L17 Other CNS

Question 1

____ of annual workplace assaults occur in healthcare fields

Answer 1

75%

Question 2

Preventative Actions to Violence

Answer 2

recognize early signs of agitation
1:1 sitter
attending to basic needs
seatbelt alarms
distraction

Question 3

Indication for seclusion or restraint

Answer 3

imminent danger to others
imminent danger to self
profound disruption of tx or damage

Question 4

You must have a ____ to restrain

Answer 4

MD order
documentation and reeval of need

Question 5

Timing of Restraints

Answer 5

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

Question 6

Types of restraints

Answer 6

hand mitts
soft loth limb restraints
enclosed beds
belts and vests

chemical restraints

use the least restrictive method necessary to correct the issue

Question 7

Pathogenesis of Subdural Hematoma

Answer 7

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

Question 8

Mass effect

Answer 8

sufficient accumulation of blood, the pressure increases causing displacement of intracranial structures

Question 9

Risk factors for subdural hematoma

Answer 9

cerebral atrophy
anti-thrombotic medication
infants

Question 10

Cerebral atrophy

Answer 10

makes bridging veins more susceptible to shear injury

common in older adults, chronic alcohol use, previous TBI

Question 11

Infants and subdural hematoma

Answer 11

cannot absorb shock of being shaken due to weak neck muscles

Question 12

Epidural Hematoma

Answer 12

rapidly expanding with arterial blood
can happen with skull fracture

Question 13

Brain herniation

Answer 13

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

Question 14

CP of Acute epidural hematoma

Answer 14

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

Question 15

subdural hematoma CP

Answer 15

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

Question 16

Medical Dx of Hematoma

Answer 16

CT scan without contrast

SDH will have crescent shape and concave hyperdensity

may see displacement of intracranial structures

Question 17

Treatment of Hematoma

Answer 17

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

Question 18

PT and Hematoma

Answer 18

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)

Question 19

Patients with diagnosed SDH and PT

Answer 19

treat identified activity and body/structure impairments

patient education for fall risk reduction and S/S of worsening SDH

Question 20

Patients at risk for SDH and PT

Answer 20

ask about headaches, alertness, changes in balance

take vitals and screen cranial nerves

treat balance to prevent falls

Question 21

Seizure

Answer 21

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

Question 22

Causes of seizures

Answer 22

(over 50%) TBI, stroke, tumors, alcohol withdrawal

fever, infections, epilepsy, diabetes mismanagement, CO poisoning

Question 23

DX of Seizures

Answer 23

Clinical history
Physical Exam
MRI with view of temporal, cortical, subcortical
EEG

Question 24

Focal Onset seizures

Answer 24

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

Question 25

Absence Seizures

Answer 25

formerly called petit mal seizures, brief episodes of staring and unresponsiveness lasting short periods

Question 26

What is the most common seizure type?

Answer 26

typical absence seizures (nonmotor and general onset)

Question 27

Classification of Seizures

Answer 27

Focal --> Aware vs Impaired General --> Motor vs Nonmotor Unknown--> Motor vs Nonmotor

Question 28

Focal Onset Seizures Classification

Answer 28

1. Focal Aware --> with motor or with nonmotor onset 2. Focal Impaired awareness -- with motor or with nonmotor onset

Question 29

General Onset Classification

Answer 29

1. Motor --> Generalized onset tonic clonic or other 2. Nonmotor --> typical absence or other

Question 30

Unknown Onset Classification

Answer 30

1. Motor --> tonic clonic (grand mal) or epileptic 2. Nonmotor --> behavior arrest

Question 31

Generalized Onset seizures

Answer 31

always cause impaired awareness originate in B hemispheres see motor activity bilaterally

Question 32

Aura

Answer 32

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

Question 33

Medial Temporal Aura

Answer 33

strange unpleasant odors feelings of deja vu feelings of extreme fear or panic

Question 34

Post seizure

Answer 34

period of extreme fatigue individuals can experience cognitive or language impairments

Question 35

Post-ical

Answer 35

time period immediately after seizure

Question 36

Medical Tx of Seizures

Answer 36

meds control 70% of seizure cases also involves behavioral mods, like good sleep, avoid stress, decrease alcohol, exercise

Question 37

TBI Seizure Managmenet

Answer 37

Drugs are given for GCS <10. Given for 1 week and then stopped if >1 week, long term management is needed

Question 38

Injury prevention with seizures

Answer 38

loosening clothing placing pillow under head roll pt onto side don't hold down pt don't put anything in their mouth

Question 39

call 911 for seizure if

Answer 39

person has never had seizure before difficulty breathing or waking after lasts longer than 5 minutes has diabetes, heart disease, other conditions

Question 40

Don't leave anyone alone after seizure until

Answer 40

they can answer who, what, when, where they can talk or communicate they are breathing normally you can wake them if they fall asleep

Question 41

People with seizures should not

Answer 41

drive, climb, operate power tools most individuals can resume after being seizure free for 6 mo to 1 year