Acute Intracranial Disorders Flashcards
What is a concussion?
mild injury
usually resolves w/in 72 hours
What are the s/sx of a concussion?
brief loss of consciousness
retrograde amnesia
confusion
memory loss
What is a contusion?
bruising of the brain
What are the s/sx of a contusion?
Unconsciousness
period of stupor or confusion
postural changes
coup-contrecoup injury
What is a coup-contrecoup injury?
an injury that occurs where the head is struck but also on the opposite side of the head that was not struck
What is a open head injury?
the skull has been penetrated by an object or blunt force
What is a closed head injury?
Blunt force trauma causes acceleration of the head & the deceleration or hits an object
What is a diffuse axonal injury?
Widespread injury
severe head injury
results in coma
usually no hemorrhage is involved
What is an intracranial hemorrhage?
bleeding in the epidural, subdural, or intracerebral spaces after a trauma
What is a intracerebral hemorrhage?
a hemorrhagic stroke
What is an epidural hemorrhage?
arterial blood flow
bleeding very fast
decreases ICP fast
What are the s/sx of an epidural hemorrhage?
ipsilateral pupillary changes
posturing
What is a subdural hemorrhage?
most common
can be acute, subacute or chronic
What is a subdural hematoma?
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
What are the s/sx of a skull fracture?
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
What is the battle’s sign?
bruising/eccyhmosis over the mastoid process
What is raccoon eyes
periorbital edema & ecchymosis around the eyes
looks like the patient has black eyes
What diagnostics are used for head injury?
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
What are the priority nursing interventions for head injuries?
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
What are the major complications of head injuries?
hemorrhage
infection
seizures
death
permanent neuro defects
What surgical intervention can be used to treat head injuries?
craniotomy
piece of the skull is removed, allowing access to a hematoma, tumor, etc.
decreases ICP
What are the complications of a craniotomy?
permanent neurological deficits
seizure disorders
infection
death
Injuries in the cervical region results in…
Quadriplegia
Injuries below T1 result in…
paraplegia
C4 injury or above cannot
Spontaneously breathe
What should you do for a pt with a C4 or above injury?
Intubate and mechanically ventilate
ABCs (C-spine)
phrenic nerve C4 (C3-C5 keeps you alive)
What are the s/sx of a spinal cord injury?
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
What are the priority interventions for a spinal cord injury?
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)
What is the life-threatening complication to monitor for with a spinal cord injury?
Autonomic Dysreflexia
life-threatening HTN following spinal cord injury
usually pts with an injury around T6 & above
What are the s/sx of autonomic dysreflexia?
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
What are the causes of autonomic dysreflexia?
distended bladder
fecal impaction
pt is cold
tight clothing
How do you treat autonomic dysreflexia?
relieve kink in the cath
catheterize the pt
remove fecal impaction
remove tight clothing
sit the patient up to decrease BP!!!
admin antiHTN
What are the s/sx of neurogenic shock?
Hypotension & bradycardia
flushed, warm, dry skin
loss of temp regulation
What is a complication of neurogenic shock?
postural hypotension
when a pt with neurogenic shock is in an upright position, they will have this
How do you transfer a pt with postural hypotension?
- raise HOB (lower if pt becomes dizzy)
- transfer pt into a reclining wheelchair
- be ready to lock and lean the wheelchair back if the pt reports dizziness
- DO NOT attempt to return the pt back to bed
What are the priority interventions for a neurogenic shock?
monitor hypoTN & bradycardia
IV fluids
Atropine (bradycardia)
Vasopressors (dopamine for hypoTN)
always use 3 people to move the pt
What type of meningitis has a vaccine?
bacterial
What is meningitis?
inflammation of the meninge’s membranes surrounding & protecting the brain & spinal cord
What are the diagnostics used for meningitis?
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!
What are the s/sx of meningitis?
excruciating, constant HA
Nuchal rigidity (stiff neck)
photophobia
Positive Kernig’s sign
Positive Brudzinski’s sign
fever & chills
N/V
tachycardia
seizures
What is Kernig’s sign?
Bend the knee at 90 degrees and extend to a completely straight
if positive, the pt will report pain while the extension
What is the Brudzinski’s sign?
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!”
What is the priority for meningitis?
Isolation!
When can a patient be removed from isolation?
if test comes back viral OR if its bacterial and the pt has been on antibiotics for 24 hrs
What kind of precautions is bacterial meningitis?
droplet
What nursing actions are pertinent for meningitis?
HOB @ 30 degrees
monitor for increased ICP
seizure precautions
neuro checks
decrease stimuli/bright light
What medications are given with meningitis?
Antibiotics
Phenytoin for seizures
Analgesics (NO opioids)
Is meningococcal meningitis reportable?
YES
What are risk factors for hemorrhagic stroke?
DM
obesity
HTN
Atherosclerosis
A-fib
oral contraceptives
smoking
family hx
What are the general s/sx of a hemorrhagic stroke?
slurred speech
visual disturbances
dizziness
weakness to extremities
What are the s/sx of a left-sided stroke?
all the A words!
inability to speak & understand language
memory intact
difficulty w/ vision
can’t do math
Frustrated easily
depression
right unilateral neglect
What are the s/sx of a right-sided stroke?
loss of depth perception
impairment in creativity
poor impulse control
left unilateral neglect
cannot recognize faces/person’s name
What medication can we give to help with nerve pain following a hemorrhagic stroke?
gabapentin
What is something you should notify the provider of with hemorrhagic strokes?
if the pt has A-fib and is taking warfarin/any blood thinner
What are the clinical manifestations of brain tumors?
positive Babinski and romberg sign
papilledema (swelling of optic nerve)
dysphagia
dysarthria (slurred speech)
What is the priority when taking care of a patient with a brain tumor?
maintain airway
neuro checks
seizure precautions/safety
give antiepileptics
stop aspirin 72 hrs pre-op
What should you inform your patient to avoid 5 days before their brain tumor surgery?
NO
ETOH
tobacco
Anticoagulants
NSAIDs
What diagnostics are used for brain tumors?
CT/MRI
EEG
Biopsy
lumbar puncture should not be done if there is increased ICP
Labs
What are possible complications of brain tumors?
Syndrome of inappropriate antidiuretic hormone (SIADH)
Diabetes Insipidus
What is the s/sx of SIADH?
fluid retention
Disorientation
HA
vomiting
muscle weakness
decreased LOC
weight gain
no thirst
How do you treat SIADH?
vasopressin
fluid restriction
What are the s/sx of diabetes insipidus?
excessive urination
- a complication of a craniotomy
How do you treat diabetes insipidus?
massive fluid replacement
Electrolyte replacement
monitor labs
