Neuro trauma Flashcards
(113 cards)
1
Q
Who has the highest mortality rates from TBI?
A
African Americans
2
Q
What is the nursing assessment for a TBI?
A
If the patient was unconscious or has amnesia
GCS
Pupil size
Pupil response to light
Corneal reflexes
Gag reflexes
3
Q
What are the three components of GCS?
A
Eye opening (4), verbal (5), motor response (6)
4
Q
When should a GCS flow chart start?
A
As soon as the initial assessment is made
5
Q
What is the number for a coma on GCS?
A
3
6
Q
What is the normal for GCS?
A
15
7
Q
What indicates a severe head injury or coma for GCS?
A
Less than 8
8
Q
What indicates a moderate head injury?
A
9-13
9
Q
What indicates a minor head trauma?
A
Greater than 13
10
Q
What are the primary neuroimaging diagnostic tools?
A
CT and MRI
11
Q
What is suspected for any patient with a head injury?
A
A cervical spine injury
12
Q
What are the priorities of management for a TBI?
A
Preserving brain homeostasis and preventing secondary brain injury
13
Q
What are the nursing interventions for a TBI?
A
Maintaining the airway
Monitoring neurologic function
Monitoring fluid and electrolyte balance
Promoting adequate nutrition
Preventing injury
Maintaining body temperature
Preventing sleep pattern disturbance
Monitoring and managing potential complications
14
Q
Why is monitoring fluid and electrolyte balance important for a patient with a TBI?
A
Patient may receive osmotic diuretics
Some may have SIADH
Some may have post traumatic diabetes insipidus
15
Q
Where should the feeding tube be if theres CSF rhinorrhea or damage to the skull base?
A
oral feeding tube instead of nasal
16
Q
Why is maintaining body temperature important for a patient with a TBI?
A
Fever → damage to hypothalamus, cerebral irritation from hemorrhage, or infection
Maintaining skin integrity
17
Q
What are potential complications of a TBI?
A
Decrease cerebral perfusion pressure (CPP)
- Elevation of head of the bed
- Increased IV fluids
- CSF drainage
Cerebral edema and herniation: leads to increased ICP
Impaired oxygenation and ventilation
Impaired fluid, electrolyte, and nutritional balance
Posttraumatic seizures
18
Q
What is adequate CPP?
A
Greater than 50 mmHg
19
Q
What is a primary head injury?
A
The consequence of direct contact to the head/brain during the instant of initial injury
20
Q
What are the symptoms of primary head injury?
A
Tissue deformation, axonal shearing, contusion, necrosis, blood-brain barrier disruption
21
Q
What is a secondary head injury?
A
Hours or days after the initial injury
22
Q
What causes a secondary head injury?
A
Results from inadequate delivery of nutrients and oxygen to the cells
23
Q
What are the symptoms of secondary head injury?
A
Cerebral edema, increase in inflammatory cytokines, mitochondrial damage, excitotoxicity, ischemia
24
Q
What happens in a scalp injury?
A
Blood vessels constrict poorly → bleeding profusely or develop hematoma
25
What is the key concern for a scalp laceration?
Infection
26
What are the types of skull fractures?
Open, closed, simple, comminuted, depressed, basal
27
What is an open skull fracture?
Tear in the dura
28
What is a closed skull fracture?
Dura is intact
29
What is a simple skull fracture?
Linear fracture → a break in the continuity of bone
30
What is a comminuted skull fracture?
A splintered or multiple fracture line
31
What is a depressed skull fracture?
Bones of the skull are forcefully displaced downward → require surgery within 24 hours of injury
32
What is a basal skull fracture?
Fracture at the base of the skull
33
What is the manifestation of a skull fracture?
Persistent, local pain
34
What are the manifestations of a basal skull fracture?
Hemorrhage from the nose, pharynx, or ears, and blood may appear under the conjunctiva
An area of ecchymosis may be seen over the mastoid (Battle’s sign)
- Behind the ears
CSF may escape from the ears and the nose
35
What are the types of brain injuries?
Open, closed, focal, diffuse
36
What is an open brain injury?
When object penetrates the skull, enters the brain, and damages the soft brain tissue in its path
When blunt trauma is so severe that it opens the scalp, skull, and dura to expose the brain
37
What is a closed (blunt) brain injury?
When the head accelerates and then rapidly decelerates or collides with another object
Brain tissue damaged but there is no opening through the skull and dura
38
What are the types of a focal brain injury?
Contusions and hematomas
39
What causes a contusion?
Severe acceleration-deceleration force or blunt trauma
40
What happens in a contusion?
Brain is bruised and damaged in a specific area
41
Where is a contusion most likely to occur?
Anterior portions of the frontal and temporal lobes
42
What is the peak for hemorrhage and edema when a contusion occurs?
18-36 hours
43
What are types of hematomas associated with a focal brain injury?
Epidural, subdural, or intracerebral
44
What is more concerning, a small rapidly developing hematoma or a large slowly developing hematoma?
Small rapidly developing
45
When is an epidural hematoma most likely?
Skiing
46
What is the fastest growing, most extreme hematoma?
Epidural
47
Where does an epidural hematoma happen?
In the epidural space, between the skull and the dura mater
48
What are the symptoms of an epidural hematoma?
Brief loss of consciousness followed by a lucid interval in which the patient is awake and conversant (because rapid absorption of CSF and decreased intravascular volume--compensation)
Patient becomes increasingly restless, agitated, and confused
Suddenly, patient's consciousness deteriorates quickly accompanied with other signs of neurological deficits (dilation and fixation of a pupil or paralysis of an extremity)
49
What is the treatment for an epidural hematoma?
Making openings through the skull (burr holes) to decrease ICP
Remove clots and control bleeding
Emergency craniotomy
50
Where does a subdural hematoma happen?
Between the dura and the brain
51
What are the causes of a subdural hematoma?
Trauma
Coagulopathies or rupture of an aneurysm
Venous in origin
Rupture of small vessels that bridge the subdural space
52
What are the signs and symptoms of an acute subdural hematoma?
Changes in LOC, pupillary signs, and hemiparesis
53
What are the indications for a craniotomy for a patient with subdural hematoma?
Coma, increasing BP, decreasing HR, and slowing respiratory rate
54
Who is most likely to get a chronic subdural hematoma?
Elderly
55
What are chronic subdural hematomas mistaken for?
Stroke
56
What are the signs and symptoms of a chronic subdural hematoma?
Severe HA comes and goes, alternating focal neurologic signs, personality changes, mental deterioration, focal seizures
57
What is the treatment for a chronic subdural hematoma?
Surgical evacuation of the clot
58
Where is an intracerebral hematoma?
Bleeding into the substance of the brain
59
What causes an intracerebral hematoma?
Traumatic falls, bullet wounds, stab injuries
Systemic hypertension: rupture of a brain vessel
Rupture of a saccular aneurysm
Vascular anomalies
Intracranial tumors
Bleeding disorders such as leukemia, hemophilia, aplastic anemia, and thrombocytopenia
Complications of anticoagulant therapy
60
What is the management of an intracerebral hematoma?
Supportive care
Control of ICP
Administration of fluids, electrolytes
Antihypertensive medications
Surgical intervention: craniotomy or craniectomy
61
What are the types of diffuse brain injuries?
Concussions and diffuse axonal injuries
62
What is a concussion?
A temporary loss of neurologic function with no apparent structural damage
63
What happens if the frontal lobe is affected in a concussion?
Bizarre irrational behavior
64
What happens if the temporal lobe is affected in a concussion?
Temporary amnesia or disorientation
65
What are the signs and symptoms of a worsening concussion?
Decrease in LOC, worsening headache, dizziness, seizures, abnormal pupil response, vomiting, irritability, slurred speech, and numbness or weakness in the arms or legs
66
What do repeated concussive incidents lead to?
Chronic traumatic encephalopathy syndrome
67
What can chronic traumatic encephalopathy syndrome present as?
Alzheimer disease → personality changes, memory impairment, and speech and gait disturbances
68
What is found for the imaging of chronic traumatic encephalopathy syndrome?
Temporal lobe atrophy
69
What happens in a diffuse axonal injury?
No lucid interval → immediate coma, decorticate and decerebrate posturing
70
What is the treatment for a diffuse axonal injury?
Supportive care
Prognosis is poor → consider organ donation
71
Why are the elderly at higher risk for hematomas?
Brain weight decreases
On aspirin and anticoagulants
72
What are the three cardinal signs of brain death?
Coma
The absence of brainstem reflexes
Apnea
73
How would brain death be confirmed?
Cerebral blood flow studies
EEG
Transcranial doppler
Brain stem auditory evoked potential
74
What are signs of increasing ICP?
Slowing of the HR
Increasing systolic BP and widening pulse pressure
Abnormal respiration patterns (irregular and slow)
75
Why is temperature control important in maintaining ICP?
A rapid increase in body temperature could cause brain stem damage (a poor prognostic sign)
76
What is a normal ICP?
15 mmHg or less
77
How can slightly increased ICP be reduced?
Hyperventilation
78
How is cerebral perfusion pressure calculated?
CPP = MAP - ICP
79
What is the ideal CPP?
>70 mmHg
80
How is mean arterial pressure calculated?
(Systolic BP + 2x diastolic BP)/3
81
Who is most likely to have a spinal cord injury?
Younger age, males, alcohol and illicit drug use
82
What happens if there is a spinal cord injury above C4?
Paralysis of respiratory muscles and tetraplegia
83
What happens due to the paralysis of respiratory muscles?
Greater risk for impaired spontaneous ventilation
- Intubated for the rest of their lives
84
What is tetraplegia?
Paralysis of all four limbs
85
What is paraplegia?
Paralysis of the lower body
86
What are the most frequently injured vertebrae?
C5-C7, T12, and L1 → due to greater range of mobility
87
What are hyperflexion injuries?
Acceleration injuries that cause sharp forward flexion of the spine
88
What causes hyperflexion injuries?
Head-on collision, fall, or driving
89
What are hyperextension injuries?
Backward snap of the spine
90
What causes hyperextension injuries?
Rear-end collision, downward fall onto the chin
91
What are the signs and symptoms of spinal cord injury?
Transient concussion (from which the patient fully recovers)
Contusion
Laceration
Compression of the spinal cord tissue
Complete transection of the spinal cord (paralyzed below the level of injury)
92
What is emergency management of a spinal cord injury?
Rapid assessment
Immobilization → spinal backboard
Extrication: remove from danger zone
Stabilization or control of life-threatening injuries
Transportation to trauma center
93
What is a primary spinal cord injury?
Result of the initial insult or trauma and are usually permanent
94
What is a secondary spinal cord injury?
Result of a contusion or tear injury, in which the nerve fibers begin to swell and disintegrate
-Reversible during the first 4-6 hours after injury
95
What are the signs and symptoms of a secondary spinal cord injury?
Ischemia, hypoxia, edema, and hemorrhagic lesions
96
What are the major causes of death in spinal cord injury?
Pneumonia
Pulmonary emboli
Sepsis
97
What is the primary cause of sepsis for patients who have had a spinal cord injury?
Bed sores lead to osteomyelitis
98
What are the respiratory problems associated with a spinal cord injury?
Retention of secretions
Increased partial pressure of arterial carbon dioxide levels
Decreased oxygen levels
Respiratory failure
Pulmonary edema
99
What is spinal shock?
Sudden depression of reflex activity in the spinal cord (areflexia) below the level of injury, muscular flaccidity, lack of sensation and reflexes
100
What are symptoms of spinal shock?
Hypotension and bradycardia
Atonic bowel
Bowel distention
Paralytic ileus
101
What should MAP be maintained for a patient in spinal shock, and why?
>85mmHg to prevent hypotension and further damage to spinal cord
102
How do you assess paralytic ileus?
Listen for bowel sounds
103
What is neurogenic shock?
Result of the loss of autonomic nervous system function below the level of the lesion
104
What are the symptoms of neurogenic shock?
Hemodynamic changes
Decrease in BP, HR, and cardiac output
Venous pooling and peripheral vasodilation
Patient does not perspire in the paralyzed portions of the body, because sympathetic activity is blocked
105
What is a BCR?
Bulbocavernosus reflex or Osinski reflex
A polysynaptic reflex that is useful in testing for spinal shock and its state
106
What is the prevention for DVT?
Low-dose anticoagulation therapy
Anti-embolism stockings
Sequential pneumatic compression devices
Indwelling filters (vena cava)
Never massage the calves or thighs
107
What is autonomic dysreflexia (hyperreflexia)?
Acute life-threatening emergency
Exaggerated autonomic responses to stimuli that are harmless in normal people
108
When does autonomic dysreflexia occur?
When a patient has cord lesions above T6, after spinal shock has resolved
109
What is the triggering stimulus for autonomic dysreflexia?
Pressure areas
Ulcer
Fecal impaction
Restrictive clothing
Full bladder or UTI
Object next to the skin
Draft of cold air
110
What are signs and symptoms for autonomic dysreflexia?
Severe and pounding headache with paroxysmal (sudden, uncontrollable) hypertension
Profuse diaphoresis above the spinal level of the lesion (most often of the forehead)
Nausea, nasal congestion
Bradycardia
Sudden increase in BP may cause retinal hemorrhage, hemorrhagic stroke, MI, or seizures
111
What is the treatment for autonomic dysreflexia?
Place patient in a sitting position to lower blood pressure (do this first)
Rapid assessment done to identify and alleviate the cause
The bladder is emptied immediately via a urinary catheter
Exam the rectum for a fecal mass
Exam the skin for any areas of pressure, irritation, or broken skin
112
What is the nurse’s job after autonomic dysreflexia occurs?
Label the medical record because it’s likely to happen
113
What are the interventions for a patient with autonomic dysreflexia?
Strategies to compensate for sensory and perceptual alterations
Measures to maintain skin integrity
Temporary indwelling catheterization or intermittent catheterization
NG tube to alleviate gastric distention
High-calorie, high-protein, high-fiber diet
Bowel program and use of stool softeners
