do maintain the airway management if we intubate them for a SCI?
Keep them immobilized
Tracheostomy (hole in neck) for severe injuries
92
What happens to patients who have impaired diaphragmatic innervation?
What are concerned about?
C2 - decreased cough strength and inability to clear secretions
Aspiration risk
93
Main goal of management for an SCI?
Prevent secondary injury
94
How do we provide hemodynamic support for an SCI?
Maintain **adequate oxygenation and ventilation**
Adequate **fluids**
**Rule out** any other injuries that could lead to **hemodynamic shock!**
**Neurogenic shock** can cause bradycardia and hypotension
95
What do we use for neuroprotection for an SCI?
Methylprednisone (steroid) administration for anti inflammatory action
96
An SCI can lead to neurogenic shock. What does this mean for the hemodynamics?
We need to treat the hypotension and bradycardia that comes with it
97
How do we treat the hemodynamic instability that can come from a SCI?
Adequate oxygenation - vent
Rule out any other injuries that can cause hemodynamic shock
Give adequate fluids
98
What is one way we can supply the brain with glucose tho?
Steroids technically since they raise BG
* point is, there is a balance
99
What meds do we give in addition to the high dose steroids for the SCI neuroprotection?
Protonix, Prilosec for the GI ulcers
Blood glucose monitoring for the skyrocketing BS
100
Neurogenic shocks unique presentation includes?
Instant hypotension with bradycardia
Warm flushed skin
101
Your patient with neurogenic shock has the injury below the 5th cervical vertebrae. What symptoms will be illicited?
Diaphragmatic breathing - due to the loss of control over the intercostal muscles.
102
Neurogenic shock patient has their injury above the 3rd cervical vertebrae. What are the symptoms associated with it?
Patient will go into **respiratory arrest immediately** from loss of control of diaphragm
103
What meds will we use for neurogenic shock?
Dopamine
Vasopressin
Levophed
Atropine
Phenylephrine
(trying to drive the pressure)
104
First line treatment for neurogenic SCI patient?
Phenylephrine
* definitely for those who don't respond to dopamine
105
What bladder and bowel management do you anticipate for a patient with neurogenic shock rt SCI?
And why?
Foley insertion hourly output
We want to monitor their output because of the hypotension in neurogenic shock leading need to monitor for the acute renal failure.
106
Patient with history of neurogenic shock , what do we need to monitor if they make it to the point they void on their own?
Monitor for residuals. May have to straight cath them.
107
What do you anticipate for a neurogenic shock rt SCI patient who is not able to stool?
Stool softener
Digital stimulation
108
Stool softener meds
Colace
Miralax
109
What meds can often cause the constipation??
Pain meds
* gabapentin , opiods
110
What pain meds do you anticipate for neurogenic shock patient rt to SCI?
Opiates
Muscle relaxants
111
What meds can we use to treat the neuropathic pain from neurogenic shock rt SCI?
Antidepressants and anticonvulsants
* gabapentin
112
Explain the difference between Autonomic Dysreflexia and Neurogenic shock
Neurogenic shock is caused by loss of control of the sympathetic and parasympathetic with a SCI - **hypotension**. .
Autonomic Dysreflexia is due to an insult at or above T6 and is caused by over-distention or other reasons - **hypertension**.
113
Autonomic Dysreflexia over-distention examples
Distended bladder
Full rectum
Infection
Pressure sores
114
Cause examples of Autonomic Dysreflexia
Distended bladder
Full rectum
Infection
Pressure sores
115
What BP do you expect for Autonomic Dysreflexia?
Hypertension
116
What does Autonomic Dysreflexia often preciptate/lead to?
When does it usually occur?
Precipitates Seizure & Stroke
* put on anticonvulsants
Can actually occur anytime after spinal shock resolves but usually within the first year
117
What position do you move Autonomic Dysreflexia patient
Put them in a sitting position to decrease pressure
118
What to vitals monitor in Autonomic Dysreflexia patient?
What medication would you use?
BP
Pulse
3-4x a day
119
How is Autonomic Dysreflexia treated?
Key is to treat the underlying cause
* bladder distention, full rectum, infection, pressure sores, pain
120
How to best **prevent** the Autonomic Dysreflexia
Pay careful attention to bladder and bowel - to avoid the distention
Be consistent on turning the patient - to avoid sores
Watch labs and temp - to monitor for infection
121
Since the there is hypertension with Autonomic Dysreflexia, what meds do you anticipate?
Antihypertensives
* beta blockers
* CCB
