6- NEUROLOGICAL TRAUMA: HEAD AND SPINAL CORD INJURY b

Question 1

Intracerebral Haemorrhage

Answer 1

Haemorrhage occurs into the substance of the brain

• May be due to trauma or a non traumatic cause:

Question 2

Intracerebral Haemorrhage treatment

Answer 2

Supportive care
• Control of ICP
• Administration of fluids, electrolytes, and antihypertensive
medications
• Craniotomy or craniectomy to remove clot and control
hemorrhage
 May not be possible due to the location or lack of circumscribed area of
hemorrhage

Question 3

Management of the Patient with Head

Injury

Answer 3

Assume cervical spine injury until this is ruled out
• Therapy to preserve brain homeostasis and prevent
secondary damage

Question 4

Therapy to preserve brain homeostasis and prevent

secondary damage

Answer 4

• Treat cerebral oedema
• Maintain cerebral perfusion; treat hypotension, hypovolemia, and
bleeding; monitor and manage ICP
• Maintain oxygenation as well as cardiovascular and respiratory
function
• Manage fluid and electrolytes

Question 5

Supportive Measures Intracerebral Haemorrhage

Answer 5

• Respiratory support; intubation and mechanical
ventilation
• Seizure precautions and prevention
• NG to manage reduced gastric motility and
prevent aspiration
• Fluid and electrolyte maintenance
• Pain and anxiety management
• Nutrition

Question 6

Nursing Process – Assessment of the

Patient with Brain Injury

Answer 6

• Health history with focus upon the immediate
injury, time, cause and the direction and force of
the blow
• Baseline assessment
• LOC: Use Glasgow Coma Scale
• Frequent and ongoing neurologic assessment
• Multisystem assessment

Question 7

Interventions Intracerebral Haemorrhage

Answer 7

• Provide ongoing assessment and monitoring is vital
• Maintain airway
• Positioning to facilitate drainage of oral secretions with
HOB usually elevated 30° to decrease venous
pressure
• Suctioning with caution
• Prevention of aspiration and respiratory insufficiency
• Monitor ABGs, ventilation, and mechanical ventilation
• Monitor for pulmonary complications
• Monitor I&O and daily weights
• Monitor blood and urine electrolytes, osmolality and blood
glucose
• Implement measures to promote adequate nutrition
• Implement strategies to prevent injury
• Assess oxygenation
• Assess bladder and urinary output
• Assess for constriction due to dressings and casts
• Pad side rails
• Use mittens to prevent self-injury; avoid restraints

Question 8

Strategies to prevent brain injury

Answer 8

• Reduce environmental stimuli
• Use adequate lighting to reduce visual hallucinations
• Implement measures to minimize disruption of sleep–wake
cycles
• Provide skin care
• Implement measures to prevent infection

Question 9

Strategies to Maintain body temperature brain injury

Answer 9

• Maintain appropriate environmental temperature
• Use coverings: sheets, blankets as per patient needs
• Administer antipyretics for fever (paracetamol)
• Use cooling blankets or cool baths; avoid shivering

Question 10

Spinal Cord Injury

Pathophysiology

Answer 10

SCI’s often occur as a result of injury to
mobile areas in the vertebrae
The result of concussion, contusion, laceration, or
compression of the spinal cord

Question 11

types of spinal cord injury

Answer 11

Primary injury

Secondary injuries

Question 12

Primary injury spinal cord injury

Answer 12

is the result of the initial trauma

Question 13

Secondary injuries spinal cord injury

Answer 13

usually the result of ischemia,
hypoxia, and haemorrhage which destroys the nerve
tissues
are thought to be reversible/
preventable during the first 4 to 6 hours after injury

Question 14

Clinical Manifestations spinal cord injury

Answer 14

Depends on type and level of injury
• If conscious patient usually
complains of back and neck pain
• Impaired respiratory function is
apparent in injuries above T6

Question 15

•Complete spincal cord complete

Answer 15

Paraplegia

•Tetraplegia (quadriplegia)

Question 16

Incomplete spincal cord

Answer 16

Some movement or feeling below the

level of the injury

Question 17

Spinal shock

Answer 17

(lasts up to 3 months)
– A sudden depression of reflex activity below
the level of spinal injury
– Muscular flaccidity and lack of sensation and
reflexes

Question 18

Acute Management Spinal shock

Answer 18

Skeletal fracture
reduction and traction
• Oxygen therapy
• IV corticosteroids
(Methylprednisone) to
reduce oedema
• Indwelling
catheter
• Administration of
IV fluids
• Surgery?

Question 19

Promotion of adequate breathing and airway

clearance spinal shock

Answer 19

Monitor carefully to detect potential respiratory
failure
– Pulse oximetry and ABGs
– Lung sounds
• Early and vigorous pulmonary care to prevent
and remove secretions
• Suctioning with caution
• Breathing exercises
• Assisted coughing
• Humidification and hydration

Question 20

Improving mobility spinal shock

Answer 20

• Maintain proper body alignment
• Turn only if spine is stable and as
indicated by physician
• Monitor blood pressure with position
changes
• PROM at least 4 times a day
• Use neck brace or collar, as prescribed,
when patient is mobilized
• Move gradually to erect position

Question 21

Maintaining skin integrity spinal shock

Answer 21

Inspect all skin areas, particularly bony
prominences
• Turn patient every 2 hours
• Ensure adequate nutrition
• Wash and dry patients skin thoroughly
• Educate patient and family on pressure
ulcer prevention

Question 22

Maintaining home and community based

care for TBI and SCI

Answer 22

Support of family
• Provide and reinforce information
• Measures to promote effective coping
• Setting of realistic, well-defined, shortterm
goals
• Referral for counselling
• Support groups-
• NSW Brain Injury Association
• Spinal Cord Injuries Australia