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Complex II > Acute Intracranial Disorders > Flashcards

Acute Intracranial Disorders Flashcards

1
Q

What is a concussion?

A

mild injury
usually resolves w/in 72 hours

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2
Q

What are the s/sx of a concussion?

A

brief loss of consciousness
retrograde amnesia
confusion
memory loss

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3
Q

What is a contusion?

A

bruising of the brain

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4
Q

What are the s/sx of a contusion?

A

Unconsciousness
period of stupor or confusion
postural changes
coup-contrecoup injury

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5
Q

What is a coup-contrecoup injury?

A

an injury that occurs where the head is struck but also on the opposite side of the head that was not struck

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6
Q

What is a open head injury?

A

the skull has been penetrated by an object or blunt force

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7
Q

What is a closed head injury?

A

Blunt force trauma causes acceleration of the head & the deceleration or hits an object

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8
Q

What is a diffuse axonal injury?

A

Widespread injury
severe head injury
results in coma
usually no hemorrhage is involved

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9
Q

What is an intracranial hemorrhage?

A

bleeding in the epidural, subdural, or intracerebral spaces after a trauma

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10
Q

What is a intracerebral hemorrhage?

A

a hemorrhagic stroke

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11
Q

What is an epidural hemorrhage?

A

arterial blood flow
bleeding very fast
decreases ICP fast

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12
Q

What are the s/sx of an epidural hemorrhage?

A

ipsilateral pupillary changes
posturing

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13
Q

What is a subdural hemorrhage?

A

most common
can be acute, subacute or chronic

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14
Q

What is a subdural hematoma?

A

Head hurts on the side of the injury
eyes are slow to react
the eye is bigger on the side of the injury
weakness/paralysis on the opposite side

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15
Q

What are the s/sx of a skull fracture?

A

amnesia
loss of consciousness
CSF leakage from nose (rhinorrhea) or ears (otorrhea) which indicates a basilar fx
the ‘halo’ sign: yellow stain around blood (bullseye) and this fluid will test positive for glucose
Battle’s sign
Raccoon eyes

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16
Q

What is the battle’s sign?

A

bruising/eccyhmosis over the mastoid process

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17
Q

What is raccoon eyes

A

periorbital edema & ecchymosis around the eyes
looks like the patient has black eyes

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18
Q

What diagnostics are used for head injury?

A

GCS
labs (CBC, CMP, drug screen)
CT of head & spine
Lumbar puncture (not done with increased ICP bc it will herniate) Do a CT 1st to R/O increased ICP before LP

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19
Q

What are the priority nursing interventions for head injuries?

A

ALWAYS suspect a cervical spine injury
MUST R/O cervical spine injury w/ CT scan before removing any devices used to stabilize the c-spine
2 large-bore IVs
foley to gravity
neuro checks (assess pupils)
check LOC, VS, I&O, mon for ear/nose leakage

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20
Q

What are the major complications of head injuries?

A

hemorrhage
infection
seizures
death
permanent neuro defects

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21
Q

What surgical intervention can be used to treat head injuries?

A

craniotomy
piece of the skull is removed, allowing access to a hematoma, tumor, etc.
decreases ICP

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22
Q

What are the complications of a craniotomy?

A

permanent neurological deficits
seizure disorders
infection
death

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23
Q

Injuries in the cervical region results in…

A

Quadriplegia

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24
Q

Injuries below T1 result in…

A

paraplegia

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25
Q

C4 injury or above cannot

A

Spontaneously breathe

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26
Q

What should you do for a pt with a C4 or above injury?

A

Intubate and mechanically ventilate
ABCs (C-spine)
phrenic nerve C4 (C3-C5 keeps you alive)

27
Q

What are the s/sx of a spinal cord injury?

A

pt doesn’t feel anything below the shoulders
hyperflexion/hyperextension
flaccid muscles
hypoTN
loss of thermoregulation = sign of neurogenic shock
absent DTRs
shallow respirations
spinal shock = total temporary loss of all reflexive & autonomic function below the injury

28
Q

What are the priority interventions for a spinal cord injury?

A

secure airway and apply c-collar (keep body flat)
O2 & suction (intubate/ventilate if GCS <8)
monitor neuro status & muscle strength/sensation
loss of thermoregulation (s/sx of neurogenic shock)

29
Q

What is the life-threatening complication to monitor for with a spinal cord injury?

A

Autonomic Dysreflexia
life-threatening HTN following spinal cord injury
usually pts with an injury around T6 & above

30
Q

What are the s/sx of autonomic dysreflexia?

A

sudden onset of extreme HTN, increased temp, severe HA, pallor, & cold below the level of injury
Other symptoms include blurred vision, diaphoresis and have an increased risk for stroke & death

31
Q

What are the causes of autonomic dysreflexia?

A

distended bladder
fecal impaction
pt is cold
tight clothing

32
Q

How do you treat autonomic dysreflexia?

A

relieve kink in the cath
catheterize the pt
remove fecal impaction
remove tight clothing
sit the patient up to decrease BP!!!
admin antiHTN

33
Q

What are the s/sx of neurogenic shock?

A

Hypotension & bradycardia
flushed, warm, dry skin
loss of temp regulation

34
Q

What is a complication of neurogenic shock?

A

postural hypotension
when a pt with neurogenic shock is in an upright position, they will have this

35
Q

How do you transfer a pt with postural hypotension?

A
  1. raise HOB (lower if pt becomes dizzy)
  2. transfer pt into a reclining wheelchair
  3. be ready to lock and lean the wheelchair back if the pt reports dizziness
  4. DO NOT attempt to return the pt back to bed
36
Q

What are the priority interventions for a neurogenic shock?

A

monitor hypoTN & bradycardia
IV fluids
Atropine (bradycardia)
Vasopressors (dopamine for hypoTN)
always use 3 people to move the pt

37
Q

What type of meningitis has a vaccine?

A

bacterial

38
Q

What is meningitis?

A

inflammation of the meninge’s membranes surrounding & protecting the brain & spinal cord

39
Q

What are the diagnostics used for meningitis?

A

CSF analysis (lumbar puncture)
- will have elevated WBCs & protein
- bacterial will have decreased glucose
- cloudy CSF = bacterial (+ gram)
- clear CSF = viral ( - gram)
CT/MRI
CBC
Culture everything!

40
Q

What are the s/sx of meningitis?

A

excruciating, constant HA
Nuchal rigidity (stiff neck)
photophobia
Positive Kernig’s sign
Positive Brudzinski’s sign
fever & chills
N/V
tachycardia
seizures

41
Q

What is Kernig’s sign?

A

Bend the knee at 90 degrees and extend to a completely straight
if positive, the pt will report pain while the extension

42
Q

What is the Brudzinski’s sign?

A

pt lays flat on back while flexing the knees and hips into a fetal position while also flexing their neck
if positive, the pt will feel pain with the flexion of their neck “Bru, that hurts!”

43
Q

What is the priority for meningitis?

A

Isolation!

44
Q

When can a patient be removed from isolation?

A

if test comes back viral OR if its bacterial and the pt has been on antibiotics for 24 hrs

45
Q

What kind of precautions is bacterial meningitis?

A

droplet

46
Q

What nursing actions are pertinent for meningitis?

A

HOB @ 30 degrees
monitor for increased ICP
seizure precautions
neuro checks
decrease stimuli/bright light

47
Q

What medications are given with meningitis?

A

Antibiotics
Phenytoin for seizures
Analgesics (NO opioids)

48
Q

Is meningococcal meningitis reportable?

A

YES

49
Q

What are risk factors for hemorrhagic stroke?

A

DM
obesity
HTN
Atherosclerosis
A-fib
oral contraceptives
smoking
family hx

50
Q

What are the general s/sx of a hemorrhagic stroke?

A

slurred speech
visual disturbances
dizziness
weakness to extremities

51
Q

What are the s/sx of a left-sided stroke?

A

all the A words!
inability to speak & understand language
memory intact
difficulty w/ vision
can’t do math
Frustrated easily
depression
right unilateral neglect

52
Q

What are the s/sx of a right-sided stroke?

A

loss of depth perception
impairment in creativity
poor impulse control
left unilateral neglect
cannot recognize faces/person’s name

53
Q

What medication can we give to help with nerve pain following a hemorrhagic stroke?

A

gabapentin

54
Q

What is something you should notify the provider of with hemorrhagic strokes?

A

if the pt has A-fib and is taking warfarin/any blood thinner

55
Q

What are the clinical manifestations of brain tumors?

A

positive Babinski and romberg sign
papilledema (swelling of optic nerve)
dysphagia
dysarthria (slurred speech)

56
Q

What is the priority when taking care of a patient with a brain tumor?

A

maintain airway
neuro checks
seizure precautions/safety
give antiepileptics
stop aspirin 72 hrs pre-op

57
Q

What should you inform your patient to avoid 5 days before their brain tumor surgery?

A

NO
ETOH
tobacco
Anticoagulants
NSAIDs

58
Q

What diagnostics are used for brain tumors?

A

CT/MRI
EEG
Biopsy
lumbar puncture should not be done if there is increased ICP
Labs

59
Q

What are possible complications of brain tumors?

A

Syndrome of inappropriate antidiuretic hormone (SIADH)
Diabetes Insipidus

60
Q

What is the s/sx of SIADH?

A

fluid retention
Disorientation
HA
vomiting
muscle weakness
decreased LOC
weight gain
no thirst

61
Q

How do you treat SIADH?

A

vasopressin
fluid restriction

62
Q

What are the s/sx of diabetes insipidus?

A

excessive urination
- a complication of a craniotomy

63
Q

How do you treat diabetes insipidus?

A

massive fluid replacement
Electrolyte replacement
monitor labs

Complex II (6 decks)

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