Head & Spinal Cord Injuries

Question 1

Risk factors: TBI

Answer 1

• Men (higher than women)
• Children up to 4
• Adolescents (15-19)
• Older adults (65+)

Question 2

TBI Prevention

Answer 2

• Fall risk precautions
• Drive safely
• Wear helmets

Question 3

Risk factors: SCI

Answer 3

• Men
• Younger age
• Alcohol & drug abuse
• 43 average age

Question 4

SCI Prevention

Answer 4

• Immobilize on backboard
• Cervical immobilization
• Skeletal fracture reduction & traction
• Diaphragmatic pacing
• Surgery
• Oxygen & cardiovascular support

Question 5

Nursing Management for TBI patients

Answer 5

• Monitor I&O, F&E, daily weights, blood glucose
• Adequate nutrition
• Maintain body temp (tylenol, blankets)
• Education

Preventing injury:
- Assess constriction from dressing, oxygenation & UOP
- Pad side rails (seizures)
- Mittens (prevent self-injury)
- Reduce environmental stimuli, minimize sleep disruption, adequate lighting
- Skin care, prevent infection

Question 6

Subdural Hematoma Treatment

Answer 6

Acute: immediate craniotomy
Chronic: burr holes (small) or craniotomy (large) after surgical evaluation

Question 7

Why is the geriatric population at higher risk for cranial bleeds?

Answer 7

• Higher mortality rate
• Poor functional outcomes
• More fractures
• Increased risk of falls & MVAs
• Higher risk of bleeding

Question 8

Signs of Basilar Skull Fracture

Answer 8

• Battle’s sign: ecchymosis behind ear
• Halo’s sign (Target): ring of fluid around blood stain; CSF leak

Question 9

Nursing management for a patient with or at risk for increased ICP

Answer 9

• Maintain patent airway, monitor resp status & lung sounds
• Position head neutrally (no twisting)
• Elevate HOB (promote venous drainage)
• Avoid valsalva maneuver, hip flexion, abd distention (increases ICP)
• Calm, quiet atmosphere, reduce stimuli
• Monitor I&O
• Strict aseptic technique

Question 10

Seizure Precautions to Stop Seizures

Answer 10

• Oxygen & suction available
• Padded side rails
• Loosened clothing
• Pillow under head
• Side-lying position post seizure
• Bed low, side rails up, privacy provided

Question 11

Medications to Stop Seizures

Answer 11

• Gabapentin, Phenytoin
• Barbiturates (-barbital)
• Benzodiazepines (-lam, -pam)
• Sulfonamides
• Valproic acid, mag sulfate, -pine

Question 12

Immediate management for a SCI & emergency meds administered

Answer 12

• Immobilization, extrication (removal), stabilization then trauma center
• Backboard with cervical immobilization
• IV corticosteroids (Methylprednisolone sodium succinate) first 24-48 hrs

Question 13

What is autonomic dysreflexia? S/Sx? Triggers?

Answer 13

• Acute emergency after spinal shock has resolved
• Exaggerated autonomic nervous system responses

S/Sx:
- Severe, pounding headache
- Sudden increase in BP can lead to: retinal hemorrhage, hemorrhagic stroke, MI, seizures
- Diaphoresis
- Nausea, nasal congestion, goosebumps, bradycardia

Triggers:
- Distended bladder (most common cause)
- Distention or contraction of visceral organs (constipation)
- Skin stimulation (pressure injury, pain, heat/cold)

Question 14

Care for Patients with Halo Traction

Answer 14

• Cervical immobilization
• Safe techniques with self-care, hygiene & ambulation
• Traction pin care
• Skin care (no irritated, red areas, breakdown)
• Monitor for infection, complications
• Pain management

Question 15

Long-term Rehab Needs for SCI Patient

Answer 15

• Increasing mobility through exercise
• Skin care (reduce pressure)
• Improve bladder & bowel control
• Addressing sexual needs
• Coping mechanisms

Question 16

Common complications for SCI patients

Answer 16

• Sepsis
• DVT
• Orthostatic hypotension
• Autonomic dysreflexia
• Skin breakdown

Question 17

Medications that Reduce Muscle Spasticity

Answer 17

• Baclofen
• Dantrolene
• Carisoprodol
• Cyclobenzaprine HCl
• Tizanidine HCl