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NURS 337 > Ch. 17 > Flashcards

Ch. 17 Flashcards

1
Q

Brain Trauma

A
  • Major head trauma
  • Closed (blunt, non-missile) trauma
  • Open (penetrating, missile) trauma
  • Coup injury
  • Contrecoup
  • Compound fractures
  • Basilar skull fracture
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2
Q

Major head trauma

A
  • A traumatic insult to the brain possibly producing physical,
    intellectual, emotional, social, and vocational changes
  • Transportation accidents
  • Falls
  • Sports-related event
  • Violence
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3
Q

Closed (blunt, non-missile) trauma

A
  • Head strikes hard surface or a rapidly moving object strikes
    the head
  • The dura remains intact and brain tissues are not exposed to
    the environment
  • Causes focal (local) or diffuse (general) brain injuries
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4
Q

Open (penetrating, missile) trauma

A
  • Injury breaks the dura and exposes the cranial contents to the environment
  • Causes primarily focal injuries
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5
Q

Coup injury

A

Injury directly below the point of impact

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6
Q

Contrecoup

A

Injury on the pole opposite the site of impact

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7
Q

Focal Brain Injury

A
  • Observable brain lesion
  • Force of impact typically produces contusions
  • Contusions can cause:
    • Extradural (epidural) hemorrhages or hematomas
    • Subdural hematomas
    • Intracerebral hematomas
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8
Q

Extradural (epidural) hemorrhages or hematomas

A
  • Bleeding between the dura mater and the skull
  • Natasha Richardson
  • Lose consciousness at injury, then become lucid for a few minutes to a few days. As the hematoma accumulates a headache of increasing severity,
    vomiting, drowsiness, confusion, seizure, and hemiparesis may develop.
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9
Q

Subdural hematomas

A
  • Bleeding between the dura mater and the brain
  • Acute-commonly within hours, located at the top of the skull, subacute over 48 hours to 2 weeks. Chronic develop over weeks to months
  • Act like expanding masses, increasing intracranial pressure that eventually compresses the bleeding vessels. Brain herniation can result
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10
Q

Intracerebral hematomas

A
  • Bleeding within the brain. Acts as an expanding mass, increasing intracranial
    pressure, compressing brain tissues, and causing edema. May appear 3-10 days after head injury
  • Cause decreasing level of consciousness
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11
Q

Diffuse Brain Injury

A
  • Diffuse axonal injury (DAI)
  • Categories:
    • Mild concussion
    • Classical concussion
    • Mild, moderate, and severe diffuse axonal injuries (DAI)
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12
Q

Diffuse axonal injury (DAI)

A
  • Shaking, inertial effect (whiplash)
  • Acceleration/deceleration
  • Axonal damage
  • Shearing, tearing, or stretching of nerve fibers
  • Severity corresponds to the amount of shearing force applied
    to the brain and brain stem
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13
Q

Mild concussion

A
  • Characterized by immediate but transitory clinical
    manifestations; CSF pressure rises, and ECG and EEG changes
    occur without loss of consciousness.
  • Lasts for 1 to several minutes, possibly with amnesia for events
    preceding the trauma
  • “Not being themselves” for up to a few days
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14
Q

Classical concussion

A
  • Consciousness is lost for up to 6 hours and reflexes fail, causing
    falls. Head pain, nausea, fatigue, attentional and memory system
    impairments, and mood and affect changes
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15
Q

Spinal Cord Trauma

A
  • Most commonly
    occurs due to vertebral
    injuries
    • Simple fracture
    • Compressed fracture
    • Comminuted fracture
      and dislocation
  • Traumatic injury of
    vertebral and neural
    tissues as a result of
    compressing, pulling,
    or shearing forces
  • Most common locations: cervical (1, 2, 4-7), and T1-L2
    lumbar vertebrae
  • Spinal shock
  • Paraplegia
  • Quadriplegia
  • Autonomic hyperreflexia
    (dysreflexia)
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16
Q

Most common locations: cervical (1, 2, 4-7), and T1-L2
lumbar vertebrae reflects

A

reflect most mobile portions of vertebral column
and the locations where the spinal cord occupies most of the
vertebral canal

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17
Q

Spinal shock

A
  • Normal activity of the
    spinal cord ceases at and
    below the level of injury;
    sites lack continuous
    nervous discharges from
    the brain
  • Complete loss of reflex
    function (skeletal,
    bladder, bowel, sexual
    function, thermal
    control, and autonomic
    control) below level of
    lesion
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18
Q

Autonomic hyperreflexia
(dysreflexia)

A
  • Massive, uncompensated
    cardiovascular response to
    stimulation of the
    sympathetic nervous
    system
  • Stimulation of the sensory
    receptors below the level
    of the cord lesion
  • Life threatening
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19
Q

Degenerative Disorders of the Spine

A
  • Degenerative disk disease (DDD)
  • Low back pain
  • Herniated intervertebral disk-displacement of disk material
    beyond the intervertebral disk space. Rupture is usually
    caused by trauma, or degenerative disk disease (thoracic region is rare)
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20
Q

Cerebrovascular Disorders

A
  • Cerebrovascular
    accident
  • Hemorrhagic stroke
  • Lacunar stroke
  • Cerebral infarction
  • Cerebral hemorrhage
  • Intracranial aneurysm
  • Vascular malformations
  • Subarachnoid hemorrhage
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21
Q

Cerebrovascular
accident

A
  • Leading cause of
    disability
  • Third leading cause of
    death in United States
    Classified
  • Global hypoperfusion
  • Ischemia (thrombotic,
    embolic)
  • Hemorrhagic
22
Q

Cerebrovascular accidents (CVAs)

A

Thrombotic stroke
* Arterial occlusions caused by thrombi formed in arteries
supplying the brain or in the intracranial vessels
* Transient ischemic attacks (TIAs)
Embolic stroke
* Fragments that break from a thrombus formed outside the brain

23
Q

Hemorrhagic stroke

A

Hypertension, ruptured aneurysms or vascular malformation,
bleeding into a tumor or hemorrhage associated with anticoagulants
or clotting disorders, head trauma, or illicit drug use

24
Q

Lacunar stroke

A

Caused by occlusion of a single deep perforating artery that supplies small penetrating subcortical vessels, causing ischemic lesions

25
Q

Cerebral infarction

A

Results when an area of the brain loses its blood supply because of vascular occlusion
* Cerebral thrombi and cerebral emboli most commonly produce
occlusion but atherosclerosis and hypotension are the dominant underlying processes

26
Q

Cerebral hemorrhage

A

Hypertension is the primary cause

27
Q

Intracranial aneurysm

A

Saccular (berry) aneurysms
* Occur frequently and likely result from congenital abnormalities in the tunica media of the arterial wall and degenerative changes
* Sac gradually grows over time
Fusiform (giant) aneurysms
* Occur as a result of diffuse arteriosclerotic changes and are found most commonly in the basilar arteries or terminal portions of the internal carotid arteries

28
Q

Vascular malformations

A

Arteriovenous malformation-tangled mass of dilated blood
vessels creating abnormal channels between the arterial and venous systems

29
Q

Subarachnoid hemorrhage

A

Blood escapes from defective or injured vasculature into the
subarachnoid space

30
Q

Cerebrovascular Disorders Manifestations

A
  • Kernig sign-straightening the knee with the hip and knee in a
    flexed position produces pain the back and neck regions
  • Brudzinski sign-passive flexion of the neck produces neck pain
    and increased rigidity
31
Q

Headaches

A
  • Migraine
  • Cluster
  • Tension-type
32
Q

Migraine

A

– Familial, episodic disorder whose marker is headache and is defined as repeated, episodic headache lasting 4 to 72 hours
– Usually women 25 to 55 years old
– Caused by combination of multiple genetic and environmental
factors

33
Q

Migraine Diagnosis

A
  • Unilateral, throbbing, worsened by movement, moderate or severe;
    and any one of the following: nausea, vomiting, accompanied by photophobia or phonophobia
34
Q

Migraine Phases

A

premonitory, aura, headache

35
Q

Migraine Triggers

A
  • Altered sleep patterns
  • Skipping meals
  • Overexertion
  • Weather change
  • Stress or relaxation from stress
  • Hormonal changes (menstrual periods)
  • Excess afferent stimulation (bright lights, strong smells)
  • Chemicals (alcohol or nitrates)
36
Q

Cluster

A

– Occur in clusters for a period of days followed by a long period of spontaneous remission
– Usually men between 20 to 50 years old
– Trigeminal activation and autonomic dysfunction
– Unilateral trigeminal distribution of severe pain with ipsilateral autonomic manifestations (tearing on affected side, ptosis of the ipsilateral eye, and stuffy nose)
– Chronic cluster headaches

37
Q

Tension-type

A

– Most common
– Average onset 2nd decade
– Mild to moderate bilateral headache with a sensation of a tight band or pressure around the head with gradual onset of pain
– Occurs in episodes and may last for several hours or several days
– Occurs at least 15 days per month for at least 3 months

38
Q

Infection and
Inflammation of the CNS

A
  • Meningitis-inflammation of the brain or spinal cord
  • Brain or spinal cord abscess
  • Encephalitis
39
Q

Meningitis-inflammation of the brain or spinal cord

A
  • Bacterial meningitis
  • Aseptic (viral, nonpurulent, lymphocytic) meningitis
  • Fungal meningitis
40
Q

Bacterial meningitis

A
  • Primarily and infection of the pia mater and arachnoid, the
    subarachnoid space, the ventricular system, and the CSF
  • Causes Neisseria meningitidis and stretococcus pneumoniae
41
Q

Aseptic (viral, nonpurulent, lymphocytic) meningitis

A

Is believed to be limited to the meninges. It produces various
symptoms and is caused by several infections agents, primarily viruses. Bacterial infections not adequately treated also cause
aseptic meningitis.

42
Q

Fungal meningitis

A

A chronic much less common condition than bacterial or viral.
The infection occurs most often in person s with impaired
immune responses or alteration sin normal body flora. It
develops gradually, usually over days or weeks.

43
Q

Brain or spinal cord abscess

A

– Localized collection of pus within the parenchyma
– Causes:
* Open trauma and during neurosurgery
* Contiguous spread of infection from the middle ear, mastoid cells, nasal cavity, nasal sinuses
* Through metastatic or hematogenous spread from distant foci
* Cryptogenically: without other associated areas of infection

44
Q

Brain abscess

A
  • Early-low-grade fever, headache (most common symptom), neck pain and stiffness with mild nuchal rigidity, confusion, drowsiness, sensory deficits, and communication deficits
  • Later: inattentiveness (distractibility), memory deficits, decreased visual acuity and narrowed visual fields, papilledema, ocular palsy,
    ataxia, and dementia
45
Q

Spinal cord abscess

A

Clinical manifestations stages:
* (1) Spinal aching
* (2) Severe root pain, accompanied by spasms of the back muscles and
limited vertebral movement
* (3) Weakness caused by progressive cord compression
* (4) Paralysis

46
Q

Encephalitis

A
  • Acute febrile illness, usually of viral origin with nervous system
    involvement
  • Most common forms of encephalitis are caused by arthropod-borne (mosquitos) viruses and herpes simplex virus
47
Q

Neurologic Complications of AIDS

A
  • Human immunodeficiency-associated cognitive dysfunction
  • HIV myelopathy
  • HIV neuropathy
  • Aseptic viral meningitis
  • Opportunistic infections
  • CNS neoplasms
48
Q

HIV myelopathy

A

Involving diffuse degeneration of the spinal cord

49
Q

HIV neuropathy

A

Isolated from peripheral nerves; consequently, the virus may directly infect nerves and cause neuropathy

50
Q
A

NURS 337 (40 decks)

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