care of clients with neurologic trauma

Question 1

what are the types of head injuries

Answer 1

scalp injury
skull fractures

Question 2

what are the types of brain injuries

Answer 2

concussion
contusion

Question 3

what are the mechanisms of injury

Answer 3

primary injury

Question 4

the consequence of direct contact to the head/brain during the instant of initial injury, causing extracranial focal injuries

Answer 4

primary injury and secondary injury

Question 5

evolves over the ensuing hours and days after the initial injury and results from inadequate delivery of nutrients and oxygen in the cells

Answer 5

secondary injuries

Question 6

any damage to the head as a result of trauma

Answer 6

head injuries

Question 7

may range from minor injury to a life-threatening emergency

Answer 7

scalp injury

Question 8

why do scalp bleed profusely when injured

Answer 8

because scalp vessels constrict poorly

Question 9

what is the management for scalp abrasion (minor scalp injury)

Answer 9

1. was wounded area with mild soap and water
2. apply pressure for 10 minutes
3. apply ice compress for 20 minutes
4. monitor for signs of increased icp

Question 10

what are the signs of increased icp

Answer 10

headache
restlessness
anisocoria
altered level of consciousness

Question 11

what is the management for scalp laceration (major scalp injury)

Answer 11

1. irrigate area with sterile NSS
2. control bleeding
   2.a. apply direct pressure
3. assist in laceration closure
   3.a. primary closure using staples or sutures
   3.b. delayed closure for wounds greater than 24 hours
4. monitor for signs of increased ICP
5. administer antibiotics and tetanus toxoid as ordered

Question 12

when should we give a dose of tetanus toxoid

Answer 12

when the last dose was >5 years ago

Question 13

a break in the continuity of the skull caused by forceful trauma

Answer 13

skull fractured

Question 14

what are the types of skull fracture

Answer 14

linear (simple)
comminuted
depressed

Question 15

what skull fracture is the break in the continuity of the bone

Answer 15

linear or simple

Question 16

what type of skull fracture is splintered or multiple fracture lines

Answer 16

comminuted

Question 17

what type of skull fracture has the bones of the skull forcefully displaced downward

Answer 17

depressed

Question 18

what are the locations of skull fracture

Answer 18

frontal
temporal
basilar

Question 19

what are the clinical manifestations of skull fracture

Answer 19

signs of local injury
persistent localized pain

Question 20

how does basilar skull fracture produce hemorrhage from the nose, pharynx, ears, and under the conjunctiva

Answer 20

this is because basilar skull fractures tend to traverse the paranasal sinus of the frontal bone or the middle ear located in the temporal bone

Question 21

what are the signs of basilar skull fracture

Answer 21

battle sign
racoon eyes
conjunctival hemorrhage

Question 22

what are the signs of CSF leakage

Answer 22

CSF otorrhea
CSF rhinorrhea

Question 23

what should you look for in blood to confirm CSF leakage

Answer 23

the halo sign

Question 24

what appears in the blood that ensures a positive halo sign

Answer 24

yellowish ring around blood

Question 25

what are the diagnostics for skull fracture

Answer 25

computed tomography scan magnetic resonance imaging

Question 26

what does computed tomography scan do to a skull fracture

Answer 26

reveals fractured area

Question 27

what does magnetic resonance imaging do to skull fracture

Answer 27

provides a better resolution and clearer pictures of uninjured area

Question 28

what are the management for nondepressed skull fractures

Answer 28

close monitoring until brain injury is ruled out symptomatic treatment

Question 29

what are the management for depressed or comminuted skull fractures

Answer 29

surgical elevation of skull and debridement within 24 hours of injury

Question 30

what are the parts of the brain

Answer 30

cerebrum cerebellum brain stem

Question 31

what should be considered in the event of any head injury

Answer 31

brain injury

Question 32

what are the mechanisms of brain injury

Answer 32

traumatic brain injury, blunt (closed) traumatic brain injury, penetrating (open)

Question 33

occurs when the head accelerates and then rapidly decelerates or collides with another object and brain tissue is damaged but there is no opening through the skull and dura

Answer 33

traumatic brain injury, blunt (closed)

Question 34

occurs when an object penetrates the skull, enters the brain, and damages the soft brain tissue in its path or when blunt trauma to the head is so severe that it opens the scalp, skull, and dura to expose the brain

Answer 34

traumatic brain injury, penetrating (open)

Question 35

causes of brain injuries

Answer 35

direct impact brain injury acceleration-deceleration brain injury blast brain injury

Question 36

what are the types of brain injury

Answer 36

contusion concussion hemorrhage

Question 37

a single, specific area of the brain is bruised and damaged

Answer 37

cerebral contusion

Question 38

a contusion that is present at both the site of impact and at the exact opposite ends of each impact

Answer 38

coup-contrecoup injury

Question 39

brain damage at the site of the impact

Answer 39

coup traumatic brain injury

Question 40

brain damage at the opposite side of the impact

Answer 40

counter-coup traumatic brain injury

Question 41

what are the manifestations of cerebral contusion

Answer 41

loss of consciousness confusion/stupor

Question 42

what are the management of cerebral contusion

Answer 42

close monitoring mannitol IV if with signs of increased ICP bed rest symptomatic and supportive treatment

Question 43

temporary loss of neurologic function with no apparent structural damage to the brain

Answer 43

concussion

Question 44

what are the specific causes of cerebral concussions

Answer 44

falls motor-vehicular accidents violent assaults contact sports history of prior concussion

Question 45

what are the physical manifestations of cerebral concussion

Answer 45

headache nausea vomiting balance problems dizziness visual problems fatigue photophobia phonophobia numbness/tingling feeling dazed feeling stunned

Question 46

what are the cognitive symptoms of cerebral concussion

Answer 46

feeling mentally "foggy" feeling slowed down difficulty concentrating difficulty remembering forgetfulness of recent information confusion about recent events answering questions slowly repeating questions

Question 47

what are the emotional manifestations of cerebral concussion

Answer 47

irritability sadness anxiety increased emotional lability nervousness

Question 48

what are the sleep-related manifestations of cerebral concussion

Answer 48

drowsiness difficulty falling asleep sleeping more or less than usual

Question 49

how many days does a patient recover from cerebral concussion

Answer 49

7-10 days

Question 50

how many weeks does some symptoms continue to manifest after the recovery

Answer 50

2 to 4 weeks

Question 51

what do other patients develop after recovery from cerebral concussion

Answer 51

post-concussion syndrome

Question 52

what are the management for cerebral concussion

Answer 52

admission may be necessary for monitoring monitoring of altered level of consciousness supportive and symptomatic care instruct to gradually return to non-sport activities after no more than 2-3 days of rest if discharged

Question 53

what should u take note when monitoring for altered level of consciousness in patients with cerebral concussion

Answer 53

worsening headaches dizziness seizures abnormal pupil response vomiting

Question 54

supportive and symptomatic care