GF12: Neuro Head Injury Flashcards
What is Neurogenic Shock?
Autonomic dysregulation following a SCI (typically with injury above T6) or TBI
What is the patho for neurogenic shock?
- SCI/TBBI causes the loss of sympathetic nervous system activity, with unopposed parasympathetic response.
- This leads to instability in HR, BP and Temp regulation
What are the s/s of neurogenic shock?
- Hypotension
- Bradycardia
- Flushed/warm skin
What is the tx for neurogenic shock?
- 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
What is the patho of a TBI primary injury?
Acceleration or deceleration injury results in shearing, injury/destruction of brain tissue, and/or hemmorhage
What is the patho of a TBI secondary injury?
- Reactive processes that occur after the initial injury and further damage brain tissue
- Ex. hypotension, hypoxia, ischemia, cerebral edema
What is the medication tx for TBI?
- Mannitol to decrease ICP
- Hypertonic NaCl, pentobarbitol: induces coma to decrease metabolic demands
- Anticonvulsant to prevent/treat seizures
- Opioid analgesics
What is the nursing care for TBI pts?
- Stabilize cervical spine
- Maintain patent airway
- Monitor VS, LOC, EKG
- Decrease ICP
- Reduce hypercarbia by hyperventilation
- Avoid suctioning
- HOB ≥30°, head midline
What is the pt teaching for TBI?
- Avoid coughing, blowing nose, extreme neck flexion/extension
- Remove restrictive clothing
What are some TBI complications?
- Brain herniation
- Hemorrhage/hematoma
- Hydrocephalus
- SIADH
Brain herniation is due to movement of brain tissue due to cerebral edema/bleeding. What are the s/s?
- Fixed/dilated pupils
- Decreased LOC
- Abnormal respirations/posturing
Describe epidural hematoma.
- Arterial bleeding into the space between the skull and dura mater
- An epidural hematoma is a neurologic emergency.
Describe subdural hematoma.
Venous bleeding into the space between the dura mater and arachnoid
What is intracerebral hemorrhage?
Accumulation of blood within the brain tissue
Why is rapid surgical intervention called for with hematomas?
to evacuate the hematoma and prevent cerebral herniation, along with medical management for increasing ICP
Why is determining arterial vs veinous bleeding w/ a TBI?
- Arterial sources will bleed out and exacerbate hematomas more quickly
- Veinous sources develop more slowly over time
What is hydrocephalus?
Increased CSF volume due to impaired reabsorption of CSF or an issue with CSF outflow
What causes SIADH w/ TBI?
Damage to the pituitary gland
Deaths occur from head trauma at what 3 points after injury?
- immediately after the injury,
- within 2 hours after injury, and about
- 3 weeks after injury
Most deaths occur immediately after the injury, either from the _____ or from _____ and ____.
- direct head trauma
- massive hemorrhage
- shock
Deaths occurring within a few hours of the trauma are caused by…
progressive worsening of the brain injury or internal bleeding
Deaths occurring 3 weeks or more after the injury result from…
multisystem failure
What is a basilar skull fracture?
- 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.
What are the s/s of a basilar skull fracture?
- 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
What is conjugate deviation of gaze?
(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
_____ and _____ generally confirms that a fracture has traversed the dura
- Rhinorrhea
- Otorrhea
The risk for _____ is high with a CSF leak. _____ should be given as a preventive measure
- Meningitis
- Antibiotics
Periorbital edema and eccymosis is also known as…
Racoon (or panda) eyes
What is postauricular ecchymosis and what Is it also called?
- Bruising behind and below the ear resulting from a basilar skull fracture
- Battle’s sign
What are two ways to test for CSF?
- Test for glucose. A positive result indicates CSF
- Halo sign
The major complications of skull fractures are…
intracranial infections, hematoma, and meningeal and brain tissue damage.
When a basilar skull fracture is suspected, an _____ tube should be inserted rather than a _____ tube.
- Orogastric
- NG
