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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
Q

what happens if increased ICP is not treated?

A

brain may herniate downwards towards brain stem (uncal herniation) causing irreversible brain damage and possibly death

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26
Q

what does hemorrhage in the brain cause?

A

brain hematomas (collection of blood) or clots

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27
Q

why are all hematomas potentially life threatening?

A

they act as space-occupying lesions and are surr by edema

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28
Q

epidural hematoma

A

NEURO EMERGENCY
TBI where blood builds up between dura mater (tough outer membrane of the CNS) and skull
results from arterial bleed

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29
Q

symptoms of epidural hematoma

A

symptoms progress QUICKLY b/c bleeding is from artery

fluctuating LOC
fixed and dilated pupil on side of injury
increased ICP causes headache

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30
Q

subdural hematoma

A

blood gathers between the dura mater, and the brain

highest mortality rate

31
Q

symptoms of subdural hematoma

A

bleeding occurs more slowly because its a venous bleed

same as epidural hematoma but slowly evolving

32
Q

intracerebral hemorrhage

A

accumulation of blood within brain tissue

33
Q

types of herniations

A

transtentorial (uncal)

central

34
Q

transtentorial uncal herniation

A

uncus (innermost part of temporal) is squeezed so much that it moves towards and puts pressure on the brainstem

35
Q

signs and symptoms of transtentorial uncal herniation

A

dilated and non-reactive pupils
ptosis (drooping eyelids) —> cranial nerve 3
rapid deterioration in LOC

36
Q

central herniation and symptoms

A

downward shift of brainstem and diencephalon
Cheyne-Stokes respirations
pinpoint and nonreactive pupils

37
Q

during physical assessment, what are you looking for in terms of the spinal cord

A
  1. ALWAYS look @ spinal cord
  2. assess for any loss in motor funct
  3. assess for tenderness along spine
38
Q

physical assessment ABCs?

A

injury to brainstem = impaired breathing

39
Q

physical assessment vital signs?

A

important to worry about signs and symptoms of ICP

if it’s missed can lead to Cushing’s Triad

40
Q

physical assessment LOC

A

confusion, delirium, disorientation

Call neurologist stat!

41
Q

what is indicative of a CSF leak?

A 
rhinorrhea and otorrhea
halo sign (glucose, yellow ring surrounded with bloody drainage)
42
Q

what must you rule out first when there’s a CSF leak?

A

meningitis by checking for nuchal rigidity after cervical injury is ruled out

43
Q

what two postures do you assess for

A

decorticate (abnormal flexion towards core) = midbrain

decrebrate (rigid extension) = brain stem

44
Q

signs and symptoms of increased ICP

A

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
Q

Late sign of increased ICP

A 
CUSHINGS TRIAD!
HTN
bradycardia
irregular respiration
widening pulse pressure 
pulse becomes thready, irreg, and rapid
46
Q

what happens when a pt with ICP needs to have a BM

A

give colace because you dont want them straining

47
Q

three categories of glasgow coma scale

A

eye, verbal, motor

48
Q

maximum score each category in glasgow

A

Eye - 4
Verbal - 5
Motor - 6

49
Q

eye opening glasgow scores

A

spontaneous 4
loud voice 3
pain 2
none 1

50
Q

verbal glasgow scores

A 
oriented 5
confused 4
inappropriate 3
incomprehensible 2
none 1
51
Q

motor glasgow scores

A 
obeys commands 6
localizes pain 5
withdrawn from pain 4
flexion/decorticate 3
extension/decerebrate 2
none 1
52
Q

Glasgow

A

comatose state

53
Q

Glasgow 9-10

A

moderate head injury

54
Q

Glasgow 13-15

A

minor head injury

55
Q

Glasgow of 15

A

normal

56
Q

how often should you assess vital in TBI pt

A

q1-2h

57
Q

why must a fever be treated immediately in TBI pt

A 
fever increases cerebral blood flow, which increases ICP
give Tylenol (doesnt respond when hypothalmic damage)
58
Q

how should you move and position pt with incr. ICP

A

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
Q

why should hyperventilation be avoided for 24 hrs in ICP pt?

A

it causes tissue ischemia because it vasoconstricts cerebral blood vessels

60
Q

what are the indications for hyperventilating ICP pt

A
  • pt needs to be deteriorating and it should be given for short time
  • PaCO2 is btwn 55-60, hyperventilate to bring down CO2
61
Q

what CO2 level should vented ICP pts be at?

A

PaCO2 between 35-38 (on low side)

62
Q

what happens if CO2 is too low in ICP pt?

A

lead to vasoconstriction which will lead to hypoxia, subsequently increasing CO2

63
Q

4 reasons why pts are put into a barbiturate coma

A
  • dont want brain overworked
  • prevent more damage from occuring
  • any stimuli can incr ICP
  • comabrain is at rest
64
Q

whats used to induce a barbiturate coma?

A
  1. propofol (Dipravan) - gen anesthetic

2. pentobarbital - barbiturate

65
Q

drug therapy for ICP and indications

A
  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
Q

how should mannitol be administered

A

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
Q

mannitol is contraindicated for whom

A

anuria pts

68
Q

what must be administered with pancuronium bromide (Pavulon)

A

aggressive sedative

69
Q

what is the patient at risk for if the pituitary gland is injured?

A 
SIADH (give vaptans which are anti vasopressin and diuretics)
Diabetes Insipidus (give vasopressin)
70
Q

ICP Monitoring

A
  • 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
Q

nutrition of ICP pt

A
  • use Dubhoff tube, small bore NG tube that reduces risk of aspiration
72
Q

surgical management

A

insert ICP device

craniotomy

73
Q

normal ICP levels

A

10-15

want

Med Surg II (6 decks)

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