Head Injury and Spinal Cord Injury Flashcards
Head injuries include any trauma to the ___, ___, or ___?
Scalp, skull, or brain
Head trauma includes any alteration in ___?
Consciousness
What are some causes of head injury?
- motor vehicle accidents
- falls
- assaults
- sports related injuries
- recreational accidents
When are the 3 key times that death occurs after a head injury?
- Immediately after the injury
- Within two days after after the injury (edema, bleeding, hypoxia)
- Three weeks after the injury (multisystem failure)
What do scalp lacerations involve?
- most minor type of head trauma
- scalp contains many blood vessels which leads to profuse bleeding
- main concern is infection and blood loss
- nurses need to assess neurological function, assess injury and bleeding, clean injury, ensure patient safety post discharge
What are the 5 types on scull fractures?
- linear
- depressed
- simple
- comminuted
- compound
What is a linear scull fracture?
Break in continuity of the bone with alterations
What is a depressed scull fracture?
Inward indentation of the skull
What is a simple scull fracture?
Linear or depressed without fragmentation
What is a comminuted skull fracture?
Multiple linear fractures with fragmentation of bone into many pieces
What is a compound fracture?
Depressed skull fracture with communicating pathway into the intracranial cavity
The location of skull fractures impacts the presentation of ____?
Symptoms
Where are the three common locations of skull fractures?
- Orbital fracture (periorbital ecchymosis (raccoon eyes) and optic nerve injuries)
- Temporal fracture (bruising behind the year - battle sign)
- Parietal fracture (deafness and battle sign)
What is rhinorrhea?
Thin fluid leaking from the nose
What is otorrhea?
Drainage from the ear
Fluid leaking from the nose or ears indicates that the fluid has traversed the ___?
Dura
Leaking fluids most be tested to determine if it is ___?
Cerebrospinal fluid (CSF)
What are the two ways to test for CSF?
- test on dextrostix or Tes-tape (looking for glucose)
2. Halo test - fluid on white gauze - exam for yellowish ring
The presence of CSF in a fracture indicates an _______________? This leads to increased risk of _________?
- opening from the skull to the brain
- infection, hematoma, meningeal and brain tissue injury
What is a diffuse head injury?
- damage impacting more than one area of the brain
- ex: concussion
What is a focal head injury?
- damage is localized to a specific area of the brain
- ex: laceration
What is a concussion?
A sudden transient mechanical head injury with disruption of neural activity and change in level of consciousness
What are the signs and symptoms of a concussion?
- amnesia (retrograde)
- headache
- photophobia
- short duration, usually resolves 72 hours, however, the effects may last weeks or months
What nursing care needs to be done for concussions?
- neuro checks q1hr until patient is back to baseline
- headache (acetaminophen q4hr prn)
- avoid sedatives, sleeping pills, alcohol beverages for 24 hours
- no strenuous activity for 48 hours
- monitor for problems with balance - ensure safety
- return to the ER if severe or worsening headache, nausea, vomiting, blurred vision, drainage from ears or nose, increasing weakness, unequal pupil size
What is post-concussion syndrome?
- occurs 2 weeks to 2 months after the concussion
- signs include; persistent headache, personality and behavioural changes, short attention span, decreased short term memory
Recurrent concussions are associated with ____ recoveries and may have long term effects
Slower
What does CTE stand for and what does it mean?
Chronic traumatic encephalopathy
- degeneration in the brain due to repeated concussions
- more extensive impairments - professional athletes being researched for short and long term effects
What is a diffuse axon injury?
- widespread axonal damage which can occur after a minor, moderate or severe traumatic brain injury (TBI)
- damage primarily occurs in the white matter of the brain
- axon is injured = inflammatory response (swelling) which causes axons to disconnect from the pathway
- may take 12-24 hours to appear
- minor TBI is a concussion
What is a moderate TBI?
- loss of consciousness from 30 minutes to up to 6 hours
- GCS of 9-12
- CT scan: focal or diffuse injury is visible
- post traumatic amnesia
- nurses need to monitor ABC’s, close observation and safety for patient, frequent vital signs, and focused neurological checks, monitoring for secondary injuries
What is a sever traumatic brain injury?
- GCS: 3-8 (unstable patients - intubation)
- loss of consciousness for longer than 6 hours
- focal and/or diffuse damage to the brain (cerebral vessels and ventricles involved)
- CT and MRI can visualize injuries
- hemodynamics unstable - required stabilization (ABC’s)
- high risk for secondary brain injury (hypotension and hypoxia)
What are some examples of focal injuries?
- lacerations
- contusions
- hematomas
- cranial nerve injuries
What are some signs of focal injuries?
- may be delayed (depends on where the injury is within the brain)
- hemorrhage
- hematoma formation
- cerebral edema
What is a contusion?
- bruising of the brain tissue within a focal area
- frequently occurs near the site of a fracture
- can develop due to hemorrhage, infarction, necrosis, and edema
What are coup and contrecoup injuries?
- occur due to significant movement of the brain inside the skull, usually a closed head injury
- the impact of the brain on the skull = coup injury
- the secondary injury occurs at the opposite side of the brain
- multiple injuries = more significant injury
- contusions that continue to evolve have a poor prognosis
What is a laceration?
- involves actual tearing of the brain tissue
- often occurs with depressed or open fractures and/or penetrating injuries
- intracerebral hemorrhage often occurs with laceration
- ## surgical repair is impossible (cannot stitch brain tissue due to texture)
What is a epidural hematoma?
- results from bleeding between the dura and the inner surface of the skull
- compression of the dura matter and therefore the brain
- neurological emergency if bleeding is arterial (associated with linear fracture to temporal bone)
- venous epidural hematoma develop slowly
What are the signs of epidural hematoma?
- initial period of unconsciousness
- brief lucid interval followed by a decrease in LOC
- headache
- nausea and vomiting
- focal findings
What does a epidural hematoma require?
- rapid surgical intervention to remove the hematoma and prevent cerebral herniation
- can improve patient outcomes
What is a subdural hematoma?
- occurs from bleeding between the dura matter and the arachnoid layer of the meninges
- most common site is at the veins that drain blood from the surface of the brain into the sagittal sinus
- usually venous, slow to develop
- can be caused by tearing of small arteries which develop more rapidly
When do signs develop in an acute subdural hematoma and what are they?
- within 48 hours of the brain injury
- associated with severe traumatic brain injury
- signs include decreased LOC and headache
- patients can range from being drowsy to unconscious
- ipsilateral pupil dilates and becomes fixed
What does ipsilateral mean?
Occurring on the same side as the injury
After the initial bleeding in subdural hematoma, the hematoma ____ over time?
Enlarges
When does a chronic subdural hematoma occur?
Over weeks or months after a seemingly minor head injury
In what age group do chronic subdural hematomas typically occur?
Patients in their 50’s and 60’s because of a larger subdural space in their scull
A chronic subdural hematoma is often mistaken for ______ or ______ in patient’s in their 50’s and 60’s?
Stroke or dementia
What is a intracerebral hematoma?
- occurs from bleeding within the brain tissue
- usually occurs in the frontal and temporal lobes
- size and location of the hematoma determine the patient outcome
What does the frontal lobe control?
- emotional expression
- problem solving
- memory
- language
- judgement
What doe the temporal lobe control?
- auditory process
- long term memory
What diagnostic tests can be used to determine cranial-cerebral trauma?
- CT scan (best diagnostic test to determine cranial-cerebral trauma because it allows for rapid diagnostics and treatment)
- MRI (provides detailed, more in depth, detailed views once patient is stable)
- cervical spinal x-rays
What are the 3 categories of the Glasgow Coma Scale?
- eye opening
- verbal response
- best motor response
What are some nursing diagnoses related to head injuries?
- risk for ineffective cerebral tissue perfusion
- hyperthermia
- impaired physical mobility
- anxiety
- potential complication; increased intracranial pressure
What is the highest score on the Glasgow coma scale?
15
What does a score of <8 mean on the Glasgow coma scale?
comatose
What does a score of 3 mean on the Glasgow coma scale?
Totally unresponsive
What is ataxia?
- the presence of abnormal uncoordinated movements
- sign of intracranial pressure
What is Cushing’s triad?
- a set of signs indicative of increased intracranial pressure
- severe hypertension
- bradycardia
- decreased respirations
What can happen to the eyes if there is too much intracranial pressure?
- eye problems such as loss of corneal reflex, periorbital ecchymosis and diplopia
- use lubricating eye drops, cool compress for swelling, diplopia eye patch, and ensure safety
What should you do if there is fluid in the head?
Raise the head of the bed immediately.
What are post traumatic seizures?
- occur in 5% of patients after a head injury
- provide safe environment
- give anticonvulsants
What are traumatic spinal cord injuries?
- result of an external physical impact
What are non-traumatic spinal cord injuries?
- result of disease, infection, or tumour
How many pairs of spinal nerves are there?
31
- 8 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral
What are the 3 membranes that the spinal cord is enclosed by?
- pia matter (inner)
- arachnoid (middle)
- dur matter (outer)
Compression of the spinal cord can be caused by ______?
- bone displacement
- interruption of blood supply
- penetrating injuries (stab or gunshot wound)
What is paraplegia?
- loss of sensation and movement to the lower limbs and trunk
What is tetraplegia?
- loss of sensation to upper and lower limbs and the trunk
- injuries at c8 or above
What is a primary injury?
- when the spinal experiences significant force which leads to the disruption of axons
- excessive stretching or laceration
What is a secondary injury?
- ongoing, progressive damage that occurs after the initial injury
- due to edema, hypoxia, ischemia, and electrolyte shifts
- apoptosis can go on for an extended time following the injury
Inflammation and edema in the spinal cord for more than ____ hours can cause permanent damage to the cord?
More than 24 hours = severe damage
- there is little to no room for inflammation in the vertebrae bodies of the spinal column
- cord becomes compressed, causing hypoxia and therefore, ischemic damage
What is spinal shock?
- 50% of patients with spinal cord injuries experience spinal shock
- decreased reflexes
- loss of sensation
- flaccid paralysis below the level of the injury
- can last from days to months
What is neurologic shock?
- SCI at cervical vertebra C5 or above can experience neurologic shock
- hypotension and bradycardia
- loss of sympathetic innervation and results in peripheral vasodilation, venous pooling, and decreased cardiac output
- severe complication requiring intensive care for extended periods of time
What are the 3 classifications of spinal cord injuries?
- mechanism of injury
- neurologic level of injury
- completeness or degree of injury
Why is the flexion/rotation the most unstable mechanism of injury
Because of the ligament damage
