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Med Surg II > Exam 2: TBI > Flashcards

Exam 2: TBI Flashcards

1
Q

acceleration

A

immobile head struck by moving object (whiplash)

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2
Q

deceleration

A

head pushed forward and hits stationary object

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3
Q

what part of brain is commonly involved in TBI injuries?

A

frontal (Broca’s speech center) and temporal (Wernicke’s)

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4
Q

primary brain injury

A

damage occurs at time of injury

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5
Q

types of primary injuries

A

open and closed head injuries

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6
Q

types of OPEN head injuries

A

linear, depressed and basilar skull fractures

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7
Q

linear fracture

A

80% of ppl

clean break

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8
Q

depressed fracture

A

bone pressed inward into brain tissue . “fragments” of skull pierce brain tissue

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9
Q

basilar fracture

A

injury @ base of brain (mastoid)

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10
Q

what occurs during basilar fractures?

A

CSF leakage (rhinorrhea and otorrhea)
potential hemorrhage
Battles sign
Racoon eyes

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11
Q

what is Battle sign and racoon eyes?

A

battle sign: meninges tear and bruising around mastoid
racoon eyes: blood from fracture seep into soft tissue around eyes and turn
them black and blue

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12
Q

closed head injury

A

(blunt trauma) to brain, either by impact, injury or physical attack
skull’s not violated
concussion, contusion and laceration

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13
Q

type of closed head injuries

A

concussion, contusion and laceration

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14
Q

concussion

A

shaking of brain

maybe none or brief loss of consciousness (>5 mins = incr severity

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15
Q

contusion

A

bruising of brain tissue @ site of impact

manifestations depend on area of impact

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16
Q

brain stem contusion =?

A

unresponsiveness

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17
Q

laceration

A

tearing of cortical surface vessels

may lead to secondary hemorrhage, cerebral edema and inflammation

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18
Q

secondary injury

A

any neuro damage occurring after initial injury

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19
Q

types of secondary injuries

A

increased ICP
hemorrhage
herniation

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20
Q

normal CSF volume

A

10-15 mg/hg

should always be less than 20

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21
Q

cranial contents

A

brain tissue, blood and CSF

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22
Q

what happens when volume increases in one component of the brain?

A

brain displaces CSF because a decrease in the other component is necessary to maintain appropriate ICP

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23
Q

what happens when the brain can no longer compensate?

A

ICP increases

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24
Q

What is the result of increasing ICP?

A

decr cerebral perfusion
tissue hypoxia
incr in CO2 —> severe vasodilation, edema and further increase in ICP

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25
what happens if increased ICP is not treated?
brain may herniate downwards towards brain stem (uncal herniation) causing irreversible brain damage and possibly death
26
what does hemorrhage in the brain cause?
brain hematomas (collection of blood) or clots
27
why are all hematomas potentially life threatening?
they act as space-occupying lesions and are surr by edema
28
epidural hematoma
NEURO EMERGENCY TBI where blood builds up between dura mater (tough outer membrane of the CNS) and skull results from arterial bleed
29
symptoms of epidural hematoma
symptoms progress QUICKLY b/c bleeding is from artery fluctuating LOC fixed and dilated pupil on side of injury increased ICP causes headache
30
subdural hematoma
blood gathers between the dura mater, and the brain | highest mortality rate
31
symptoms of subdural hematoma
bleeding occurs more slowly because its a venous bleed | same as epidural hematoma but slowly evolving
32
intracerebral hemorrhage
accumulation of blood within brain tissue
33
types of herniations
transtentorial (uncal) | central
34
transtentorial uncal herniation
uncus (innermost part of temporal) is squeezed so much that it moves towards and puts pressure on the brainstem
35
signs and symptoms of transtentorial uncal herniation
dilated and non-reactive pupils ptosis (drooping eyelids) ---> cranial nerve 3 rapid deterioration in LOC
36
central herniation and symptoms
downward shift of brainstem and diencephalon Cheyne-Stokes respirations pinpoint and nonreactive pupils
37
during physical assessment, what are you looking for in terms of the spinal cord
1. ALWAYS look @ spinal cord 2. assess for any loss in motor funct 3. assess for tenderness along spine
38
physical assessment ABCs?
injury to brainstem = impaired breathing
39
physical assessment vital signs?
important to worry about signs and symptoms of ICP | if it's missed can lead to Cushing's Triad
40
physical assessment LOC
confusion, delirium, disorientation | Call neurologist stat!
41
what is indicative of a CSF leak?
``` rhinorrhea and otorrhea halo sign (glucose, yellow ring surrounded with bloody drainage) ```
42
what must you rule out first when there's a CSF leak?
meningitis by checking for nuchal rigidity after cervical injury is ruled out
43
what two postures do you assess for
decorticate (abnormal flexion towards core) = midbrain | decrebrate (rigid extension) = brain stem
44
signs and symptoms of increased ICP
1st CHANGE IN LOC (restlessness, irritability, confusion, wants to sleep) - Changes in vitals (incr or decr pulse, widening or narrowing of pulse pressure, incr temp) - headache - projectile vomiting - pinpoint and uneven pupillary changes
45
Late sign of increased ICP
``` CUSHINGS TRIAD! HTN bradycardia irregular respiration widening pulse pressure pulse becomes thready, irreg, and rapid ```
46
what happens when a pt with ICP needs to have a BM
give colace because you dont want them straining
47
three categories of glasgow coma scale
eye, verbal, motor
48
maximum score each category in glasgow
Eye - 4 Verbal - 5 Motor - 6
49
eye opening glasgow scores
spontaneous 4 loud voice 3 pain 2 none 1
50
verbal glasgow scores
``` oriented 5 confused 4 inappropriate 3 incomprehensible 2 none 1 ```
51
motor glasgow scores
``` obeys commands 6 localizes pain 5 withdrawn from pain 4 flexion/decorticate 3 extension/decerebrate 2 none 1 ```
52
Glasgow
comatose state
53
Glasgow 9-10
moderate head injury
54
Glasgow 13-15
minor head injury
55
Glasgow of 15
normal
56
how often should you assess vital in TBI pt
q1-2h
57
why must a fever be treated immediately in TBI pt
``` fever increases cerebral blood flow, which increases ICP give Tylenol (doesnt respond when hypothalmic damage) ```
58
how should you move and position pt with incr. ICP
avoid extreme flexion and extensionof neck head should be midline and in neutral position log roll - NO draw sheet 3 ppl must move pt w/ no help from pt avoid hip flexion
59
why should hyperventilation be avoided for 24 hrs in ICP pt?
it causes tissue ischemia because it vasoconstricts cerebral blood vessels
60
what are the indications for hyperventilating ICP pt
- pt needs to be deteriorating and it should be given for short time - PaCO2 is btwn 55-60, hyperventilate to bring down CO2
61
what CO2 level should vented ICP pts be at?
PaCO2 between 35-38 (on low side)
62
what happens if CO2 is too low in ICP pt?
lead to vasoconstriction which will lead to hypoxia, subsequently increasing CO2
63
4 reasons why pts are put into a barbiturate coma
- dont want brain overworked - prevent more damage from occuring - any stimuli can incr ICP - comabrain is at rest
64
whats used to induce a barbiturate coma?
1. propofol (Dipravan) - gen anesthetic | 2. pentobarbital - barbiturate
65
drug therapy for ICP and indications
1. Mannitol: treat cerebral edema, usualy given w/ Lasix 2. dexamethasone (Decadron): corticosteroid that reduces cerebral inflammation 3. pancuronium bromide (Pavulon): neuromuscular blocker 4. Colace: decr. use of valsalva w/ BM
66
how should mannitol be administered
better as bolus rather than continuous IV must be drawn up thru filtered needle (so glass shards are injected into pt) very short term freq I&O
67
mannitol is contraindicated for whom
anuria pts
68
what must be administered with pancuronium bromide (Pavulon)
aggressive sedative
69
what is the patient at risk for if the pituitary gland is injured?
``` SIADH (give vaptans which are anti vasopressin and diuretics) Diabetes Insipidus (give vasopressin) ```
70
ICP Monitoring
- decrease sensory overload - do things one @ a time - limit suctioning b/c will incr CO2 = incr ICP - seizure precautions - restless = mittens on hands - flaccid feet = footboard or high top sneakers
71
nutrition of ICP pt
- use Dubhoff tube, small bore NG tube that reduces risk of aspiration
72
surgical management
insert ICP device | craniotomy
73
normal ICP levels
10-15 want

Med Surg II (6 decks)

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