Neuro: traumatic brain injury

Question 1

neuro checks every

Answer 1

15-30 mins

Question 2

this scale is used at the scene of accident, ER and throughout acute care

-used as a predictor of outcome
-used in research
-high inter rater reliability

Answer 2

glasgow coma scale GCS

Question 3

score of GCS

Answer 3

3-15

or tester may separate eye opening, best motor response, and verbal response

Question 4

GCS

score 3 to 8

Answer 4

severe injury

Question 5

GCS score 9 to 12

Answer 5

mod injury

Question 6

GCS score 13 to 15

Answer 6

mild injury

Question 7

what are some limitations to GCS

Answer 7

pre-existing conditions - language
aphasia
alcohol or meds
other injury

Question 8

localized to site of impact on skull

Answer 8

local brain injury

Question 9

widely scattered shearing of axons (DAI)

Answer 9

diffuse brain injury

Question 10

raised intracranial pressure ICP

normal while laying down

Answer 10

0-10 mmHG

Question 11

ICP

def abnormal.

Answer 11

20mmHg

Question 12

ICP
>20mmHg

Answer 12

contraindicated for PT

Question 13

ICP

causes neuro dysfunction

Answer 13

20-40mmHg

Question 14

ICP

almost always death

Answer 14

40-60mmHg

Question 15

symptoms of ICP

Answer 15

-changes in LOC
-eyes impaired
-decerebrate/decorticate/flaccid
-decreased motor function
-HA
-seizures
-change in vitals
-vomiting
-infarts

Question 16

these are. _____ insults

-intracranial infection
-cerebral arterial vasospasm
-hydrocephalus
-post-traumatic epilepsy
-brain edema
-arterial hypoexmia
-arterial hypotension
-anemia
-hyponatremia
-intracranial hematoma

Answer 16

secondary

Question 17

cerebral arterial vasospasm velocities over ______ = _____ activites, supine exercise OK

Answer 17

100; OOB activites

Question 18

the brain’s viscoelastic properties allow it to move away from the mass lesion

Answer 18

-midline shift
-distortion
-herniation thru foramen magnum

Question 19

hypoxic and ischemic brain damage most commonly seen where in the brain

Answer 19

hippocampus, BG, scattered sites of cerebral cortex, cerebellum

Question 20

hypoxia vs ischemia?

Answer 20

hypoxia: decrease of O2 in blood and tissues b/c not breathing (entire brain)

ischemia: blood flow restriction to area occluded

Question 21

surgical interventions for hematoma

Answer 21

-craniotomy
-craniectomy
debridment and lavage of compound wounds to minimize infection
-insertion of device to measure ICP, requiring burr hole usually of frontal bone

Question 22

ventriculostomy

Answer 22

measures and drains CSF

-mobile and pole

Question 23

Bolt

Answer 23

measures only ICP
-cant go far becuase attached to machine

Question 24

pressure transducer at the same ____ level as ventricles

Answer 24

horizontal

EAM landmark

Question 25

every time the pt head moves, the EVD must be __

Answer 25

re-leveled

Question 26

EVD; prior to mobilization

Answer 26

EVD must be clamped by nurse or PT/OTR with nurse's permission

Question 27

treatment of raised ICP include

Answer 27

-osmotic therapy -sedative/hypnotic drug therapy -vasoreductive therapy -skeletal muscle paralytics and or relaxants -core temp normalized

Question 28

medications for ICP include

Answer 28

-anti-convulsants -corticosteroids -sedatives/anesthesia -skeletal muscle paralytics -skeletal muscle relaxannts -cardiovacular meds -antibiotics -narcotic analgesics

Question 29

metabolic care includes

Answer 29

indwelling catheter serum electrolytes aritficial feedings once bowel sounds return

Question 30

pulmonary complications

Answer 30

neurogenic pulmonary edema fat embolism in lung respiratory acidosis pneumonia

Question 31

how is neurogenic pulmonary edema gotten

Answer 31

asociated with increased pulmonary microvascular permeability

Question 32

how is respiratory acidosis occur

Answer 32

from artifical ventilation

Question 33

fever causes increased ___ demands increased ____ demands can be sign of ____ can be caused by damage to ____ can be sign of. ____ with brain herniation

Answer 33

-increased caloric demands -increased metabolic demands -can be sign of infection-most -commonly of respiratory and urinary tracts -damage to hypothalamus "neurogenic fever" -irritation with brain herniation

Question 34

systemic arterial hypertension can result in ____ disruption causing more ___

Answer 34

brain barrier disruption; causing more brain edema

Question 35

systemic arterial hypertension can be caused by ____

Answer 35

noxious stimuli

Question 36

loss of autoregulation of cerebral blood flow increases _____

Answer 36

blood brain volume : intracranial hypertension

Question 37

heart rate is controlled by various regions in

Answer 37

diencephalon caudally to myelencephalon (medulla)

Question 38

need to consider in addtion to location of injury:

Answer 38

RR temp level of arousal meds infeciton anemia or acute blood loss PE **Tachycardia