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NURS 412 > Acute Cranial Problems > Flashcards

Acute Cranial Problems Flashcards

1
Q

Head injury

A

refers to any trauma to scalp, skull, or brain

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2
Q

Head trauma

A

refers mainly to cranio-cerebral trauma, which includes alteration in consciousness, regardless of the duration.
Head trauma has high likelihood for poor outcome.

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3
Q

What are time periods of death from head trauma?

A

Immediately after the injury
Within 2 hrs after the injury
Approx. 3 weeks post injury

Majority of death from a head injury occur immediately after the injury

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4
Q

Types of head injury

A

Scalp lacerations
- most common type
- scalp is highly vascular (lots of bleeding)
- complications: blood loss and infection
Skull fractures
- Linear or depressed
- Simple, comminuted (3 or more pieces), or compound
- Closed or open

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5
Q

Skull fracture manifestations

A

Racoon eyes & rhinorrhea (CSF leaking from nose)
Battle sign (postauricular ecchymosis) with otorrhea (CSF from ear) - bruising behind ear
Halo or ring sign (double ring) -Yellowish ring encircles blood if CSF is present

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6
Q

What does CSF leak increase the risk of?

A

Meningitis

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7
Q

What are head traumas categorized as?

A

diffuse (several areas to brain) - concussion
focal (localized) – one area - contusion, hematoma

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8
Q

Classification of brain injury

A

Mild (GCS score 13-15)
Moderate (GCS 9-12)
Severe (GCS 3-8)

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9
Q

Concussions

A

diffuse injury
a sudden transient mechanical head injury with disruption of neural activity and a change in LOC

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10
Q

Postconcussion syndrome

A

seen 2 weeks to 2 months post concussion

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11
Q

Chronic traumatic encephalopathy (CTE)

A

Degeneration in brain from repeated concussions

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12
Q

Signs of concussions

A

Brief disruption in LOC
Amnesia
Headache
Short duration

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13
Q

Signs of postconcussion syndrome

A

Persistent headache
Lethargy
Personality & behavioral changes
↓ short-term memory, ↓ attention span
Changes in intellectual ability

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14
Q

Diffuse axonal injury (DAI)

A

Widespread axonal damage that occurs following mild, moderate, or severe traumatic brain injury (TBI)
Trauma changes the function of axon → results in axon swelling
signs & symptoms: decreased LOC, increased ICP, decorticate, decerebration, global cerebral edema

vegetative state is common

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15
Q

Focal injury

A

Can be mild to severe; localized to an area of injury
Consists of laceration, contusions, hematomas, and cranial nerve injury

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16
Q

Laceration

A

focal injury
tearing of brain tissue
Often associated with penetrating injuries
Severe tissue damage

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17
Q

Contusion

A

focal injury
Bruising of brain tissue within a local area

Coup-contrecoup injury

18
Q

what is Coup-contrecoup injury>

A

Coup → contusions or lacerations occur both at the site of direct impact of brain on the skull
Contrecoup → at a secondary area of damage on opposite side away from injury, leading to multiple contused areas

19
Q

Complications of head injury

A

Epidural hematoma
Subdural hematoma
Intraparenchymal hematoma
Traumatic subarachnoid hemorrhage

20
Q

Epidural hematoma

A

From bleeding between dura & inner surface of skull
Often result of torn artery
Symptoms:
- unconsciousness at the scene
- A brief lucid interval followed by ↓ LOC
- Headache, N/V

21
Q

Subdural hematoma

A

From bleeding between dura matter & arachnoid layer of brain
Usually venous in origin, thus, slower to develop

22
Q

Types of subdural hematoma

A

Acute subdural hematoma
- signs within 48 hrs of injury
- ↑ ICP; ↓ LOC, headache
Subacute subdural hematoma
- Occur within 2- 14 days of injury
- Subdural hematoma may appear to enlarge over time
Chronic subdural hematoma
- Develops over weeks or months after a seemingly minor injury
- Peak incidence in 50s and 60s
- Alcoholics increased risk

23
Q

Intraparenchymal hematoma

A

aka intracerebral hematoma
Collection of blood within parenchyma, from bleeding within brain tissue itself
Usually occurs in the frontal and temporal lobes

24
Q

Traumatic subarachnoid hemorrhage

A

Result of traumatic forces damaging the superficial vascular structures in subarachnoid space
May dispose pts to cerebral vasospasm & ↓CBF

25
Q

Functions of the brain

A

Frontal lobe
- behaviour, intelligence, memory, movement
Parietal lobe
- intelligence, language, reading, sensation
Occipital lobe
- vision
Temporal lobe
- behaviour, hearing, memory, speech, vision
Cerebellum
- balance, coordination
Brain stem
- blood pressure, breathing, consciousness, HR, swallowing

26
Q

Brain tumors

A

Primary- arising from tissues in the brain
Secondary- resulting from a malignant neoplasm located somewhere else in the body. These are the most common kind.
Classified from the tissue they arise from for ex meningiomas.
Over half of all brain tumours are malignant.
Unless treated all will eventually cause death by tumour volume leading to increased ICP.

27
Q

Manifestations of brain tumors

A

Depend on location, rate of growth and size.
headache common symptom (worse at night). Dull and constant.
Seizures especially in gliomas and brain metastases.
Nausea and vomiting from increased ICP
Cognitive and motor dysfunctions and sensory deficits depending on location of the tumour.

28
Q

What does tx of brain tumors aim to do?

A
  1. Identifying the tumour
  2. Removing or decreasing tumour mass.
  3. Preventing or managing increased ICP
29
Q

What is the care of brain tumors?

A

meds - steriods
sx - risk of removing part of the brain that is functional (removes tumor)
Ventricular shunts (fluid in ventricles- risk of infection and displacement)
Radiation
Chemo (systemic) and targeted therapy (difficulty d/t BBB)

30
Q

Neurosurgery reasons

A

The removal or repair of brain tissue to prevent more harm
To give palliative relief of distressing symptoms when the cause cannot be removed

Trauma
- Fractured skull, Traumatic brain injury
Infection
- Cerebral and spinal abscesses
Vascular disorders
- Cerebral aneurysm, Arteriovenous malformation
Spinal disorders
- tumors of spine
Congenial abnormalities
- hydrocephalus
Cerebral and spinal tumors
- glioma
Degenerative disorders
- Arthritic changes in the spine

31
Q

Surgical approaches

A

Burr Holes
- Holes drilled into skull and is used for
- Insertion of brain needles to remove tissue for biopsy, or subdural hematoma
- To insert Gigli’s saw to create a bone flap in a craniotomy
Craniotomy - bone flap is surgical removed and then returned after sx. performed so brain can be accessed for further sx
Decompressive craniectomy - bone flap is removed but us not returned to skull after sx. performed to relieve pressure on brain
Hypophysectomy - removal of pituitary gland

32
Q

Post craniotomy care

A

Safe recovery from anesthesia
Monitoring for signs of increased ICP & its clinical management
Provide nursing care based on pt’s degree of dependency
Promote rehabilitation

33
Q

Management of Increased ICP

A

Hourly neurological observations, e.g., Glasgow Coma Scale
VS per protocol, e.g., q1h
Full neurological assessment
Report any change in pt’s condition immediately
Admin ordered meds to increased ICP
Likely caused by hemorrhage into wound site, cerebral edema, or hydrocephalus
- increase HOB to 30-40 degrees
- Chin and sternum should be aligned
- Pace nursing activities to  frequency of stimulation
- Prevent constipation (don’t want straining)
- Pain control
- Require good oxygen supply and sufficient CO2 to stimulate respiration
- If cerebral edema is causing deterioration of neurological status,
May need to administer Mannitol

34
Q

Wound care

A

Inspect incision to ensure edges remain well approximated and staples/sutures intact
Monitor for redness, discharge, signs of infection
Incision usually left open to air
Removal of sutures, usually in 2 wks
Cover incision when going outside

35
Q

Safety considerations

A

Support positioning with towels and pillows to prevent pressure on surgical site
Sign at bedside e.g, “No right bone flap”
Keep bed at lowest level – risk of falling

36
Q

Bacterial meningitis

A

Acute inflammation of meningeal tissues surrounding brain & spinal cord
Medical emergency

37
Q

Clinical manifestations of bacterial meningitis

A

Fever, severe headache
N/V
Nuchal rigidity (resistance to flexion of the neck)
+ve Kernig sign (pain when hip flexed to 90º and extension of the knee)

38
Q

Complications of bacterial meningitis

A

↑ ICP (major cause of altered mental status)

39
Q

Encephalitis

A

acute inflammation of brain (from virus)

40
Q

Manifestations of encephalitis

A

Onset is typically nonspecific
Fever, headache, N/V
Signs appear on day 2 or 3
Signs may vary from min. to coma
Hemiparesis, seizures, tremors, cranial nerve palsies, personality changes, memory impairment, amnesia

NURS 412 (21 decks)

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