Midterms_ CARE OF PATIENTS WITH HEAD AND SPINAL CORD INJURIES CARE OF PATIENTS WITH HEAD AND SPINAL CORD INJURIES

Question 1

s any trauma that leads to injury of the scalp, skull, or brain. The injuries can range from a minor bump on the skull to serious brain injury.

Answer 1

Head injury

Question 2

Two Types of Brain Injury

Answer 2

1. Acquired Brain Injury
2. Traumatic Brain Injury

Question 3

injury to the brain that occurs after birth. Many different factors can cause an ABI, including:

Answer 3

ACQUIRED BRAIN INJURY (ABI)

Answer 4

Anoxic injuries (a prolonged lack of oxygen)
- Hypoxia (decreased oxygen flow)
- Epilepsy or other seizure disorders
Strokes
- Cerebral ischemia (restricted blood flow)
- Infections, such as encephalitis or
meningitis
- Neurotoxic events (exposure to toxic
chemicals or drugs)
- Hydrocephalus

Question 5

most common types of ABI is a

Answer 5

traumatic brain injury, or TBI

Question 6

means an acquired injury to the brain caused by external physical force. The injury occurs when a blow to the head or body causes the brain to move rapidly inside the skull. The impact and movement can injure brain cells, nerves and blood vessels.

Answer 6

traumatic brain injury, or TBI

Question 7

Classifications of TBI

Answer 7

1. Epidural Hematoma
   2.Subdural Hematoma
2. Subarachnoid Bleed
   4.Intracerebral Bleed
   5.Shear Injury
3. Edema
4. Skull Fracture

Question 8

bleeding is located between the dura mater and the skull.

Answer 8

Epidural Hematoma

Question 9

located
beneath the dura mater (sub-below), between it and the arachnoid mater

Answer 9

subdural hematoma

Question 10

bleeding occurs in the
space beneath the arachnoid layer where the CSF is located. Often there is intense headache and vomiting with subarachnoid bleeding.

Answer 10

Subarachnoid Bleed

Question 11

bleeding occurs within the
brain tissue itself.

Answer 11

Intracerebral Bleed

Question 12

Sometimes, the damage is due to shear
injury, where there is no obvious bleeding in the brain, but instead the nerve fibers within the brain are stretched and torn.

Answer 12

Shear Injury

Question 13

All injuries to the brain may also cause
swelling or edema, no different than the swelling that surrounds a bruise on an arm or leg.

Answer 13

Edema

Question 14

The bones of the skull are classified as
flat bones, meaning that they do not have an inside marrow. It takes a significant amount of force to break the skull, and the skull does not absorb any of that impact. It is often transmitted directly to the brain.

Answer 14

Skull fracture

Question 15

Skull fractures- Location:

Answer 15

Skull Vault Fractures:

Skull base fractures: serious prognosis

Question 16

Risks/complications: neuroinfection (purulent meningitis, brain abscess), CSF fistula, IC hypotension syndrome (CFS), n. I and n.II. injury, deafness, n.VII. damage

Answer 16

Eyeglasses-like“ hematoma – Processus mastoideus ecchymosis Battle sign –

Question 17

SKULL FRACTURES: DIAGNOSIS

Answer 17

Clinical physical evaluation
- palpation
- local pain, edema, or decline
- Skull X-ray or brain/skull CT (bone window)
- Liquorrhea nasalis (CSF leakage through broken
meninges)
- Otorrhea

Question 18

Ecchymosis over mastoid area

Answer 18

(Battle’s sign) MAIN SYMPTOM

Question 19

S/Sx

PERSISTENT LOCALIZED PAIN

Answer 19

SKULL FRACTURE)

Question 20

S/Sx

TEMPORARY LOSS OF NEUROLOGIC FUNCTION WITH NO STRUCTURAL DAMAGE)

Answer 20

CONCUSSION

Question 21

MODERATE BRAIN INJURY IN WHICH BRAIN IS BRUISED AND DAMAGED IN SPECIFIC AREA)

Answer 21

CONTUSION

Question 22

HEADACHE,DIZZINESS, ANXIETY,IRRITABILITY AND LETHARGY

Answer 22

POST CONCUSSION SYNDROME SYMPTOMS LIK

Question 23

is a condition that refers to bruises around both eyes.
● These bruises look like the dark patches around the eyes that are characteristic of raccoons.
● The pooling of blood around the eyes is most commonly associated with fractures of the base of the anterior cranial fossa

Answer 23

RACCOON SIGN
● Raccoon eyes

Question 24

temporary,usually caused by blow to the head, eg. Falls and sports

Answer 24

CONCUSSION

Question 25

S/Sx of Concussion

Answer 25

headache, loss of memory (amnesia)and confusion. The amnesia usually involves forgetting the event that caused the concussion.

Question 26

Concussions are categorized based on severity:

Answer 26

Grade 1 Grade 2 Grade 3

Question 27

This type involves no loss of consciousness and resolution of any other symptoms within 15 minutes.

Answer 27

Grade 1

Question 28

There’s no loss of consciousness with this type of concussion, but the symptoms last longer than 15 minutes.

Answer 28

Grade 2

Question 29

This type involves loss of consciousness and other symptoms lasting more than 15 minutes.

Answer 29

Grade 3

Question 30

concussion can lead to longer-term or chronic symptoms,a condition called

Answer 30

post-concussive syndrome (PCS).

Question 31

refers to bruising and bleeding in the brain, typically arising in areas where the cerebral cortex of the brain strikes the skull or dura mater, the tough membrane surrounding the brain and spinal cord.

Answer 31

CONTUSION

Question 32

are two other hallmarks not necessarily seen in contusion cases

Answer 32

Nausea and vomiting

Question 33

S/ Sx Contusion

Answer 33

- Lower pulse - High blood pressure - Dilation in one or both pupils - Affected breathing - Tingling in the limbs

Question 34

DIAGNOSIS

Answer 34

❖ PHYSICAL EXAMINATION (GLASCOW COMA SCALE) ❖ NEUROLOGICAL EXAMINATION ❖ CT SCAN,PET ❖ XRAYS

Question 35

COMPLICATIONS

Answer 35

● BRAIN DEATH (IRREVERSIBLE END OF BRAIN ACTIVITY) ● POST TRAUMATIC AMNESIA ● DEMENTIA (LOSS OF BRAIN FUNCTION) ● APHASIA ● TINNITUS ● MENINGITIS ● POST TRAUMATIC SEIZURES ● ATAXIA ● COMA

Question 36

Medications

Answer 36

Mannitol Furosemide Barbiturates Phenytoin

Question 37

NURSING DIAGNOSIS

Answer 37

A. Ineffective airway clearance and impaired gas exchange related to brain injury B. Ineffective cerebral tissue perfusion related to increased icp and decreased CPP C. Deficient fluid volume related to LOC and hormonal dysfunction D. Imbalanced nutrition less than body requirement related to metabolic changes,fluid restriction and inadequate intake E. Risk for injury related to seizures, disorientation or brain damage F. Potential for impaired skin integrity related to bed rest.hemiparesis hemiplegia and immobility G. Potential for disturbed sleep pattern related to brain injury and frequent neurological checks

Question 38

injury damage to any part of the spinal cord or nerves at the end of the spinal canal often causes permanent changes in strength, sensation and other body functions below the site of the injury

Answer 38

spinal cord injury

Question 39

transmits nerve signals from the brain to the rest of the body. It is enclosed and safeguarded by layers of tissue known as the meninges and a column of vertebrae (spinal bones).

Answer 39

spinal cord

Question 40

3 layers of meninges

Answer 40

Dura mater Arachnoid mater Pia mater

Question 41

Most Frequently involved parts of the vertebrae are the_____

Answer 41

- Cervical—C5, C6, and C7 - Thoracic—T12 - Lumbar—L1

Question 42

Most common vertebrae involved are (SCI)

Answer 42

C5, C6, C7, T12, and L1 because they have the greatest ROM

Question 43

Risk factors SCI gender and age

Answer 43

Male age 16-30

Question 44

Emergency signs and symptoms

Answer 44

Extreme back pain or pressure in your neck, head or back Weakness, incoordination or paralysis in any part of your body Numbness, tingling or loss of sensation in your hands, fingers, feet or toes Loss of bladder or bowel control Difficulty with balance and walking Impaired breathing after injury An oddly positioned or twisted neck or back OTHER SYMPTOMS

Question 45

Tetraplegia with total loss of muscular/respiratory function.

Answer 45

C-1 to C-3:

Question 46

Tetraplegia with impairment, reduced pulmonary capacity,complete dependency for ADLs.

Answer 46

C-4 to C-5

Question 47

Tetraplegia with some arm/hand movement allowing some independence in ADLs.

Answer 47

C-6 to C-7:

Question 48

Tetraplegia with limited use of thumb/fingers, increasing independence.

Answer 48

C-7 to T-1

Question 49

Paraplegia with intact arm function and varying function of intercostal and abdominal muscles.

Answer 49

T-2 to L-1

Question 50

Mixed motor-sensory loss; bowel and bladder dysfunction.

Answer 50

L-1 to L-2 or below:

Question 51

SCI 2 Categories

Answer 51

Complete and Incomplete

Question 52

SCI Test and Diagnosis

Answer 52

History Physical examination (inspection, testing for sensory function and movement, and asking some questions about the accident, neurological examination) X Rays Computerized tomography (CT) scan Magnetic resonance imaging (MRI)

Question 53

is a treatment option for an acute spinal cord injury

Answer 53

Methylprednisolone (Medrol)

Question 54

SCI - MEDICAL MANAGEMENT

Answer 54

1. High dose corticosteroids (Methylprednisolone) - Mannitol Dextran 2. Naloxone

Question 55

SURGICAL MANAGEMENT

Answer 55

Diskectomy Laminectomy taminotor Diskectomy with fusion Fixation and Fusion REDUCTION

Question 56

damage above the reflex defecation center in the sacral cord,

Answer 56

Upper Motor Neuron lesion

Question 57

damage within the reflex defecation center

Answer 57

Lower Motor Neuron lesion

Question 58

An over-activity of the autonomic nervous system causing abrupt onset of excessively high blood pressure

Answer 58

HEALTH RISKS - AUTONOMIC DYSREFLEXIA

Question 59

is the presence of bone in soft tissue where one normally does not exist. The acquired form is most frequently seen with either musculoskeletal trauma, spinal cord injury, or central nervous system injury.

Answer 59

HETEROTOPIC OSSIFICATION

Question 60

Damage to spinal column Acute traumatic injuries Overuse Treatment Nsaids Acetaminophen Muscle relaxants Tramadol Narcotics

Answer 60

MUSCULOSKELETAL PAIN

Question 61

Damage to the central nervous system Compression neuropathies Segmental pain Treatment - Anti Seizure medications Antidepressants - Therapy PT/OT, cold, heat, massage Modalities - TENS, acupuncture Adaptive equipment

Answer 61

NEUROPATHIC PAIN

Question 62

Steroidal injections, blocks, biofeedback Relaxation, hypnotism, vibration, Surgery - if compression neuropathies are unresponsive to conservative measures, surgery may be necessary

Answer 62

NEUROPATHIC PAIN CONTRAINDICATION

Question 63

Poorly localized and defined Treatment Above the level of injury nociceptive pain due to visceral injury or inflammation-treatment is identifying the cause and then treating the injury or inflammation. Below the level of injury may be nociceptive or neuropathic celiac plexus block can be diagnostic if

Answer 63

VISCERAL PAIN