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Advanced MedSurg > Head Injuries (Final Exam) > Flashcards

Head Injuries (Final Exam) Flashcards

1
Q

Death occurs at which three points in time after injury?

A

1) immediately after = direct trauma and blood loss
2) within 2 hrs after = progressive or internal bleeding
3) 3 weeks after = multi-system failure

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2
Q

What are 5 types of head injuries?

A

1) scalp lacerations
2) skull fractures
3) diffuse (generalized)
4) focal (localized)
5) coup-contrecoup

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3
Q

What is a major complication of scalp lacerations?

A

blood loss and infection

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4
Q

What are 5 manifestations of skull fractures?

A

1) raccoon eyes
2) battle’s sign (bruising behind the ear)
3) Halo sign: yellow-ring staining behind bloody center spot on gauze found in CSF drainage
4) rhinorrhea: leakage of CSF from the nose
5) otorrhea: fluid leakage from the ear

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5
Q

What are 3 considerations for skull fracture manifestations?

A

1) provide meningitis-prophylactic antibiotics
2) NG tubes are CONTRAINDICATED, use orogastric tube
3) rhinorrhea could be hidden unless the patient is specifically assessed (drain gauze and look for halo sign)

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6
Q

In terms of a diffused head injury, what is a concussion and what may it result in?

A

a brief disruption in LOC; may result in postconcussion syndrome (2 weeks to 2 months)

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7
Q

What are signs and symptoms of diffused (generalized) head injury? (6)

A

1) persistent headache
2) lethargy
3) PERSONALITY/BEHAVIOR CHANGE
4) short attention span
5) decreased memory
6) CHANGES IN INTELLECTUAL ABILITY

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8
Q

A focal (localized) head injury contains which 2 subtypes?

A

1) lacerations

2) contusions

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9
Q

What is a laceration?

A

tearing of brain tissue

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10
Q

what is a contusion?

A

bruising of brain tissue

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11
Q

What can contusions lead to (2) and what medication can worsen bleeding?

A

Can rebleed or seizures can occur

Potential for increased hemorrhage if on anticoagulants !! (assess med regimen)

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12
Q

What is the main complication of a contusion?

A

EPIDURAL HEMATOMA (neurologic emergency, requires rapid evacuation)

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13
Q

Describe an epidural hematoma (4)

A

1) initial period of unconsciousness
2) brief lucid interval followed by a decrease in LOC
3) s/s: headache, nausea, vomiting
4) focal findings

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14
Q

What is a coup-contrecoup injury?

A

patient is hit on the front of the head and bounces back, causing bleeding at the BACK of the head

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15
Q

What is an acute subdural hematoma? (4)

A

1) occurs within 24-48 hours of injury
2) SYMPTOMS ARE RELATED TO INCREASED ICP
3) decreased LOC, headache
4) ipsilateral pupil dilated (pupil non-reactive to light on affected side) and FIXED IF SEVERE

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16
Q

When is intubation for a patient with a head injury needed? (3)

A

1) glasgow coma scale >8
2) PaCo2 >20 mmHg
3) C1-C4 injury

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17
Q

first step in emergency treatment for a patient with a head injury?

A

assume neck AND spinal cord injury = stabilize the cervical spine

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18
Q

Acute care and nursing implementations for a patient with a head injury? (4)

A

1) elevate the HOB
2) loose collection pad under the nose and over the ear
3) administer antiemetics and analgesics
4) preop preparation if needed = patient should be NPO

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19
Q

nursing care interventions that are CONTRAINDICATED for patients with a head injury? (4)

A

1) sneezing/blowing nose (pressure)
2) NG tubes
3) nasotracheal suctioning
4) DRINKING THROUGH A STRAW

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20
Q

What are the 3 fluids that impact intracranial pressure?

A

1) brain tissue (highest)
2) blood
3) CSF

21
Q

What other injury should always be assumed to accompany a head injury?

A

SPINAL CORD INJURIES

22
Q

What is the formula to calculate CPP (cerebral perfusion pressure)?

A

CPP = MAP - ICP

23
Q

What is the normal CPP?

  • Less than 50 indicates (2)
  • Less than 30 is ____
A

normal CPP = 60-100 mmHg
less than 50: initial ischemia, neural death
less than 30: irreversible (death)

24
Q

What is MAP (mean arterial pressure)?

A

amount of pressure that is used to push blood through the arteries

25
Q

normal MAP?
s/s of MAP less than 70 (3)
MAP greater than 150…

A

normal MAP = 70-150 mmHg

less than 70: syncope, blurred vision, faint

more than 150: vasoconstriction is lost

26
Q

What is the normal ICP?

A

5-15 mmHg

27
Q

What is the formula for MAP?

A

systolic BP + (2)(diastolic BP) / 3

28
Q

What can increased ICP and decreased CPP lead to (2)

A
  • brain ischemia and infarction
29
Q

What are common causes of increased ICP?

  • mass (4)
  • cerebral edema (3)
A

mass: hematoma, contusion, abscess, tumor

cerebral edema: hydrocephalus, head injury, brain inflammation

30
Q

Clinical manifestations of increased ICP? (“larry can’t orgasm during high vomiting”)

A

1) LOC decreases (most reliable indicator)
2) Cushing’s triad: systolic hypertension with widening pulse pressure, bradycardia with full and bounding pulse, irregular RR) late sign
3) Ocular signs: unilateral dilation, sluggish/no response to light, ptosis of the eyelid (upper eyelid relaxation)
4) Decrease in motor function: decorticate (flexion), deceberate (extension)
5) Headache: worse in the morning
6) Vomiting: projectile, no nausea

31
Q

Why does hypothermia treatment benefit the brain after recovery from cardiac arrest?

A

reduces damage to the brain after a cardiac arrest (can lead to lack of blood flow, causing damage to the brain and decreased LOC)

32
Q

What device is used to measure ICP?

A

Ventriculostomy: gold standard for measuring ICP; specialized catheter inserted into the lateral ventricle connected to an external transducer

33
Q

3 functions of a ventriculostomy?

A

1) directly measures the pressure within the ventricles
2) facilitates removal or sampling CSF
3) allows for intravascular drug administration

34
Q

How does a ventriculostomy keep ICP within normal limits?

A

drains when the ICP exceeds the upper pressure parameter set by the provider

35
Q

Nursing considerations for ventriculostomy? (2)

A

1) every time the patient is repositioned, assess that the transducer is leveled
2) the transducer must be leveled with the foramen of Monro (tragus of the ear)

36
Q

Complications of ventriculostomies (2)

A

1) inaccurate readings d/t CSF leaks around the monitoring device, obstruction of the intraventricular catheter (from tissue or blood clot), height difference between the catheter and the transducer kinks in the tubing
2) infection: ICP used for >5 days, CSF leak, concurrent systemic infection

37
Q

How to avoid infection with ventriculostomy? (3)

A

routinely assess insertion site, aseptic technique, monitor the CSF for a change in drainage color or clarity

38
Q

Medications used for head injuries (3)

A

1) mannitol (osmitrol)
2) hypertonic saline solution
3) corticosteroids (dexamethasone, methyprednisolone)

39
Q

Mannitol/Osmitrol (5)

A
  • route: IV
  • osmotic diuretic
  • decreases ICF by (1) plasma expansion and (2) osmotic effect
  • reduces ICP by decreasing total brain fluid content
  • nursing consideration: monitor fluid and electrolytes (K+, Mg, vitals, urine output)
40
Q

Hypertonic saline solution (2)

A
  • moves water out of the brain cells into the blood vessels to reduce swelling and improve CBF
  • nursing consideration: frequent monitoring of BP and Na+ levels
41
Q

Corticosteroids (dexamethasone, methyprednisolone) (4)

A
  • treats vasogenic edema around tumors and abscesses
  • NOT RECOMMENDED FOR TBI (causes bleeds)
  • complications: hyperglycemia, increased risk for infections, GI bleed)
  • nursing considerations: regularly monitor fluid intake and sodium levels, perform blood glucose monitoring q6h, PPIs (pantoprazole, famotidine) to prevent GI ulcers
42
Q

Adjunct medications used to treat metabolic effects that can WORSEN ICP such as fever, seizures, pain, agitation (5)

A

1) barbituates: decreases metabolic demands
2) phenytoin: antiseizure
3) antipyretics: fever
4) analgesics: pain
5) phenobarbital: IV piggyback 0.9% NaCl (the only fluid that can piggyback medications)

43
Q

What fluids can increase ICP? (2)

A

1) 0.45% NaCl

2) 5% dextrose

44
Q

Nutritional therapy for head injuries (2)

A

1) start within 3 days of injury

2) PN/EN feed

45
Q

What areas are assessed with the Glasgow Coma Scale? (3)

A

1) open eyes when a verbal/painful stimulus is applied
2) speaking
3) obey commands

46
Q

What is the highest and lowest score for GCS? What score is the patient said to be in a coma and consider mechanical ventilation?

A

15 (highest level of functioning), 3 (lowest)

8 or less = coma/intubation

47
Q

Why are subdural hematoma more deadly than subarachnoid hematoma?

A

subdural hematoma have increased morbidity and mortality despite surgery to evacuate the hematoma and can result in CEREBRAL EDEMA

48
Q

What is the best diagnostic test to determine craniocerebral trauma?

A

CT scan

Advanced MedSurg (11 decks)

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