Closed Head Injury Flashcards
When is a tetanus shot needed for a patient with a scalp laceration?
if last vaccination is > 5 yrs ago
Types of skull fractures?
- linear (hairline fracture)
- depressed
- simple, compound
- comminuted
- penetrating
CSF Rhinorrhea is a manifestation of what type(s) of skull fracture?
Frontal
CSF Otorrhea and battle’s sign are manifestations of what type(s) of skull fracture?
Temporal, Parietal, Basilar
Raccoon eyes are manifestations of what type(s) of skull fracture?
Basilar or facial
Facial paralysis is a sign of what type(s) of skull fracture?
parietal, basilar
Characteristics of Postconcussion syndrome?
- lasts 2 weeks to 2 months
- Persistent headache
- Lethargy
- Personality and behavior changes
- Shortened attention span, decreased short-term memory
- Changes in intellectual ability
Widespread axonal damage occurring after mild, moderate or severe injury?
Diffuse Axonal Injury (DAI)
Focal bruising of brain tissue, usually in closed head injury
contusion
coup-contrecoup is an example of what type of injury?
contusion
S/S of a brain contusion and how long should they be monitored for?
- Usually LOC, also can be stupor/confusion
- Monitor 24-48 hrs, follow-up one week
Tearing of the brain tissue often associated intracerebral hemorrhage?
cerebral lacerations
What is an Epidural Hematoma?
- Bleeding between the dura and the inner surface of the skull
- is a neurologic emergency
- Venous or arterial origin
Venous origin of an Epidural Hematoma?
often the dural sinus
Classic signs of an Epidural Hematoma?
- initial period of unconsciousness, followed by periods of LOC and consciousness
- HA, N/V
- focal findings
What is a Subdural Hematoma?
- Bleeding between the dura and arachnoid layer
- Usually venous in origin
- slowly develops a mass large enough to produce symptoms
Most common cause of a Subdural Hematoma?
the veins that drain the brain surface into the sagittal sinus
Who is at increased risk of developing a Subdural Hematoma?
the elderly and alcoholics
Categories of Subdural hematomas (SDH)?
- Acute SDH (within 48 hours)
- Subacute SDH (2-14 days)
- Chronic SDH
S/S of an Acute SDH
- within 48 hours
- Drowsy and confused
- Ipsilateral pupil dilates and becomes fixed
S/S of a Subacute SDH?
- 2-14 days
- After initial bleeding, appears to enlarge
Chronic SDH ?
- Weeks/months after a minor head injury
- Peak incidence age 60-80
- Presenting complaint often focal symptoms, not signs of increased ICP
- Delay in diagnosis in older adults
Head Injury Diagnostic Studies?
- Head CT: best tool
- MRI: can find small bleeds
- Transcranial Doppler studies: shows blood flow
- Cervical spine x-ray
Emergency care for a head injury?
- ABC’s
- assume a neck injury
- assess for injury/CSG leaks
Nursing Implementation Acute Intervention for a head injury - how to manage ICP and edema
- Administer glucocorticoids/diuretics (dexamethasone, mannitol, furosemide)
- Minimize procedures (suction, turn)
- elevate HOB
Nursing Implementation Acute Intervention for a head injury - how to decrease metabolic demands?
Barbituates
Nursing Implementation Acute Intervention for a head injury - Primary goal?
Maintain cerebral perfusion and oxygenation
Nursing Implementation Acute Intervention - assess ICP pt’s eyes for what?
corneal reflex, periorbital edema, diplopia
Common causes of Meningitis?
Streptococcus pneumoniae , Neisseria meningitidis
Viral cause of menigitis?
enteroviruses, arboviruses, human immunodeficiency virus, and herpes simplex virus (HSV)
Meningitis Clinical Manifestations?
- Headache (severe)/fever/photophobia
- Meningeal signs
- Nuchal rigidity
- Kernig’s sign
- Brudzinski’s sign
- ↓ LOC
- Seizures
Pain in the lower back and resistance to straightening the leg at the knee?
is a positive Kernig sign, indicating meningeal irritation
Involuntary flexion of the hip and knees with passive flexion of the head?
is a positive Brudzinski’s sign for meningeal irritation.
Bacterial Meningitis Complications?
- ↑ ICP (most common
- Temporary or permanent cranial nerve dysfunction
- Noncommunicating hydrocephalus
Viral Meningitis Complications?
- generally self-limiting disease
- Manage symptoms, expect full recovery
Why are lumbar punctures contraindicated in patients with increased ICP?
can cause the brain to herniate downward thru the foramen magnum
Meningitis Diagnostic Studies?
- CT scan
- Culture
- Blood, Sputum, Nasopharyngeal secretions
- Lumbar puncture and CSF analysis
- PCR to detect viral DNA/RNA
Meningitis Nursing Implementation - acute interventions?
- IV antibiotics
- Pain-positioning, codeine
- Fever-tylenol
- Photophobia-dark environment
Meningitis Nursing Implementation?
- Health Promotion:
- Manage Acute Intervention
- Seizure precautions
- Droplet precautions (bacterial)
Causes of Encephalitis?
- viruses
- Ticks or mosquitoes can transmit epidemic encephalitis
Type of Encephalitis common in AIDS patients?
CMV encephalitis
Diagnostic studies for Encephalitis?
CT, MRI, PET, Tests for viral infection
Encephalitis Clinical Manifestations?
- Onset-flu-like symptoms
- Fever, headache, nausea, vomiting
- Signs appear in 2 to 3 days
- ↓ LOC
- CNS abnormalities
CNS abnormalities with Encephalitis?
- cranial nerve palsies
- seizures
Encephalitis Nursing Management?
- Prevention
- Mosquito control
- Environmental
- Insect repellant
- Supportive care
- HSV infection-antivirals
- Acyclovir (Zovirax)
- Antiseizure drugs
