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z_MS1_Neuro Study > GF12: Neuro Head Injury > Flashcards

GF12: Neuro Head Injury Flashcards

1
Q

What is Neurogenic Shock?

A

Autonomic dysregulation following a SCI (typically with injury above T6) or TBI

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2
Q

What is the patho for neurogenic shock?

A
  • SCI/TBBI causes the loss of sympathetic nervous system activity, with unopposed parasympathetic response.
  • This leads to instability in HR, BP and Temp regulation
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3
Q

What are the s/s of neurogenic shock?

A
  • Hypotension
  • Bradycardia
  • Flushed/warm skin
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4
Q

What is the tx for neurogenic shock?

A
  • IV fluids
  • Vasopressors can help tighten blood vessels and increase blood pressure.
    • Commonly used vasopressors include norepinephrine, phenylephrine, dopamine, and epinephrine.
  • If the heart rate is low, your doctor may prescribe atropine
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5
Q

What is the patho of a TBI primary injury?

A

Acceleration or deceleration injury results in shearing, injury/destruction of brain tissue, and/or hemmorhage

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6
Q

What is the patho of a TBI secondary injury?

A
  • Reactive processes that occur after the initial injury and further damage brain tissue
  • Ex. hypotension, hypoxia, ischemia, cerebral edema
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7
Q

What is the medication tx for TBI?

A
  • Mannitol to decrease ICP
  • Hypertonic NaCl, pentobarbitol: induces coma to decrease metabolic demands
  • Anticonvulsant to prevent/treat seizures
  • Opioid analgesics
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8
Q

What is the nursing care for TBI pts?

A
  • Stabilize cervical spine
  • Maintain patent airway
  • Monitor VS, LOC, EKG
  • Decrease ICP
    • Reduce hypercarbia by hyperventilation
    • Avoid suctioning
    • HOB ≥30°, head midline
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9
Q

What is the pt teaching for TBI?

A
  • Avoid coughing, blowing nose, extreme neck flexion/extension
  • Remove restrictive clothing
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10
Q

What are some TBI complications?

A
  • Brain herniation
  • Hemorrhage/hematoma
  • Hydrocephalus
  • SIADH
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11
Q

Brain herniation is due to movement of brain tissue due to cerebral edema/bleeding. What are the s/s?

A
  • Fixed/dilated pupils
  • Decreased LOC
  • Abnormal respirations/posturing
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12
Q

Describe epidural hematoma.

A
  • Arterial bleeding into the space between the skull and dura mater
  • An epidural hematoma is a neurologic emergency.
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13
Q

Describe subdural hematoma.

A

Venous bleeding into the space between the dura mater and arachnoid

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14
Q

What is intracerebral hemorrhage?

A

Accumulation of blood within the brain tissue

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15
Q

Why is rapid surgical intervention called for with hematomas?

A

to evacuate the hematoma and prevent cerebral herniation, along with medical management for increasing ICP

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16
Q

Why is determining arterial vs veinous bleeding w/ a TBI?

A
  • Arterial sources will bleed out and exacerbate hematomas more quickly
  • Veinous sources develop more slowly over time
17
Q

What is hydrocephalus?

A

Increased CSF volume due to impaired reabsorption of CSF or an issue with CSF outflow

18
Q

What causes SIADH w/ TBI?

A

Damage to the pituitary gland

19
Q

Deaths occur from head trauma at what 3 points after injury?

A
  • immediately after the injury,
  • within 2 hours after injury, and about
  • 3 weeks after injury
20
Q

Most deaths occur immediately after the injury, either from the _____ or from _____ and ____.

A
  • direct head trauma
  • massive hemorrhage
  • shock
21
Q

Deaths occurring within a few hours of the trauma are caused by…

A

progressive worsening of the brain injury or internal bleeding

22
Q

Deaths occurring 3 weeks or more after the injury result from…

A

multisystem failure

23
Q

What is a basilar skull fracture?

A
  • Fracture to the base of the skull
  • This fracture is often associated with a tear in the dura and subsequent leakage of CSF
  • Manifestations can evolve over the course of several hours and vary with the location and severity of fracture.
24
Q

What are the s/s of a basilar skull fracture?

A
  • CSF or brain otorrhea, bulging of tympanic membrane caused by blood or CSF
  • Battle’s sign, racoon eyes, tinnitus or hearing difficulty, rhinorrhea, facial paralysis, conjugate deviation of gaze, vertigo
25
Q

What is conjugate deviation of gaze?

A

(CED) is defined as a sustained shift in horizontal gaze toward 1 side, together with gaze failure to the other side, caused by lesions in the brainstem, basal ganglia, or cortical frontal eye fields

26
Q

_____ and _____ generally confirms that a fracture has traversed the dura

A
  • Rhinorrhea
  • Otorrhea
27
Q

The risk for _____ is high with a CSF leak. _____ should be given as a preventive measure

A
  • Meningitis
  • Antibiotics
28
Q

Periorbital edema and eccymosis is also known as…

A

Racoon (or panda) eyes

29
Q

What is postauricular ecchymosis and what Is it also called?

A
  • Bruising behind and below the ear resulting from a basilar skull fracture
  • Battle’s sign
30
Q

What are two ways to test for CSF?

A
  • Test for glucose. A positive result indicates CSF
  • Halo sign
31
Q

The major complications of skull fractures are…

A

intracranial infections, hematoma, and meningeal and brain tissue damage.

32
Q

When a basilar skull fracture is suspected, an _____ tube should be inserted rather than a _____ tube.

A
  • Orogastric
  • NG

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