L4_Head injury_ brain tumor_ 2022 Moodle

Question 1

what is Battle’s sign

Answer 1

postauricular ecchymosis (bruise) or periorbital ecchymosis

Question 2

test for CSF

Answer 2

1. CSF gives a positive reading for glucose by using destrostix
2. Halo sign (CSF on white gauze pad coalesces into the center with a yellow ring encircles the fluid

Question 3

should a NG tube be inserted once basilar skull fracture is suspected?

Answer 3

no since NG will penetrate into brain

Question 4

Nursing care for patient at risk for
Increased ICP (8)

Answer 4

• Monitor vital signs, report for cushing traid .
• Monitor neurologic status closely and compare to baseline to evaluate patient’s response to treatment and enable immediate reporting and modification of treatment if
  necessary.
• Monitor respiratory status: rate, rhythm, depth of respirations; PaO2, PaCO2, because increased PaCO2 is a potent cerebral blood vasodilators that increase cerebral blood flow and may increase ICP.
• Limit suction passes to less than 10 seconds to prevent increased ICP.
• Position with head of bed up 30 degrees or greater to promote cerebral venous outflow,
  reducing ICP.
• Maintain normothermia because elevated temperature increases cerebral metabolism
  and causes increased ICP.
• Give sedation to decrease agitation and hyperactivity that cause increased ICP.
• Decrease stimuli in patient’s environment to prevent increases in ICP.

Question 5

how does increase in PaCO2 affect CBF

Answer 5

Increase in PaCO2, relaxes smooth muscle, dilates cerebral vessels,
decrease cerebrovascular resistance, increase CBF.

Question 6

how does decrease in PaCO2 affects CBF

Answer 6

Decrease in PaCO2, constricts cerebral vessels, increases
cerebrovascular resistance, decreases CBF.

Question 7

how can mannitol helps manage ICP

Answer 7

• Potent diuretic
• Draws fluid from the intracellular and
  interstitial spaces into vascular
  compartment.
• –> hemodilution –> reduces blood
  viscosity –> improves cerebral blood flow
  & O2
• Reduces RBC rigidity & facilitates RBC movement into small vessels.

Question 8

is opioid suitable for mild head injury

Answer 8

no

Question 9

complications of head injury (3)

Answer 9

• Cerebral edema is the most common cause of increased ICP in the patient with a head injury, with the swelling peaking approximately
  48 to 72 hours after injury.
• Intracranial bleeding or hematoma increase the volume of contents within the rigid, closed compartment of the skull

–> causing increased ICP and herniation of the brain stem and resulting in irreversible brain anoxia and brain death.