Complex Exam 3 - acute intracranial disorders Flashcards
Does loss of consciousness occur with a concussion?
briefly
What are s/sx of a concussion?
- retrograde amnesia
- confusion
- memory loss
What is a contusion?
bruising of the brain
Does loss of consciousness occur with a contusion?
YES
What posturing can occur from a contusion?
decorticate and decerebrate
What can a diffuse axonal injury lead to?
coma
What does intracerebral hemorrhage lead to?
hemorrhagic stroke
What are s/sx of intracranial hemorrhages?
- decreased LOC
- ipsilateral pupillary dilation (on the side of injury)
- weakness
What type of intracranial hemorrhage causes ICP to decrease fast?
epidural
When should you monitor for a CSF leak from the nose or ears? What does it indicate?
- skull fractures
- basilar skull fracture
What is the “halo sign”?
a yellow stain surrounded by blood that will test positive for glucose
Battle’s sign can happen with skull fractures. What is this?
bruising over the mastoid process
What is it called when a patient with a skull fracture has periorbital edema and ecchymoses?
raccoon eyes
When should a lumbar puncture be avoided?
with increased ICP
How can increased ICP be ruled out?
CT
What is the patient at risk for after a craniotomy?
- permanent neuro deficits
- seizure disorder
- infection
- death
How should the patient be positioned if their head injury was infratentorial?
flat on either side
How should the patient be positioned if their head injury was supratentorial?
head midline with HOB @ 30 degrees
What SCI results in quadriplegia?
injury to the cervical region
What SCI results in paraplegia?
injuries below T1
What SCI causes the inability to protect the airway?
C4 and above
What is the function of the phrenic nerve?
stimulates spontaneous breathing
What happens to the bladder of a patient with a SCI?
spastic and flaccid neurogenic bladder
What SCI causes hypertonia?
above L1/L2
What SCI causes hypotonia?
below L1/L2
What happens to BP and RR with a SCI?
hypotension and shallow respirations
If a patient with a SCI experiences loss of thermoregulation what is it a sign of?
neurogenic shock
Should the HOB be raised with a SCI?
NO
What is important to monitor with a SCI?
- neuro status
- muscle strength
- mobility
- sensation
- skin breakdown
How should a patient with a SCI be moved?
logroll
What type of SCI causes autonomic dysreflexia?
injury around T6 and above
What are the s/sx of autonomic dysreflexia?
- extreme HTN
- severe headache
- diaphoresis
- increased temp
- anxiety/restlessness
- goosebumps
What does autonomic dysreflexia increase the risk of?
stroke, seizure, death
What are the 3 B’s that cause autonomic dysreflexia?
- bladder: distended
- bowel: fecal impaction
- breakdown of skin: tight clothing
What is important to teach with autonomic dysreflexia?
bladder/bowel training
When does neurogenic shock usually occur?
within 24 hours of a spinal cord injury
What happens to BP and HR with neurogenic shock?
hypotension and bradycardia
How can postural hypotension occur with neurogenic shock?
keeping the pt in an upright position
How can postural HTN be avoided with neurogenic shock?
transfer the patient in stages by first raining the HOB and then transferring the patient into a reclining wheelchair
If a patient experiences dizziness with neurogenic shock what should be done?
- lower HOB
- lock and lean wheelchair to fully reclining position
What medication should be given for bradycardia with neurogenic shock?
atropine
What are vasopressors used for with neurogenic shock?
to treat hypotension
How many people should be used to transfer a patient in neurogenic shock?
3
Is viral meningitis contagious?
not very
Is bacterial meningitis contagious?
very
What type of meningitis has a vaccine?
bacterial
Meningitis causes a positive kernig’s sign. What does this mean?
there is pain and resistance when attempting to straighten the knee, the head flexes up
Meningitis causes a positive brudzinski’s sign. What does this mean?
the knees and hips flex when the patient’s neck is flexed
What happens to DTR’s with a SCI?
they are absent
What happens to DTR’s with meningitis?
they are hyperactive
What happens to the neck of a patient with meningitis?
stiff, rigid
Can meningitis cause seizures?
YES
What will the CSF of a patient with bacterial meningitis look like?
- cloudy
- decreased glucose
- positive gram stain
- increased WBC’s and protein
What will CSF of a patient with viral meningitis look like?
- clear
- negative gram stain
- increased WBC’s and protein
What isolation precautions should be used for meningitis?
droplet
How long does a patient with bacterial meningitis have to be isolated?
at least 24 hours
Is meningitis a reportable disease?
yes
What type of meningitis needs antibiotics?
bacterial
What vaccines should be given for meningitis?
- Hib
- pneumonia (PPSV 13 or 23)
- meningococcal (MCV 4)
Which side of the brain causes aphasia, agnosia, alexia, agraphia, apraxia, dysarthria, and dysphagia?
left
Which side of the body is weak/paralyzed after a left-sided stroke?
right
Which side of the brain causes unilateral neglect?
right
Which side of the brain causes depression, anger/frustration?
left
Which side of the brain causes overestimation of abilities, loss of depth perception, and poor impulse control/judgment?
right
Which side of the body is weak/paralyzed after a right-sided stroke?
left
What are important to know about a patient with hemorrhagic stroke?
- a-fib
- blood thinner use
- time the s/sx started
How should you communicate with someone after a stroke?
- short phrases
- gestures/pointing
- no distraction
- patience
- repetition
- one question at a time
- communication board
What diet should someone be on after a stroke until their speech path is clear?
NPO
What infant reflex returns if there is a brain tumor?
babinski
What is papilledema and when does it happen?
optic nerve swelling that occurs with brain tumors
Brain tumors can cause the inability to discriminate sounds, loss of gag reflex, and loss of blink response. What are these examples of?
cranial nerve dysfunction
What are s/sx of brain tumors?
- HA
- dysarthria
- dysphagia
- vertigo
- hemiparesis
- papilledema
What should be stopped before surgery for brain tumors?
- 72 hours before: aspirin
- 5 days before: alcohol, tobacco, anticoagulants, NSAIDS
What does a CT tell you about a brain tumor?
- size
- location
- extent
What labs should be monitored with brain tumors?
- electrolytes
- renal function
- endocrine function
What causes SIADH?
overproduction of ADH due to damaged hypothalamus
What does the overproduction of ADH cause?
fluid retention
What medication can be given for SIADH?
conivaptan (vasopressin antagonist)
What happens of SIADH goes untreated?
seizures, coma
What can cause diabetes insipidus?
- supratentorial surgery, craniotomy
- ADH deficiency
What does ADH deficiency cause?
increased urine excretion
How is diabetes insipidus treated?
- fluid replacement
- electrolyte replacement
What intracranial disorder can have photophobia?
meningitis
