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Patho - Neuro > Disorders of Trauma > Flashcards

Disorders of Trauma Flashcards

1
Q

What is ICP

A

fluid at rest as measured in the brain

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2
Q

contents of the skull (3)

A

brain and vascular tissue

CSF (cerebral spinal fluid)

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3
Q

what is normal ICP amount

A

0-15 mm Hg

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4
Q

what is normal ICP influenced by

A

changes in arterial and venous pressure, posture, temp, blood gases (esp. CO2)

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5
Q

where can you measure ICP

A

ventricles, subdural space, epidural space, and the brain tissue itself

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6
Q

what are the 3 cranial contents

A

brain
cerebral spinal fluid
blood

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7
Q

what is the Monroe-Kellie hypothesis

A

any increase in 1 of the cranial contents results in IICP

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8
Q

what is dynamic equilibrium

A

everything in the brain stays the same

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9
Q

when can the brain expand

A

in infancy - suture lines aren’t’ sealed yet (hydrocephalus)

skull fractures - herniation through fracture line

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10
Q

where is CSF displaced to in ICP?

A

the spinal cord

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11
Q

Compensatory mechanisms of CSF

A

vasoconstriction - decreases pressure
CSF shunted to spinal cord
brain slows down CSF production - expands

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12
Q

what % of body’s oxygen is used by the brain

A

20

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13
Q

what % of body’s glucose is used by the brain

A

25

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14
Q

the brain HAS TO HAVE these 2 things

A

oxygen and glucose

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15
Q

the blood flow to our brain is maintained by

A

auto regulation

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16
Q

what does auto regulation do

A

adjusts cerebral blood vessels to maintain constant blood flow during changes in arterial BP

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17
Q

what do vessels in the brain do when a pt. is hypotensive

A

dilate - to increase pressure (auto-regulation)

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18
Q

what do vessels in the brain do when a pt. is hypertensive

A

constrict - to decrease pressure (auto-regulation)

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19
Q

when does auto regulation not work

A

If MAP 150 mm Hg

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20
Q

what s/s will we see in pt. whose oxy. level drops

A

**altered LOC (most sensitive indicator)

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21
Q

what is a late sign of ICP

A

**Cushing’s Triad

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22
Q

what is Cushing’s Triad

A

widening pulse pressure
Brady w/full and bounding pulse
change in resp.

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23
Q

which vital sign is most indicative of ICP

A

widening pulse pressure, bradycardia

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24
Q

what other factors in our body affect CBF (cerebral blood flow)

A

CO2 - it dilates the vessels
high co2 - dilate vessels
low co2 - constriction of vessels (decrease ICP)

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25
Q

oxygen

A

causes vessels to dilate to get oxygen to the brain

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26
Q

what causes IICP

A

mass lesions - hematoma, abscess, tumor, hemorrhage

metabolic insult - lead/arsenic intoxication, uremia

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27
Q

2 major problems of ICP

A

inadequate cerebral perfusion

cerebral herniation

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28
Q

what population(s) have head injuries

A

children
geriatrics
adolescents (male)

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29
Q

types of head injuries

A

scalp lacerations - bleed profusely

skull fractures

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30
Q

questions to ask w/skull fractures

A

open or closed
linear (along line of bone) or depressed (dented in)
simple (no fragments), comminuted (lots of pieces of bone), or compound (communicating down to intracranial cavity)

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31
Q

what is the worst type of skull fracture

A

compound

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32
Q

how do we test drainage from nose we suspect as CSF

A

glucose test tape to see if sugar is in it

blood causes false +

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33
Q

the location of the fracture alters the presentation of the manifestations, t or f

A

true

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34
Q

damage to the frontal lobe you will see changes in

A

executive function

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35
Q

damage to the occipital lobe you will see changes in

A

vision

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36
Q

a basilar skull fracture is where

A

back of the head - hard hit to break bone

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37
Q

CSF leaking from the nose is called

A

rhinorrhea

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38
Q

typically in a basilar skull fracture you have a tear in the

A

Dura and leak CSF (through nose, ear)

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39
Q

when CSF leaks from nose or ear it increases risk of

A

infection

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40
Q

which assessment finding is most indicative of ICP in a pt. admitted with a basilar skull fracture

A

papilledema

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41
Q

2 ways to classify a brain injury

A

diffuse or generalized (can’t localize to certain area of brain)
OR
focal or localized (mass lesion)

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42
Q

classifying a brain injury w/GCS

A

minor (13-15)
moderate (9-12)
severe (3-8)

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43
Q

when does post concussion syndrome occur

A

2 weeks to 2 months after injury

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44
Q

what is the most important thing in concussions to have a full return to normal

A

rest - no tv

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45
Q

a contusion can also be referred to as

A

coup contracoup

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46
Q

do you have to have an impact to sustain coup contracoup

A

no (shaken baby, seat belt restraint prevents impact)

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47
Q

if you are on this medicine and sustain coup contracoup it is a death sentence

A

coumadin - difficult to stop brain bleed

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48
Q

contusions are usually closed head injuries, t or f

A

true

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49
Q

classification for contusions on GCS

A

8 or lower

50
Q

what happens to the brain tissue in lacerations

A

tearing

51
Q

lacerations typically occur with these type of fractures

A

depressed/open fractures

52
Q

can we surgically repair lacerations

A

no - sutures would create more damage

53
Q

lg intracerebral lacerations have very poor outcomes, t or f

A

true

54
Q

diffuse axonal injury are considered general injuries to the brain, t or f

A

true - theory is axons are sheared

55
Q

lg intracerebral lacerations have very poor outcomes, t or f

A

true

56
Q

what part of the brain is not working in a vegetative state

A

frontal lobe (executive fxn, speech, recognition)

57
Q

majority of pt w/diffuse axonal injury are in a veg state, t or f

A

true - most don’t recover

58
Q

what part of the brain is not working in a vegetative state

A

frontal lobe exectuive fxn

59
Q

majority of pt w/diffuse axonal injury are in a veg state, t or f

A

true

60
Q

what happens in a epidural hematoma

A

bleeding between dura and inner surface of the skull

61
Q

**an epidural hematoma is an emergent condition, t or f

A

true

62
Q

what will we do for pt w/epidural hematoma

A

cat scan - prepare for OR

63
Q

most life threatening head injury

A

epidural hematoma - bleeding wont stop w/o surgical intervention

64
Q

what will we do for pt w/epidural hematoma

A

prepare for surgery

65
Q

most life threatening head injury

A

epidural hematoma - bleeding wont stop w/o surgical intervention

66
Q

s/s of a acute subdural hematoma occur within the first

A

24-48 hrs LOC

67
Q

what vessel bleeds in a subdural hematoma

A

venous bleed - mostly

68
Q

population with chronic subdural hematomas

A

elderly - brain shrinks=more space between brain/skull

alcoholics

69
Q

3 types of subdural hematomas

A

acute
sub-acute
chronic

70
Q

population with chronic subdural hematomas

A

elderly - brain shrinks more space between brain/skull

71
Q

s/s of chronic hematoma

A

forgetful
weird feeling in arm
confusion
somnolent (sleepy)

72
Q

what kind of lesion is an intracerebral hematoma

A

mass lesion

73
Q

dx of intracerebral hematoma

A

CT scan for rapid results

cervical spine x-ray

74
Q

s/s of intracerebral hematoma

A

ICP (stroke, trauma, aneurysm)

75
Q

after CT scan, assess pt for

A

urine passage - allergic reaction - encourage fluids

76
Q

what are emergency nurse actions for pt with head injury after a fall from a 3rd floor roof

A

stabilize c-spine
assess airway
assess respiration

77
Q

how many chest x-rays are in a CT scan

A

about 20 - cancer causing

78
Q

what are emergency nurse actions for pt with head injury after a fall from a 3rd floor roof

A

stabilize c-spine
assess airway
assess respiration

79
Q

spinal cord ends between which 2 vertebrae

A

1 and 2

80
Q

*ascending spinal cord track does what

A

sensory - carry info to the brain - pain/temp/body position

81
Q

spinal cord ends between

A

1 and 2

82
Q

upper motor neurons never leave the

A

CNS

83
Q

lower motor neurons go to the

A

skeletal muscles

84
Q

what do lower motor neurons do

A

goes out to skeletal muscles

85
Q

s/s of upper motor neurons

A

spasticity/hyper-reflexia

86
Q

s/s of lower motor neurons

A

hyporeflexia/flaccidity

87
Q

reflexes are wired in the

A

CNS

88
Q

reflexes are wired in the

A

CNS

89
Q

tough layer around spinal cord

A

dura

90
Q

spinal cord is rarely transected, t or f

A

true

91
Q

primary spinal cord injury is

A

what happened

92
Q

secondary injury of the spinal cord is

A

what damage after the injury - progressive

93
Q

events occurring in spinal cord injury/prognosis

A

*injury
edema - compressed cord = decreased blood flow (within 24hrs perm damage occurs)
above and below injury there is ischemic damage
prognosis cant be determined for 72 hours

94
Q

spinal shock is life threatening, t or f

A

false - experienced by half of those with acute spinal cord injury

95
Q

s/s of spinal shock

A

temp loss of reflexes, sensations

flaccid paralysis below injury

96
Q

how long does spinal shock last?

A

days - months (temporary) - may return w/hyper-reflexia (erection,etc)

97
Q

what happens in neurogenic shock

A

unopposed parasympathetic stimulation
massive vasodilation
sympathetic impulses don’t counteract it

98
Q

s/s of neurogenic shock

A

hypo-tension and bradycardia - can have hypothermia

99
Q

neurogenic shock can be life-threatening, t or f

A

true

100
Q

how would you differentiate neurogenic shock from hypovolemic shock

A

hypovolemic shock = hypotensive/tachycardia

neurogenic shock = hypotensive/bradycardia

101
Q

classification of SCI

A

mechanism of injury - how did it occur
skeletal level of injury -
neurological level of injury
completeness or degree of injury

102
Q

which classification of SCI is the most unstable injury

A

flexion-rotation (Christopher reeve)

103
Q

when a spinal cord injury comes into the ER, Dr will do a rectal exam, why?

A

muscle tone - sphincter

104
Q

where is the level of the injury in SCI- 2 different ways

A

skeletal level- bone - which vertebrae has damage

neurological level - function- lowest level w/norm sensory and motor (full or partial)

105
Q

thoracic or lumbar SCI pt will present with

A

paraplegic

106
Q

cervical SCI pt will present with

A

tetraplegic or quadriplegic

107
Q

paralysis of all 4 extremities occurs when

A

cervical cord is involved

108
Q

most SCI occur in what part of the spine

A

cervical and lumbar (most flexible part of spine)

109
Q

SCI degree of involvement (2)

A

incomplete/partial - some motor sensory going on

complete cord involvement - no motor/sensory below injury

110
Q

in cauda equina (spinal nerves coming off end of spine) syndrome what 2 questions do you want to ask the pt.

A

do you have any numbness or tingling
do you have any loss of bowel/bladder
if so pt. needs work-up (imaging)

111
Q

if cauda equina syndrome is left untreated what can happen

A

perm damage to bowel/bladder

112
Q

what happens in autonomic dysreflexia (autonomic hyper-reflexia)

A

uncompensated sympathetic stimulating body

parasympathetic cant respond

113
Q

autonomic dysreflexia occurs with this type of SCI

A

SCI T6 or higher
wont occur during spinal shock - recovered
visceral stimulation

114
Q

s/s of autonomic dysreflexia

A

excruciating headache

hypertensive

115
Q

most common precipitating factor of autonomic dysreflexia

A

distended bladder

second most factor distended rectum (impaction)

116
Q

second most common precipitating factor of autonomic dysreflexia

A

distended rectum (impaction)

117
Q

what should we use when doing rectal exam or placing Foley in autonomic dysreflexia

A

lidocaine

118
Q

pt with t6 injury 6 months ago develops facial flushing hypertension

A

elevate HOB - relieve pressure
assess for distended bladder
give BP med

119
Q

what change in VS would the nurse note specific in neurogenic shock

A

bradycardia

120
Q

BP 80/60, pulse 120, resp rate 30 theses findings are most likely associated with what?

A

hypovolemic

Patho - Neuro (6 decks)

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