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Med Surg II > Exam 2: Craniocerebral Trauma, Tumors, & Inflammation > Flashcards

Exam 2: Craniocerebral Trauma, Tumors, & Inflammation Flashcards

1
Q

What are head injuries defined as ?

A

Any injury or trauma to the scalp, skull, or brain

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2
Q

What are the most common causes of Head injuries ?

A
  • Falls*
  • MVA*
  • Firearms
  • Sports
  • Recreation
  • War
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3
Q

How much more likely are males to suffer head injuries than females ?

A

twice as likely

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4
Q

CranioCerebral Traumas are caused by what ?

A

Sudden force to the head

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5
Q

What are types of sudden forces to the head, that cause Craniocerebral Trauma ?

A
  • Accleration (blow to a head. Ex: hit with a bat)
  • Deceleration
    (when a person comes to an abrupt halt & the brain tissue continues to move forward in the cranium)
  • Compression
    (Impact & bleeding can cause compression on the brain tissue)
  • Penetration (Ex: Gun shot wound, Arrow, etc)
    (essentially anything that penetrates the skull into the brain tissue)
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6
Q

What is a Coup-Contrecoup Contusion ?

A

A coup injury occurs at the site of injury & a contrecoup injury occurs on the side opposite of the area that was hit

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7
Q

What are the different types of skull fractures ?

A
  • Frontal
  • Orbital
  • Temporal
  • Parietal
  • basilar
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8
Q

With Frontal skull fractures, there is exposure through were ?

A

through the frontal sinus

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9
Q

What is a symptoms associated with a Frontal skull fracture ?

A

Rhinorrhea - CSF leaking through the nose

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10
Q

What is a distinguishing sign with Orbital skull fractures ?

A

Raccoon eyes (periorbital ecchymosis)

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11
Q

What are signs/symptoms associated with a Temporal skull fracture ?

A
  • Boggy temporal muscle
  • Oval shaped bruise behind the ear (aka: Battles sign)
  • Otorrhea (CSF leaking out of the ear)
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12
Q

What are signs and symptoms associated with Parietal skull fractures ?

A
  • Deafness
  • Otorrhea (CSF leaking out of the ear)
  • Facial paralysis
  • Loss of taste
  • Battles sign (bruising behind the ear0
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13
Q

What are signs & symptoms associated with a Basilar skull fracture ?

A
  • Otorrhea (CSF or brain)
  • Bulging tympanic membrane
    (when looking inside ear w/ an otoscope)
  • Battles sign (bruising behind the ear)
  • Difficulty hearing
  • Tinnitus (Ringing in the ear)
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14
Q

When pt’s have CSF leaks with skull fractures, there is a HIGH risk for what ?

A

High risk for infection !

b/c there is an opening in the spinal column

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15
Q

Pt’s with CSF leaks from skull fractures will need what ?

A

Aggressive antibiotic treatment

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16
Q

True or False: CSF does have sugar in it ?

A

True !

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17
Q

What are complications of Skull Fractures ?

A
  • Intracranial infection**
  • Hematoma
  • Meningeal & brain tissue damage
  • Leakage of CSF
    (can interfere w/the normal balance of CSF within the spinal column)
  • Risk for Seizures
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18
Q

What are Meninges of the brain & spinal cord ?

A

Membranes that line the skull and the spine

meninges enclose the brain & spinal cord

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19
Q

What do we know about concussions ?

A
  • Diffuse injury
  • May or may not lose consciousness
    (important to note if they did or did not)
  • Symptoms are typically of short duration
  • important to note if the pt has amnesia from the event
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20
Q

What are we looking for in patients who suffered a concussion ?

A

Post Concussion Syndrome

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21
Q

When does somebody with Post Concussion Syndrome typically present after they’ve had a concussion ?

A

2-3 weeks after injury

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22
Q

What are manifestations of Post Concussion Syndrome ?

A
  • Headache
  • Lethargy
  • Change in personality
  • Changes in attention span
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23
Q

What is a Contusion ?

A

Bruising of the brain in a focal area

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24
Q

A contusion may contain areas of what ?

A
  • Hemorrhage
  • Infarct (death of brain tissue)
  • Edema
  • any of these 3 can cause symptoms *
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25
Q

True or False: Contusions may continue to bleed or re-bleed after the time of injury ?q

26
Q

With brain injuries, what is the main thing we want to monitor for ?

A

A change in LOC (sleepy, less responsive, etc.)

27
Q

What are the 3 types of Intracranial Hemorrhage/Hematoma ?

A
  • Epidural
  • Subdural
  • Intracerebral
28
Q

Where does an Epidural hemorrhage/hematoma occur ?

A

Between the dura and skull

  • usually arterial but can be venous
29
Q

What are the classic signs of an Epidural Hemorrhage ?

A 
1st = Initial unconsciousness
2nd = then a brief lucid interval
3rd = followed by decreased LOC
30
Q

Are subdural hemorrhages usually arterial or venous ?

31
Q

Subdural Hemorrhages occur where ?

A

Between the dura and the brain tissue itself

32
Q

When do symptoms of an Acute Subdural hemorrhage occur ?

A

Symptoms 24-48hrs

33
Q

When do the symptoms of a Subacute Subdural hemorrhage occur ?

A

2days to 2weeks

34
Q

When do Chronic Subdural hemorrhages typically occur ?

A

weeks to months (> 20days)

35
Q

What are Intracerebral hemorrhages ?

A

Actual bleeding in the brain tissue

36
Q

Intracerebral hemorrhages typically occur where ?

A

Frontal or Parietal lobes

37
Q

what is the prognosis of Intracerebral hemorrhages ?

A

Depends on the size of the Intracranial bleed

38
Q

What are classic symptoms of Intracerebral hemorrhages ?

A
  • Headache
  • Change in speech
  • N & V
  • Change in LOC
39
Q

What are things that put pt’s at risk for bleeds ?

A
  • HTN
  • Trauma
  • Tumor
  • Being highly anti-coagulated
40
Q

What does the Emergency management for suspected brain injuries ?

A
  • If unresponsive - assess ABC’s
  • If responsive - Assess ABC’s (b/c we know things can change)
  • Stabilize cervical spine
    (have to assume theres a neck injury, and have to protect the spine until we know otherwise. will involve a C-collar or taping the pt’s head down if he is lying on a board)
  • O2 via non-rebreather (to increase oxygenation)
  • Establish 2 large Bore IV’s, administer NS or LR
  • Assess scalp
  • Control any bleeding
  • Assess for Rhinorrhea & Otorrhea
  • Monitor Vital signs very closely
    (watching for Cushings Triad which is seen with IICP)
41
Q

What are the goals/nursing management for Brain injuries ?

A
  • Maintain adequate cerebral perfusion
  • Pt free of pain, discomfort & infection
  • Attain maximal cognitive, motor & sensory function
42
Q

What do Nursing management interventions for Brain injuries include ?

A
  • Neuro assessment (glasgow coma scale)
  • Airway
  • Stratagies to reduce IICP
  • Seizure precautions (*safety & *airway)
  • Interventions for altered LOC
    • Protect eyes (patch, drops, ointment)
    • Nutrition (may require TPN) & Elimination (stool soft.)
    • Monitor for hyperthermia
    • Prevent contractures & skin breakdown
    • Auditory & tactile stimulation
    • Psychological & Family support
    • Continue to monitor for Rhinorrhea & Otorrhea
      (which would indicate that theres a CSF leak)
43
Q

What are the 2 types of Intracranial Tumors (aka: brain tumors) that pt’s can have ?

A

Primary or Secondary

44
Q

What are Primary tumors ?

A

They start in the brain

  • most are benign but they can still cause trouble
45
Q

What are Secondary Intracranial Tumors ?

A

Metastatic, because it generated somewhere else (ex: Lung cancer)

46
Q

What is the most common Manifestation of Intracranial Tumors ?

A

Headache

  • Other manifestations rely heavily on the location & size
47
Q

What other Manifestations may we see with Intracranial Tumors ?

A
  • Behavior changes
  • Language changes
    • either inability to speak certain words OR confusion
48
Q

What are types of Cranial Surgeries when talking about Intracranial Tumors ?

A
  • Burr holes (just holes to relieve pressure)
  • Craniotomy/Craniectomy
  • Shunt
49
Q

What is the management/Complications with Intracranial Tumors ?

A
  • Prevent IICP (need to watch LOC very closely)
  • Infection
  • CSF Leak
  • Monitor fluid/electrolytes (DI or SIADH)
50
Q

What is Encephalitis ?

A

Acute inflammation of the brain tissue

51
Q

What is Meningitis ?

A

Acute inflammation of the meninges around the brain and spinal cord

52
Q

Meningitis is usually what type of infection ?

53
Q

Encephalitis is usually what type of infection ?

54
Q

What does the Tx look like for meningitis ?

A

Starting Antibiotics as soon as CSF specimen is obtained

  • want drugs that cross the BBB !!
55
Q

What are symptoms of Meningitis ?

A
  • Fever

- Severe headache

56
Q

Inflammation from Meningitis can cause what ?

A
  • Nuchal rigidity
  • Kernig sign (hamstring pain w/attempt to straighten leg)
  • Brudzinski in children (flexion of hip w/flexion of neck)
57
Q

Encephalitis can be caused by what types of things ?

A
  • West Nile
  • Herpes
  • CMV (Cytomegalo virus)
  • Eastern & Venezuelan Equine Viruses
  • Possibly ZIKA (from mosquito bites, ticks, etc)
58
Q

What are the symptoms of Encephalitis ?

A

Similar to Meningitis

  • Fever
  • Severe headache
59
Q

What is the Tx for Encephalitis ?

A
  • Prevention
  • Antivirals, Anti-seizure
  • Supportive care
60
Q

True or False: Both meningitis & Encephalitis can be fatal if left untreated ?

Med Surg II (13 decks)

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