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MedSurg > acute intracranial problems 2 > Flashcards

acute intracranial problems 2 Flashcards

1
Q

causes of hydrocephalus

A
  • excess CSF production
  • obstruction of flow
  • inability to reabsorb the CSF
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2
Q

tx of hydrocephalus

A

ventriculostomy or ventriculoperitoneal (VP) shunt

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3
Q

cerebral edema

A

increased accumulation of fluid in the extravascular spaces of brain

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4
Q

causes of cerebral edema

A
  • mass lesions
  • head injuries
  • brain surgery
  • cerebral infx
  • vascular insult
  • toxic or metabolic encephalopathic conditions
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5
Q

vasogenic cerebral edema

A
  • leakage of macromolecules from the capillaries into the surrounding extracellular space
  • most common type
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6
Q

cytotoxic cerebral edema

A

disruption of the integrity of cell membranes

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7
Q

interstitial cerebral edema

A

result of hydrocephalus

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8
Q

consciousness

A
  • clear state of awareness of self and the environment in which attention is focused on immediate matter
  • state of awareness and orientation to time, place, and person
  • controlled by the RAS
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9
Q

unconsciousness

A

abnormal state of complete or partial unawareness of self or environment

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10
Q

cause of unconsciousness

A
  • interruptions of impulses from the RAS

- alterations in functioning of the cerebral hemispheres

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11
Q

dramatic consciousness

A
  • coma

- d/t direct compression; decreased O2, glucose; toxic effects

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12
Q

subtle consciousness

A
  • flattening affect
  • change in orientation
  • decrease in level of attention
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13
Q

unconscious pt: immediate considerations

A
  • assess respiratory and CV function
  • no response to painful stimuli
  • no swallow, cough, corneal, and pupillary reflexes
  • incontinent
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14
Q

head injury

A

any injury to the scalp, skull, or brain

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15
Q

poor outcome of head injury

A
  • intracranial hematoma
  • older age
  • abnormal motor response
  • impaired/absent eye mvmts
  • decreased BP, O2; increased CO2, ICP
  • GCS
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16
Q

head injury death points

A
  • immediately
  • within 2 hours
  • in 3 weeks
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17
Q

scalp lacerations

A
  • profuse bleeding, easy to see

- complications: blood loss and infection

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18
Q

skull fx

A

type and severity depends on:

  • velocity
  • momentum
  • direction and shape of the injuring agent
  • site of impair
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19
Q

diffuse brain injury

A

generalized

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20
Q

focal brain injury

A

localized

21
Q

s/s of frontal skull fx

A

CSF rhinorrhea or pneumocranium

22
Q

s/s of orbital skull fx

A
  • raccoon eyes

- optic nerve injury

23
Q

s/s of temporal skull fx

A
  • battle’s sign (bruising behind ear)
  • CSF otorrhea
  • middle meningeal artery disruption
  • epidural hematoma
24
Q

s/s of parietal skull fx

A
  • bulging tympanic membrane
  • Battle’s sign
  • CSF/brain otorrhea
  • deafness
  • facial paralysis
  • loss of taste
25
Q

s/s of posterior fossa skull fx

A
  • occipital bruising resulting in cortical blindness
  • visual field defects
  • ataxia
26
Q

s/s of basilar skull fx

A
  • battle’s sign
  • bulging of tympanic membrane
  • CSF/brain otorrhea
  • tinnitus
  • rhinorrhea
  • facial paralysis
  • vertigo
27
Q

fluid leaking from ears/nose

A

must be tested for CSF

  • dextrostix (tes-tape strip)
  • or halo/ring sign test
28
Q

concussion

A

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

  • may or may not lose total consciousness
  • diffuse injury
29
Q

s/s of concussion

A
  • brief disruption in LOC
  • retrograde amnesia
  • HA
30
Q

postconcussion syndrome

A

2 weeks to 2 months after the injury

31
Q

s/s of post concussion syndrome

A
  • persistent HA
  • lethargy
  • personality and behavioral changes
  • shortened attention span
  • decreased short term memory
  • changes in intellectual ability
32
Q

s/s of diffuse axonal damage

A
  • widespread axonal dmg
  • decreased LOC
  • increased ICP
  • decortication or decerebration
  • global cerebral edema
33
Q

contusion

A
  • focal injury

- bruising of the brain tissue within a focal area

34
Q

coup-contrecoup injury

A

brain moves inside the skull d/t high energy or high impact injury mechanism
-similar to whiplash, hitting both back (countecoup) and front(coup) of head

35
Q

complications of coup-contrecoup injury

A
  • hemorrhage

- sz

36
Q

lacerations

A
  • focal injury

- actual tearing of the brain tissue

37
Q

delayed responses to lacerations

A
  • hemorrhage
  • hematoma formation
  • seizures
  • cerebral edema
38
Q

complications of brain injuries

A

hematomas: epidural, subdural, intracerebral

39
Q

epidural hematoma

A
  • bleeding between the dura and the inner surface of the skull
  • a neurological emergency
  • associated with a linear fx crossing a major artery in the dura, causing a tear
  • can be venous or arterial
40
Q

s/s of epidural hematoma

A
  • initial period of unconsciousness at the scene
  • with a brief lucid interval followed by a decreased in LOC
  • HA
  • n/v
41
Q

tx of epidural hematoma

A
  • immediate surgical intervention

- burrhole

42
Q

subdural hematoma

A
  • bleeding between the dura mater and the arachnoid layer of the meninges
  • results from injury to the brain tissue and its blood vessels
  • usually venous, but can also be arterial
43
Q

acute subdural hematoma s/s

A
  • 24-48 hours after severe trauma
  • immediate deterioration
  • decreased LOC
  • HA
  • drowsy, confused, or unconscious
  • ipsilateral pupil dilation
44
Q

tx of acute subdural hematoma

A
  • craniotomy

- evacuation and decompression

45
Q

subacte subdural hematoma s/s

A
  • 48hr - 2 weeks
  • alteration in mental status
  • progression depends on size and location
46
Q

tx of subacte subdural hematoma

A

evacuation and decompression

47
Q

chronic subdural hematoma s/s

A
  • weeks or months, usually >20 days
  • non specific, non localizing progression
  • progressive alteration in LOC
48
Q

tx of chronic subdural hematoma

A
  • evacuation and decompression

- membranectomy

MedSurg (22 decks)

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