Head and Spinal Cord Trauma

Question 1

-Blow to the head that jars the brain: diffuse and microscopic brain injury
-Temporary neurologic impairment

Answer 1

Concussion

Question 2

-Assessment Findings
-Brief lapse of consciousness; disorientation
-Headache; blurred or double vision
-Emotional irritability; dizziness
-Diagnostic Findings: skull radiography, CT scan, MRI
-Medical Management
-Temporary inactivity
-Mild analgesia
-Observation for neurologic complications
-Nursing Management
-Neurologic assessment
-Close observation: signs of increased ICP
-Client instruction: contact primary provider, return to ED if symptoms of increased ICP occur

Answer 2

Chronic Traumatic Encephalopathy (CTE)

Question 3

What can CTE lead to?

Answer 3

Alzheimer, Parkinson’s, depression

Question 4

-Pathophysiology and Etiology
-More serious than concussion & leads to structural injury to the brain
-Coup and contrecoup injury (direct & ricochet injury)
-Cerebral edema or skull fracture
-Assessment Findings
-Hypotension; rapid, weak pulse; shallow respirations; pale, clammy skin
-Temporary amnesia
-Effects of permanent brain damage
-Diagnostic Findings: skull radiography, CT scan, MRI
-Medical Management: Drug therapy; mechanical ventilation
-Nursing Management: Periodically monitor
-LOC, neurologic changes, respiratory distress, signs of increased ICP, vital signs
-Head injury prevention
-Seatbelts, infant car seats, protective headgear, neck restraints, no alcohol or drugs while driving
-Chronic Traumatic Encephalopathy (CTE):
-Repetitive concussions
-Sports related
-Long-term effects: dementia, depression, Parkinson disease, and early-onset Alzheimer

Answer 4

Contusion

Question 5

-Pathophysiology and Etiology
-Head trauma
-Cerebral vascular disorders
-Types: epidural (rapid neuro deterioration occurs), subdural, intracerebral
-Assessment Findings: Location dependent, bleeding rate, hematoma size, autoregulation
-Diagnostic Findings: MRI, CT scan, ICP monitoring
-Medical Management: Indications of surgical emergency: rapid change in LOC; signs of uncontrolled increased ICP
-Surgical Management: Burr holes/Trephining: drill holes in skull to relieve pressure
-Intracranial surgery: craniotomy, craniectomy (remove piece of skull to relieve pressure), and cranioplasty (repair defect in skull)
-Surgical Approaches
-Supratentorial
-Infratentorial
-Nursing Management: All head injuries are emergencies.
-Nurse’s role
-History, neurologic examination, vital signs, LOC (call the doctor)
-Limb movement; pupil reactions
-Trauma: Head examination; respiratory status; Neurologic changes
Nursing Management—(cont.)
-Preoperative Nursing Care:Hair removal, vital signs, neurologic assessment (changes); anti embolism stockings, anticonvulsant (Phenytoin); Restrict fluids/NPO
-Postoperative Nursing Care: Supine or side-lying position; Regular monitoring; observe for increased ICP; Control thrombus or embolus; cerebral edema

Answer 5

Cerebral Hematomas

Question 6

-Pathophysiology and Etiology:
-Head injuries: open, closed
-Skull fractures: simple, depressed, comminuted
-See Table 39-2
-Assessment Findings: signs and symptoms: Localized headache; bump, bruise, or laceration; hemiparesis (weakness on one side); shock
-Rhinorrhea (drainage from the nose), otorrhea (ear drainage)
-Periorbital ecchymosis (raccoon eye), Battle sign (bruise behind ear)
-Conjunctival hemorrhages: unequal pupils
-seizures: seizure protocol and make sure to have suctioning at bedside
-Diagnostic Findings: skull radiographs, CT scan, MRI
-Medical and Surgical Management: Simple fracture: bed rest; observation for increased ICP; Lacerated scalp: clean, debride, and suture; Depressed skull fracture
-Craniotomy, antibiotics
-Osmotic diuretics, anticonvulsants
-Nursing Management: Signs of head trauma; Drainage from the nose or ear; Halo sign (bloodstain surrounded by clear/yellow stain-CSF leak); Neurologic assessments
-Hourly: LOC; pupil, motor, and sensory status
-Every 15 to 30 minutes: vital signs
-Prepare for the possibility of seizures.

Answer 6

Skull Fractures

Question 7

-Pathophysiology and Etiology
-Accidents (vehicular), violence
-Complications: Respiratory arrest and spinal shock
-Spinal shock (areflexia):loss of sympathetic reflex activity below the level of injury; poikilothermia (body temp of environment) see book for full definition
-Autonomic dysreflexia (hyperreflexia): exaggerated sympathetic response
-Assessment Findings: Pain, difficulty breathing, numbness, paralysis (tetraplegia, paraplegia); Neurologic examination: shows level of Spinal Cord Injury
-Diagnostic Findings: Radiography, myelography, MRI, CT scan
-Medical Management: Cervical collar, cast or brace, traction, turning frame; IV, vital sign stabilization, corticosteroids; Surgical intervention
-Surgical Management: Bone fragment removal; Dislocated vertebrae repair; Spine stabilization
-Nursing Process Assessment:
-Injury; treatment at scene
-Neurologic assessment: document findings
-Vital signs; respiratory status
-Movement, sensation below injury level
-Signs
-Worsening neurologic damage
-Respiratory distress
-Spinal shock
-Diagnosis, Planning, and Interventions
-Ineffective Breathing Pattern; Ineffective Airway Clearance
-Neuropathic pain
-Impaired physical mobility
-Anxiety
-Risks: Impaired Gas Exchange; Disuse Syndrome; Ineffective Coping
-Evaluation of expected outcome

Answer 7

Spinal Cord Injuries

Question 8

For an Epidural hematoma how ofter should you check the vitals?

Answer 8

every 15-30 minutes

Question 9

-Pathophysiology and Etiology
-Trauma
-Herniated intervertebral disks
-Tumors of the spinal cord/surrounding structures
-Assessment Findings: weakness, paralysis, pain, paresthesia
-Diagnostic Findings: spinal radiography, CT, MRI, myelography, electromyography
-Medical Management: Cervical collar or brace; bed rest; skin traction; hot, moist packs; Skeletal muscle relaxants, drug therapy, corticosteroids, analgesics
-Surgical Management
-Diskectomy: removal of ruptured disk
-Laminectomy: removal of the posterior arch of a vertebra to expose the spinal cord to remove lesions
-Spinal fusion: grafting a piece of bone taken from another area, such as the iliac crest, onto the vertebrae to fuse the vertebral spinous process
-Chemonucleolysis: injection of the enzyme to shrink or dissolve the disk
-Nursing Management (see Nursing Guidelines 39-2 and Box 39-2)
-Neurologic examination
-Conservative therapy
-Spinal support and alignment; bed rest in semi-Fowler position; tractions
-Proper body mechanics
-Muscle relaxants and analgesics; moist heat application
-Evaluation of client response to therapy
-Postsurgical Nursing Management
-Monitor vital signs
-Hourly deep breathing exercises
-Examine the dressing for CSF leakage or bleeding
-Assess neurovascular status
-Voiding status
-Fracture bed pan

Answer 9

Spinal Nerve Root Compression

Question 10

Removal of ruptured disk

Answer 10

Diskectomy

Question 11

Removal of the posterior arch of a vertebra to expose the spinal cord to remove lesions

Answer 11

Laminectomy

Question 12

Grafting a piece of bone taken from another area, such as the iliac crest, onto the vertebrae to fuse the vertebrae spinous process

Answer 12

Spinal fusion

Question 13

injection of the enzyme to shrink or dissolve the disk

Answer 13

Chemonucleolysis