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Nursing Theory > Head Injury and Spinal Cord Injury > Flashcards

Head Injury and Spinal Cord Injury Flashcards

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1
Q

Head injuries include any trauma to the ___, ___, or ___?

A

Scalp, skull, or brain

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2
Q

Head trauma includes any alteration in ___?

A

Consciousness

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3
Q

What are some causes of head injury?

A
  • motor vehicle accidents
  • falls
  • assaults
  • sports related injuries
  • recreational accidents
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4
Q

When are the 3 key times that death occurs after a head injury?

A
  1. Immediately after the injury
  2. Within two days after after the injury (edema, bleeding, hypoxia)
  3. Three weeks after the injury (multisystem failure)
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5
Q

What do scalp lacerations involve?

A
  • 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
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6
Q

What are the 5 types on scull fractures?

A
  1. linear
  2. depressed
  3. simple
  4. comminuted
  5. compound
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7
Q

What is a linear scull fracture?

A

Break in continuity of the bone with alterations

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8
Q

What is a depressed scull fracture?

A

Inward indentation of the skull

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9
Q

What is a simple scull fracture?

A

Linear or depressed without fragmentation

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10
Q

What is a comminuted skull fracture?

A

Multiple linear fractures with fragmentation of bone into many pieces

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11
Q

What is a compound fracture?

A

Depressed skull fracture with communicating pathway into the intracranial cavity

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12
Q

The location of skull fractures impacts the presentation of ____?

A

Symptoms

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13
Q

Where are the three common locations of skull fractures?

A
  1. Orbital fracture (periorbital ecchymosis (raccoon eyes) and optic nerve injuries)
  2. Temporal fracture (bruising behind the year - battle sign)
  3. Parietal fracture (deafness and battle sign)
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14
Q

What is rhinorrhea?

A

Thin fluid leaking from the nose

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15
Q

What is otorrhea?

A

Drainage from the ear

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16
Q

Fluid leaking from the nose or ears indicates that the fluid has traversed the ___?

A

Dura

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17
Q

Leaking fluids most be tested to determine if it is ___?

A

Cerebrospinal fluid (CSF)

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18
Q

What are the two ways to test for CSF?

A
  1. test on dextrostix or Tes-tape (looking for glucose)

2. Halo test - fluid on white gauze - exam for yellowish ring

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19
Q

The presence of CSF in a fracture indicates an _______________? This leads to increased risk of _________?

A
  • opening from the skull to the brain

- infection, hematoma, meningeal and brain tissue injury

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20
Q

What is a diffuse head injury?

A
  • damage impacting more than one area of the brain

- ex: concussion

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21
Q

What is a focal head injury?

A
  • damage is localized to a specific area of the brain

- ex: laceration

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22
Q

What is a concussion?

A

A sudden transient mechanical head injury with disruption of neural activity and change in level of consciousness

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23
Q

What are the signs and symptoms of a concussion?

A
  • amnesia (retrograde)
  • headache
  • photophobia
  • short duration, usually resolves 72 hours, however, the effects may last weeks or months
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24
Q

What nursing care needs to be done for concussions?

A
  • 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
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25
Q

What is post-concussion syndrome?

A
  • occurs 2 weeks to 2 months after the concussion
  • signs include; persistent headache, personality and behavioural changes, short attention span, decreased short term memory
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26
Q

Recurrent concussions are associated with ____ recoveries and may have long term effects

A

Slower

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27
Q

What does CTE stand for and what does it mean?

A

Chronic traumatic encephalopathy

  • degeneration in the brain due to repeated concussions
  • more extensive impairments - professional athletes being researched for short and long term effects
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28
Q

What is a diffuse axon injury?

A
  • 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
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29
Q

What is a moderate TBI?

A
  • 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
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30
Q

What is a sever traumatic brain injury?

A
  • 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)
31
Q

What are some examples of focal injuries?

A
  • lacerations
  • contusions
  • hematomas
  • cranial nerve injuries
32
Q

What are some signs of focal injuries?

A
  • may be delayed (depends on where the injury is within the brain)
  • hemorrhage
  • hematoma formation
  • cerebral edema
33
Q

What is a contusion?

A
  • 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
34
Q

What are coup and contrecoup injuries?

A
  • 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
35
Q

What is a laceration?

A
  • 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)
36
Q

What is a epidural hematoma?

A
  • 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
37
Q

What are the signs of epidural hematoma?

A
  • initial period of unconsciousness
  • brief lucid interval followed by a decrease in LOC
  • headache
  • nausea and vomiting
  • focal findings
38
Q

What does a epidural hematoma require?

A
  • rapid surgical intervention to remove the hematoma and prevent cerebral herniation
  • can improve patient outcomes
39
Q

What is a subdural hematoma?

A
  • 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
40
Q

When do signs develop in an acute subdural hematoma and what are they?

A
  • 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
41
Q

What does ipsilateral mean?

A

Occurring on the same side as the injury

42
Q

After the initial bleeding in subdural hematoma, the hematoma ____ over time?

A

Enlarges

43
Q

When does a chronic subdural hematoma occur?

A

Over weeks or months after a seemingly minor head injury

44
Q

In what age group do chronic subdural hematomas typically occur?

A

Patients in their 50’s and 60’s because of a larger subdural space in their scull

45
Q

A chronic subdural hematoma is often mistaken for ______ or ______ in patient’s in their 50’s and 60’s?

A

Stroke or dementia

46
Q

What is a intracerebral hematoma?

A
  • 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
47
Q

What does the frontal lobe control?

A
  • emotional expression
  • problem solving
  • memory
  • language
  • judgement
48
Q

What doe the temporal lobe control?

A
  • auditory process

- long term memory

49
Q

What diagnostic tests can be used to determine cranial-cerebral trauma?

A
  • 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
50
Q

What are the 3 categories of the Glasgow Coma Scale?

A
  1. eye opening
  2. verbal response
  3. best motor response
51
Q

What are some nursing diagnoses related to head injuries?

A
  • risk for ineffective cerebral tissue perfusion
  • hyperthermia
  • impaired physical mobility
  • anxiety
  • potential complication; increased intracranial pressure
52
Q

What is the highest score on the Glasgow coma scale?

A

15

53
Q

What does a score of <8 mean on the Glasgow coma scale?

A

comatose

54
Q

What does a score of 3 mean on the Glasgow coma scale?

A

Totally unresponsive

55
Q

What is ataxia?

A
  • the presence of abnormal uncoordinated movements

- sign of intracranial pressure

56
Q

What is Cushing’s triad?

A
  • a set of signs indicative of increased intracranial pressure
  • severe hypertension
  • bradycardia
  • decreased respirations
57
Q

What can happen to the eyes if there is too much intracranial pressure?

A
  • 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
58
Q

What should you do if there is fluid in the head?

A

Raise the head of the bed immediately.

59
Q

What are post traumatic seizures?

A
  • occur in 5% of patients after a head injury
  • provide safe environment
  • give anticonvulsants
60
Q

What are traumatic spinal cord injuries?

A
  • result of an external physical impact
61
Q

What are non-traumatic spinal cord injuries?

A
  • result of disease, infection, or tumour
62
Q

How many pairs of spinal nerves are there?

A

31

  • 8 cervical
  • 12 thoracic
  • 5 lumbar
  • 5 sacral
63
Q

What are the 3 membranes that the spinal cord is enclosed by?

A
  • pia matter (inner)
  • arachnoid (middle)
  • dur matter (outer)
64
Q

Compression of the spinal cord can be caused by ______?

A
  • bone displacement
  • interruption of blood supply
  • penetrating injuries (stab or gunshot wound)
65
Q

What is paraplegia?

A
  • loss of sensation and movement to the lower limbs and trunk
66
Q

What is tetraplegia?

A
  • loss of sensation to upper and lower limbs and the trunk

- injuries at c8 or above

67
Q

What is a primary injury?

A
  • when the spinal experiences significant force which leads to the disruption of axons
  • excessive stretching or laceration
68
Q

What is a secondary injury?

A
  • 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
69
Q

Inflammation and edema in the spinal cord for more than ____ hours can cause permanent damage to the cord?

A

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
70
Q

What is spinal shock?

A
  • 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
71
Q

What is neurologic shock?

A
  • 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
72
Q

What are the 3 classifications of spinal cord injuries?

A
  1. mechanism of injury
  2. neurologic level of injury
  3. completeness or degree of injury
73
Q

Why is the flexion/rotation the most unstable mechanism of injury

A

Because of the ligament damage

Nursing Theory (6 decks)

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