Head Injury/Cranial Surgery - Exam 6

Question 1

What are some symptoms of hydrocephalus in children or adults?

Answer 1

1. N/V
2. HA
3. Irritability
4. Behaviorial changes

Question 2

What are some potential complications of VP shunt placement?

Answer 2

1. Infection
2. Neurologic injury
3. Shunt failure

Question 3

What are some components of the neurologic assessment for infants with suspected increased ICP?

Answer 3

1. Fontanels
2. Suture lines
3. Head Circumference
4. High pitched cry

Question 4

What is hydrocephalus?

Answer 4

Imbalance in the production and absorption of CSF in ventricular system

Question 5

What are some signs of acute increased ICP that require immediate intervention?

Answer 5

• Papilledema
• Pupillary change
• LOC
• Lethargy

Question 6

What is a ventriculorperitoneal shunt?

Answer 6

A surgically placed drainage tube from the ventricle in the brain to the peritoneal cavity, allowing for CSF to drain

Question 7

How is hydrocephalus managed?

Answer 7

Management is directed toward the relief of the hydrocephalus, treatment of complications, and management of problems related to the effect of the disorder on psychomotor development/function.

Question 8

What is the treatment for hydrocephalus?

Answer 8

The treatment is routinely surgical which is accomplished by direct removal of an obstruction (tumor) or placement of a shunt that provides drainage of the CSF from the ventricles to an extracranial compartment, usually the peritoneum. The major complications of the shunts are infection and malfunction

Question 9

What should family members of patients with a ventriculoperitoneal shunt be taught to observe for that would indicate that the shunt is not working appropriately?

Answer 9

Evidence of increased ICP such as pupillary dilation, changes in blood pressure

Question 10

What does head injury include?

Answer 10

Any trauma to scalp, skull, or brain

Question 11

What is a traumatic brain injury?

Answer 11

A serious form of head injury

Question 12

What are some of the common causes of traumatic brain injuries?

Answer 12

50% of all TBIs are due to motor vehicle accidents

Other causes include: assaults, sports-related injuries, recreational accidents and war related injuries.

Males are twice as likely to sustain a TBI as females. Up to 22% of patients hospitalized with head injuries die.

Question 13

When do deaths from head trauma occur?

Answer 13

3 time points after injury:

1. Immediately after the injury
2. Within 2 hours after injury
3. Approximately 3 weeks after injury

Early assessment and intervention is critical in the prevention of deaths. 2% of the US population currently live with disabilties resulting from TBI

Question 14

What are scalp lacerations, the signs and symptoms, and nursing interventions?

Answer 14

Skin laceration with profuse bleeding

Stop bleeding. Clean wound. Prevent infection.

Question 15

What is a concussion, signs/symptoms, nursing implications?

Answer 15

Minor head injury

Breif disruption in LOC, possible amnesia of events surrounding, HA

Teach families about post-concussion syndrome

Question 16

What is a contusion, signs/symptoms, nursing implications?

Answer 16

Major head injury.

Bruising of brain. Symptoms depend on location.

Neurologic assessment for focal findings or change in LOC. Seizure precautions.

Question 17

What is skull fracture, signs/symptoms, nursing implications?

Answer 17

1. Two types
   
   1. Simple or linear
   2. Comminuted or compound
2. Battle’s sign (bruising behind ear)
3. Possible focal symptoms
4. Halo sign
5. Ottorrhea - CSF leaking from ears
6. Rhinorrhea - CSF leaking from nose
7. Monitor neurologic status
8. Prevent infection
9. Check drainaage with dextrostix for glucose (if positive = CSF)
10. May need surgical repair

Question 18

What is battle’s sign?

Answer 18

Bruising behind ear. Seen with skull fractures

Question 19

What is otorrhea?

Answer 19

CSF leaking from ears. Seen with skull fractures

Question 20

What is rhinorrhea?

Answer 20

CSF leaking from nose. Seen with skull fractures

Question 21

What is subdural hematoma (SDH), signs/symptoms, nursing implications?

Answer 21

1. Acute - looks like increased ICP
2. Subacute - onset of neuro changes is over days
3. Chronic - symptoms develop slowly, often confused with other diseases
4. Careful serial neurologic assessments
5. Possible surgical evacuation of the hematoma

Question 22

What is an epidural hematoma (EH), signs/symptoms, nursing implications?

Answer 22

1. Unconscious at scene of trauma followed by brief lucid period, then rapid decline in neurologic status as ICP rises
2. Institute measures to decrease ICP
3. A medical emergency
4. Intubation and ventilatory support
5. Measures to decrease ICP
6. Emergency surgery to evacuate hematoma

Question 23

What is intracerebral hemorrhage (ICH), signs/symptoms, nursing implications?

Answer 23

• HA then decreased LOC
• S/S depend on where in the brain bleeding occurs
• Develop symptoms of increased ICP
• Support ABCs as needed
• Measures to decrease ICP
• Measures to maintain CPP

Question 24

What is diffuse axonal injury (DAI), signs/symptoms, nursing implications?

Answer 24

• s/sx of increased or diffuse ICP
• Cerebral edema
• High mortality
• ICU management of ICP and CPP

Question 25

Concussion

Answer 25

1. A sudden, transient head injury that involves disruption of brain activity and change in LOC
2. May result in post-injury syndrome such a post-concussive syndrome
3. Usually involves no structural brain damage (no findings on ct scan)
4. Amnesia for events immediately preceding (anterograde) and following (retrograde) injury is common
5. Nursing monitoring of neurologic status for focal deficits and change in LOC is important

Question 26

Contusion

Answer 26

1. Bruising of brain tissue within a focal area
2. Often involves a coup-contrecoup injury
3. Nursing monitoring of neurologic status for focal deficits and change in LOC is important

Question 27

Diffuse axonal injury (DAI)

Answer 27

1. Widespread disruption of axons and cells throughout the brain
2. Nursing measures to reduce ICP are indicated
3. Nursing monitoring of neurologic status for focal deficits and change in LOC is important
4. Patient develops symptoms of increase intracranial pressure
5. Other signs and symptoms such as retinal hemorrhages or fractures may be seen

Question 28

Epidural hematoma (EH)

Answer 28

1. Source of bleeding is usually arterial
2. Injury may be followed by a lucid period then rapid deterioration of LOC which may require emergency surgical removal
3. Punctate trauma from sports related injury with skull fracture can be risk

Question 29

Intracerebral hemorrhage (ICH)

Answer 29

1. Occurs from bleeding within brain tissue leading to cerebral edema
2. Nursing measures to reduce ICP are indicated
3. Outcomes and management similar to stroke
4. Nursing monitoring or neurologic status for focal deficits and change in LOC is important
5. Patient develops symptoms of increased intracranial pressure

Question 30

Subdural hematoma (SDH)

Answer 30

1. Source of bleeding is usually venous
2. Seemingly minor head injury can cause this in older adults
3. Has three classifications: acute, subacute, chronic
4. Chronic alcoholism is a major risk factor
5. Nursing monitoring of neurologic status for docal deficits and change in LOc is important