GF13: Neuro Head Injury 2 Flashcards
A whiplash injury is formally known as…
Coup-contrecoup injury
Describe a coup-contrecoup injury.
- Damage from coup-contrecoup injury occurs when the brain moves inside the skull due to high-energy or high-impact injury mechanisms.
- Contusions or lacerations occur both at the site of the direct (primary) impact of the brain on the skull (coup) and at a second area of damage on the opposite side away from injury (contrecoup), leading to multiple contused areas.
- Contrecoup injuries tend to be more severe.
Seizures can occur because of a brain contusion, particularly when the injury involves…
the frontal or temporal lobes
What is important to keep in mind regarding anticoag use in TBI?
It is contraindicated as it can cause more bleeding
Why are we concerned about risk for falls with elderly pts?
- Use of anticoags is common
- If pt falls and obtains a TBI that bleeds, the anticoags can worsen the injury
What are the s/s of epidural hematoma?
- Classic s/s of epidural hematoma:
- an initial period of unconsciousness at the scene, with a
- brief lucid interval followed by a decrease in LOC.
- Presence of rhinorrhea or otorrhea
- Other manifestations may be a headache, nausea and vomiting, or focal findings.
What are the 3 categories of subdural hematomas?
acute, subacute, or chronic
What is the timing, progression and tx for an acute subdural hematoma?
- Timing: manifests within 24 to 48 hours of the injury
- Progression: immediate deterioration
- Tx: Craniotomy, evacuation and decompression
What is the timing, progression and tx for a subacute subdural hematoma?
- Timing: usually occurs within 2 to 14 days of the injury.
- Progression: decline in mental status as hematoma develops. Progression dependent on size and location of hematoma
- Tx: evacuation and decompression
What is the timing, progression and tx for a chronic subdural hematoma?
- Timing: develops over weeks or months after a seemingly minor head injury
- Progression: nonspecific, non-localizing progression. Progressive change in LOC
- Tx: evacuation and decompression, membranectomy
Why are pts w/ a hx of alcohol abuse more prone to subdural hematomas?
- Increased risk of falls
- Alcohol is a vasodilator and will promote bleeding injuries
What are the immediate interventions for TBI pts?
- ABC’s
- Stabilize cervical spine
- Give O2
- Establish IV access with 2 large-bore catheters to infuse fluids/meds
- Intubate if GCS <8
- Control external bleeding with sterile pressure dressing
- Remove pts clothing
Why would we need to pay attention to keeping a pt normothermic?
- Temperature control center of brain may be damaged
- Fever can quickly climb via feedback loop
What are two typical points that intubation would be called for w/ TBI pts?
- GCS ≤8
- Impaired/absent gag reflex
What is the continual monitoring after emergent tx for TBI is completed?
Monitor VS, LOC, O2 sat, Cardiac rhythm, GCS score, pupil size and reactivity
What is the main concern of concussion and contusions?
Increased ICP
What diagnostic tests are used for TBI?
CT, MRI, Cervical spine x-ray series
Why is a CT helpful for TBI?
- Is the best diagnostic test to evaluate for head trauma.
- It allows for rapid diagnosis and intervention in the acute care setting
Why is a MRI helpful for TBI?
is more sensitive than the CT scan in detecting small lesions
Why is a cervical spine x-ray series helpful for TBI?
Cervical spine trauma often occurs at the same time as a head injury and should be done to clear it or diagnose injury
What are some procedures employed to relieve ICP?
- Craniotomy: to see/allow control of bleeding vessels
- Burr holes: for emergent, rapid decompression. Typically followed by a craniotomy.
- Craniectomy: reduce the pressure inside the cranial vault and reduce the risk for herniation.
What are 5 nursing diagnoses for the patient who has sustained a head injury?
- Decreased intracranial adaptive capacity
- Ineffective tissue perfusion
- Hyperthermia
- Risk for injury
- Anxiety
What are six nursing goals for the patient with an acute head injury? The patient will…
- maintain adequate cerebral oxygenation and perfusion;
- stay afebrile;
- be free of discomfort;
- be free from infection;
- have adequate nutrition; and
- attain maximal cognitive, motor, and sensory function.
What are the s/s of a concussion?
- Brief (or no) loss of consciousness
- HA
- Retrograde amnesia
