Closed Head Injury Flashcards

1
Q

When is a tetanus shot needed for a patient with a scalp laceration?

A

if last vaccination is > 5 yrs ago

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2
Q

Types of skull fractures?

A
  • linear (hairline fracture)
  • depressed
  • simple, compound
  • comminuted
  • penetrating
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3
Q

CSF Rhinorrhea is a manifestation of what type(s) of skull fracture?

A

Frontal

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4
Q

CSF Otorrhea and battle’s sign are manifestations of what type(s) of skull fracture?

A

Temporal, Parietal, Basilar

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5
Q

Raccoon eyes are manifestations of what type(s) of skull fracture?

A

Basilar or facial

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6
Q

Facial paralysis is a sign of what type(s) of skull fracture?

A

parietal, basilar

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7
Q

Characteristics of Postconcussion syndrome?

A
  • lasts 2 weeks to 2 months
  • Persistent headache
  • Lethargy
  • Personality and behavior changes
  • Shortened attention span, decreased short-term memory
  • Changes in intellectual ability
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8
Q

Widespread axonal damage occurring after mild, moderate or severe injury?

A

Diffuse Axonal Injury (DAI)

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9
Q

Focal bruising of brain tissue, usually in closed head injury

A

contusion

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10
Q

coup-contrecoup is an example of what type of injury?

A

contusion

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11
Q

S/S of a brain contusion and how long should they be monitored for?

A
  • Usually LOC, also can be stupor/confusion

- Monitor 24-48 hrs, follow-up one week

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12
Q

Tearing of the brain tissue often associated intracerebral hemorrhage?

A

cerebral lacerations

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13
Q

What is an Epidural Hematoma?

A
  • Bleeding between the dura and the inner surface of the skull
  • is a neurologic emergency
  • Venous or arterial origin
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14
Q

Venous origin of an Epidural Hematoma?

A

often the dural sinus

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15
Q

Classic signs of an Epidural Hematoma?

A
  • initial period of unconsciousness, followed by periods of LOC and consciousness
  • HA, N/V
  • focal findings
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16
Q

What is a Subdural Hematoma?

A
  • Bleeding between the dura and arachnoid layer
  • Usually venous in origin
  • slowly develops a mass large enough to produce symptoms
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17
Q

Most common cause of a Subdural Hematoma?

A

the veins that drain the brain surface into the sagittal sinus

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18
Q

Who is at increased risk of developing a Subdural Hematoma?

A

the elderly and alcoholics

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19
Q

Categories of Subdural hematomas (SDH)?

A
  • Acute SDH (within 48 hours)
  • Subacute SDH (2-14 days)
  • Chronic SDH
20
Q

S/S of an Acute SDH

A
  • within 48 hours
  • Drowsy and confused
  • Ipsilateral pupil dilates and becomes fixed
21
Q

S/S of a Subacute SDH?

A
  • 2-14 days

- After initial bleeding, appears to enlarge

22
Q

Chronic SDH ?

A
  • 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
23
Q

Head Injury Diagnostic Studies?

A
  • Head CT: best tool
  • MRI: can find small bleeds
  • Transcranial Doppler studies: shows blood flow
  • Cervical spine x-ray
24
Q

Emergency care for a head injury?

A
  • ABC’s
  • assume a neck injury
  • assess for injury/CSG leaks
25
Q

Nursing Implementation Acute Intervention for a head injury - how to manage ICP and edema

A
  • Administer glucocorticoids/diuretics (dexamethasone, mannitol, furosemide)
  • Minimize procedures (suction, turn)
  • elevate HOB
26
Q

Nursing Implementation Acute Intervention for a head injury - how to decrease metabolic demands?

A

Barbituates

27
Q

Nursing Implementation Acute Intervention for a head injury - Primary goal?

A

Maintain cerebral perfusion and oxygenation

28
Q

Nursing Implementation Acute Intervention - assess ICP pt’s eyes for what?

A

corneal reflex, periorbital edema, diplopia

29
Q

Common causes of Meningitis?

A

Streptococcus pneumoniae , Neisseria meningitidis

30
Q

Viral cause of menigitis?

A

enteroviruses, arboviruses, human immunodeficiency virus, and herpes simplex virus (HSV)

31
Q

Meningitis Clinical Manifestations?

A
  • Headache (severe)/fever/photophobia
  • Meningeal signs
    • Nuchal rigidity
    • Kernig’s sign
    • Brudzinski’s sign
  • ↓ LOC
  • Seizures
32
Q

Pain in the lower back and resistance to straightening the leg at the knee?

A

is a positive Kernig sign, indicating meningeal irritation

33
Q

Involuntary flexion of the hip and knees with passive flexion of the head?

A

is a positive Brudzinski’s sign for meningeal irritation.

34
Q

Bacterial Meningitis Complications?

A
  • ↑ ICP (most common
  • Temporary or permanent cranial nerve dysfunction
  • Noncommunicating hydrocephalus
35
Q

Viral Meningitis Complications?

A
  • generally self-limiting disease

- Manage symptoms, expect full recovery

36
Q

Why are lumbar punctures contraindicated in patients with increased ICP?

A

can cause the brain to herniate downward thru the foramen magnum

37
Q

Meningitis Diagnostic Studies?

A
  • CT scan
  • Culture
    • Blood, Sputum, Nasopharyngeal secretions
  • Lumbar puncture and CSF analysis
  • PCR to detect viral DNA/RNA
38
Q

Meningitis Nursing Implementation - acute interventions?

A
  • IV antibiotics
  • Pain-positioning, codeine
  • Fever-tylenol
  • Photophobia-dark environment
39
Q

Meningitis Nursing Implementation?

A
  • Health Promotion:
  • Manage Acute Intervention
  • Seizure precautions
  • Droplet precautions (bacterial)
40
Q

Causes of Encephalitis?

A
  • viruses

- Ticks or mosquitoes can transmit epidemic encephalitis

41
Q

Type of Encephalitis common in AIDS patients?

A

CMV encephalitis

42
Q

Diagnostic studies for Encephalitis?

A

CT, MRI, PET, Tests for viral infection

43
Q

Encephalitis Clinical Manifestations?

A
  • Onset-flu-like symptoms
    • Fever, headache, nausea, vomiting
  • Signs appear in 2 to 3 days
    • ↓ LOC
    • CNS abnormalities
44
Q

CNS abnormalities with Encephalitis?

A
  • cranial nerve palsies

- seizures

45
Q

Encephalitis Nursing Management?

A
  • Prevention
    • Mosquito control
    • Environmental
    • Insect repellant
  • Supportive care
  • HSV infection-antivirals
    • Acyclovir (Zovirax)
  • Antiseizure drugs