L17 Other CNS Flashcards
____ of annual workplace assaults occur in healthcare fields
75%
Preventative Actions to Violence
recognize early signs of agitation
1:1 sitter
attending to basic needs
seatbelt alarms
distraction
Indication for seclusion or restraint
imminent danger to others
imminent danger to self
profound disruption of tx or damage
You must have a ____ to restrain
MD order
documentation and reeval of need
Timing of Restraints
no longer than 4 hours for adults
no longer than 2 hours for 9-17 yo
no longer than 1 hour for <9 yo
pts should be monitored once and hour and moved at regular intervals
Types of restraints
hand mitts
soft loth limb restraints
enclosed beds
belts and vests
chemical restraints
use the least restrictive method necessary to correct the issue
Pathogenesis of Subdural Hematoma
trauma, fall, blow to head can result in tear of bridging veins
these veins pass through subdural potential space, if torn will cause venous blood to accumulate in space
blood accumulation happens slowly over time
sufficient accumulation of blood causes pressure increase
Mass effect
sufficient accumulation of blood, the pressure increases causing displacement of intracranial structures
Risk factors for subdural hematoma
cerebral atrophy
anti-thrombotic medication
infants
Cerebral atrophy
makes bridging veins more susceptible to shear injury
common in older adults, chronic alcohol use, previous TBI
Infants and subdural hematoma
cannot absorb shock of being shaken due to weak neck muscles
Epidural Hematoma
rapidly expanding with arterial blood
can happen with skull fracture
Brain herniation
occurs when mass effect is severe enough to push intracranial structures from one compartment to another
this can occur due to hematoma, intracranial tumor, edema in brain
CP of Acute epidural hematoma
high velocity impact
associated with other injuries
minutes to hours for symptom onset
symptoms of increased pressure
explosive headache, altered mental status, cranial nerve palsies, nausea, change to vital signs, coma
subdural hematoma CP
minimal to low force trauma
over several days to weeks after trauma event
headache, cognitive impairment, decreased alterness, worsening balance, then signs of increased intracranial pressure
Medical Dx of Hematoma
CT scan without contrast
SDH will have crescent shape and concave hyperdensity
may see displacement of intracranial structures
Treatment of Hematoma
watch and wait for chronic or small SDH
surgical intervention by craniotomy if S/S of increased intracranial pressure
burr hole –helps relieve pressure on brain
PT and Hematoma
same PT exam as pt with other cortex pathology
monitor high risk patients (older adults who have fallen, patients on antithrombotic meds who fell, infants)
Patients with diagnosed SDH and PT
treat identified activity and body/structure impairments
patient education for fall risk reduction and S/S of worsening SDH
Patients at risk for SDH and PT
ask about headaches, alertness, changes in balance
take vitals and screen cranial nerves
treat balance to prevent falls
Seizure
abnormal, unregulated electrical discharge that occurs within the brain’s cortical gray matter and interrupts normal brain function
believed to occur b/c of disruption to normal balance of excitation and inhibition of neurons in cortex
Causes of seizures
(over 50%) TBI, stroke, tumors, alcohol withdrawal
fever, infections, epilepsy, diabetes mismanagement, CO poisoning
DX of Seizures
Clinical history
Physical Exam
MRI with view of temporal, cortical, subcortical
EEG
Focal Onset seizures
originate in networks in one hemisphere
may originate in subcortical structures
may be localized but can spread to other areas and evolve into general onset seizures
Absence Seizures
formerly called petit mal seizures, brief episodes of staring and unresponsiveness lasting short periods
What is the most common seizure type?
typical absence seizures
(nonmotor and general onset)
Classification of Seizures
Focal –> Aware vs Impaired
General –> Motor vs Nonmotor
Unknown–> Motor vs Nonmotor
Focal Onset Seizures Classification
- Focal Aware –> with motor or with nonmotor onset
- Focal Impaired awareness – with motor or with nonmotor onset
General Onset Classification
- Motor –> Generalized onset tonic clonic or other
- Nonmotor –> typical absence or other
Unknown Onset Classification
- Motor –> tonic clonic (grand mal) or epileptic
- Nonmotor –> behavior arrest
Generalized Onset seizures
always cause impaired awareness
originate in B hemispheres
see motor activity bilaterally
Aura
can occur in isolation or be an indicator that the individual may be about to experience a large seizure
the specific sensation is tied to the location of seizure
Medial Temporal Aura
strange unpleasant odors
feelings of deja vu
feelings of extreme fear or panic
Post seizure
period of extreme fatigue
individuals can experience cognitive or language impairments
Post-ical
time period immediately after seizure
Medical Tx of Seizures
meds control 70% of seizure cases
also involves behavioral mods, like good sleep, avoid stress, decrease alcohol, exercise
TBI Seizure Managmenet
Drugs are given for GCS <10. Given for 1 week and then stopped
if >1 week, long term management is needed
Injury prevention with seizures
loosening clothing
placing pillow under head
roll pt onto side
don’t hold down pt
don’t put anything in their mouth
call 911 for seizure if
person has never had seizure before
difficulty breathing or waking after
lasts longer than 5 minutes
has diabetes, heart disease, other conditions
Don’t leave anyone alone after seizure until
they can answer who, what, when, where
they can talk or communicate
they are breathing normally
you can wake them if they fall asleep
People with seizures should not
drive, climb, operate power tools
most individuals can resume after being seizure free for 6 mo to 1 year
