T3-Blueprint: Head Injuries

Question 1

What are the normal percentages of head? What happens if one of these percentages changes?

Answer 1

Brain: 80%
CSF: 10%
Blood: 10%

Body has to adjust

Question 2

What concerns might the nurse have about sedation in the acute head injury patient?

Answer 2

Interferes with the need to perform periodic neurological exams to assess for LOC and extent of injury

Question 3

Why do infants handle ICP better?

Answer 3

Fontanels are not closed yet–more room for growth

Question 4

What are signs of ICP?

Answer 4

• Headache (on awakening, in absence of eating)
• Vomiting
• Personality changes
• Irritability, fatigue
• Gait changes
• Double/blurred vision
• Pupils react more slowly, then dilate and become fixed
• Increased head circumference
• Bulging fontanels
• LOC: sleepy to coma (decreased recognition of parents)

Question 5

What are late signs of ICP?

Answer 5

• Cushings triad
• Bradycardia
• Increased BP
• Irregular breathing

Question 6

What is cushings triad (late sign of ICP)?

Answer 6

Bradycardia
High BP
Slow breathing

Question 7

What does ICP monitoring tell?

Answer 7

Amount of pressure build up in head

Question 8

What does a ventricular catheter do?

Answer 8

Surgical insertion that burrs a hole (external ventricular drain)…it drains excess CSP

Question 9

What is the name of the catheter the surgeon can manipulate?

Answer 9

Bolt catheter

Question 10

What are some treatments for ICP?

Answer 10

• Mannitol
• Steroids
• Versed
• Antibiotics
• Anti-epleptics
• Barbituates
• Phenobarbital

Question 11

Should we do neck compression for ICP? Explain

Answer 11

Avoid; keep the head midline and elevate HOB

Question 12

How should environment be for child with ICP?

Answer 12

Calm environment

Question 13

How should child eat if they have ICP?

Answer 13

NG feedings

Question 14

How do we hydrate child with ICP?

Answer 14

2/3 maintenance–dont want to increase ICP even more by adding lots of extra fluids

Question 15

Signs of ICP?

Answer 15

• Headaches
• Irritability
• High pitched cry
• Vomiting
• Visual changes
• Ataxia
• Seizures

Question 16

What is a neurological sign of ICP?

Answer 16

“Cat cry”

Question 17

What are the 5 LOC states?

Answer 17

1. Lethargy
2. Obtunded
3. Stupor
4. Coma
5. Persistent vegetative state

Question 18

Falls asleep quickly

Answer 18

Lethargy

Question 19

What is obtunded?

Answer 19

Arousable with stimulation

Question 20

Deep sleep, responds to vigorous, repeated stimulation

Answer 20

Stupor

Question 21

What is coma?

Answer 21

No response to decerebrate posturing to pain

Question 22

Eyes open, limbs spastic, no words, some swallow

Answer 22

Persistent vegetative state

Question 23

What are 3 parts to glasgow coma?

Answer 23

1. Eye opening (up to 4 pts)
2. Verbal response (up to 5 pts)
3. Motor resposne (up to 6 pts)

Question 24

How is glasgow coma scored?

Answer 24

3-15

Question 25

What is a good glasgow coma score?

Answer 25

15

Question 26

What is a poor score for glasgow coma?

Answer 26

8 or less (3=worst)

Question 27

What is the last sense to be lost with coma?

Answer 27

Hearing

Question 28

What are nursing interventions for a child with an acute head injury?

Answer 28

Anti-inflammatory meds and pain management

Question 29

What are nursing interventions for the unconscious child?

Answer 29

- ABC (only suction if needed) - Pain control - ICP monitoring - Bowel functioning - Skin care

Question 30

What are long term issues of a child with an acute head injury?

Answer 30

Physical problems | Cognitive impairments

Question 31

Premature closures of the sutures/absence of sutures

Answer 31

Craniostenosis

Question 32

Craniostenosis is the result for premature closure of the sutures/absence of sutures. What does that cause?

Answer 32

Increased ICP--> seizures, coma, death

Question 33

What are manifestations of craniostenosis? What age?

Answer 33

Early CORONAL sutures will show depression of the ORBITAL roof leading to visual changes like exophthalmia, strabismus, and other eye findings 18 months

Question 34

What is the mangement for craniostenosis?

Answer 34

Frequent positional changes in newborns and infants

Question 35

What is the treatment for craniostenosis?

Answer 35

Need surgical correction to realign cranial bones which relieves ICP pressure and helps cosmetic issues

Question 36

If craniostenosis is not treated, what happens?

Answer 36

Brain damage and mental retardation can occur

Question 37

What is the post-op for craniostenosis?

Answer 37

- Emotional support - PRESSURE DRESSINGS - Careful monitor of Hct and Hgb!

Question 38

Small skull due to lack of brain growth

Answer 38

Microcephaly

Question 39

What are 5 etiologies for microcephaly?

Answer 39

1. Cromosomal abnormality 2. Radiation exposure in preg. 3. Maternal infections like rubella or toxoplasmosis 4. Maternal alcoholism 5. 3rd trimester trauma, metabolic disorders, anoxia

Question 40

Hypoxic-ischemic brain injury: What are near drownings for infants and toddlers?

Answer 40

Infants: bath tub Toddlers: toilet bowel

Question 41

What happens in hypoxic-ischemic brain injuries?

Answer 41

- Laryngospasm - Swallow water - Vomit, gasp, aspirate - Blood shunts to the brain and heart - Hypoxia leads to brain damage!!!

Question 42

What happens in shaken baby syndrome?

Answer 42

Retinal hemorrhages Torn subdural vessels

Question 43

What is the most common head injury?

Answer 43

Concussion

Question 44

What is the hallmark signs of concussion?

Answer 44

Amnesia | Confusion

Question 45

Cranial injury: What kind of fracture? Treatment? Skin laceration and fracture

Answer 45

Compound--antibiotics and surgery

Question 46

Cranial injury: What type of fracture? Result in dural year, hemorrhage into nose and middle ear

Answer 46

Basilar

Question 47

Cranial injury: What are 2 key signs of basilar fractures?

Answer 47

1. Raccoon eyes | 2. Battle sign

Question 48

Cranial injury--basilar fracture What is raccoon eyes?

Answer 48

Anterior basal fractures! Bilateral periorbital ecchymosis--associated with orbital fractures

Question 49

Cranial injury--basilar fracture What is the battle sign?

Answer 49

Effusion of blood under ear Retroauricular ecchymosis Fracture of auditory canal/lower areas of the skull!

Question 50

Cranial injuries: What type of fracture? Traumatic separations of cranial sutures

Answer 50

Diastatic

Question 51

Why do kids get cranial injury easier?

Answer 51

- Insufficient musculoskeletal support of head - Thinner, softer brain - Thinner and compliant skull of younger children

Question 52

If a child has unilateral dilated pupils, what does this mean?

Answer 52

Intracranial mass

Question 53

If a child has a brainstem herniation what will their pupils be like?

Answer 53

Fixed and dilated

Question 54

What does it mean if a child has bilateral fixed and dilated pupils?

Answer 54

Brainstem herniation from increased ICP

Question 55

What kind of pupils for inter cranial mass?

Answer 55

Unilateral dilated

Question 56

What kind of injury if child has fixed and dilated pupils?

Answer 56

Brainstem herniation

Question 57

What kind of pupils will child have if they have a brainstem herniation from increased ICP?

Answer 57

Bilateral fixed and dialted