neuro pt. 2 (TBI/concussion/hematoma)

Question 1

what stage of TBI is when injury occurs related to the direct force at the time of event

Answer 1

primary

Question 2

what stage of TBI are problems resulting from the initial wound

Answer 2

secondary

Question 3

examples of secondary complications of TBI

Answer 3

biochemical changes
inadequate perfusion
hypoxia

Question 4

what should be assessed with all head injuries?

Answer 4

C spine

Question 5

describe glasgow coma scale as the patient improves

Answer 5

score goes up

Question 6

what is response from the initial injury that can worsen the trauma?

Answer 6

secondary injury

Question 7

what are common causes if secondary injury?

Answer 7

ischemia
hypercapnia
cerebral edema
sustained HTN

Question 8

how are secondary injuries harmful after TBI

Answer 8

they inc. ICP

Question 9

what is done to prevent effects of secondary injry in TBI

Answer 9

all things to dec. ICP!
-calm, quiet, neutral position, no clustering, maintain o2, dec. CO2, no trendelenberg, no valsalva, minimal stimulation, visitor restriction

Question 10

is a skull fracture a TBI?

Answer 10

yes

Question 11

what kind of skull fracture is an open wound

Answer 11

compound

Question 12

what kind of skull fracture is a closed wound or where edges don’t meet

Answer 12

dispalced

Question 13

what kind of skull fracture is a crack

Answer 13

linear

Question 14

what kind of skull fracture is when depressed bone fragments are pushed into brain tissue

Answer 14

compressed/depressed

Question 15

which skull fracture typically needs surgical repair and has high risk of infection

Answer 15

compression/depression

Question 16

what fractures occur at the base o fore of skull

Answer 16

basilar skull fracture

Question 17

what kind of skull fracture is a basilar skull fracture? (2 options)

Answer 17

linear or displaced

Question 18

what is important to assess in basilar skull fracture?

Answer 18

extraocular movements from impingement of cranial nerves

Question 19

what is important to avoid with basilar skull fractures

Answer 19

nasogastric or nasotrachial suctioning
-it increases the chance of tube passing the fracture and going to the brain

Question 20

what does CSF drainage fromt he ear or nose from a basilar skull fracture indicate?

Answer 20

damage to dura

Question 21

what does otorrhea (CSF drainage from ear) indicate in basilar skull fracture

Answer 21

fracture in middle fossa

Question 22

what is a delayed finding of basilar skull fracture

Answer 22

ecchymosis (bruising) behind ear - Battle’s sign

Question 23

what is battle’s sign

Answer 23

bruising behind ear - late sign of basialr skull fracture

Question 24

what does rhinorrhea (CSF drainage from nose) indicate in basilar skull fracture?

Answer 24

fracture in anterior fossa

Question 25

what is a late finding of basilar skull fracture

Answer 25

raccoon eyes (bruising around etes)

Question 26

what is a layering of yellow fluid when blood is wiped with gauze?

Answer 26

halo sign - indicative of csf

Question 27

what is an effective test for csf but takes time

Answer 27

test fluid for beta-2 transferrin

Question 28

treatment of basilar skull fracture

Answer 28

csf leaks heal spontaneously 20% need surgery loose gauze draped to ear or nose to quantify amount and character of fluid (DO NOT OCCLUDE) neuro/cranial nerve assessment

Question 29

any alteration in mental status resulting from trauma

Answer 29

concussion

Question 30

concussion management

Answer 30

rest the brain! (no stimulants, no screens, no physical activity, no schoolwork)

Question 31

what is post concussion syndrome

Answer 31

lasting effects 6 mo. to 5 yrs after initial injury

Question 32

bruising of brain

Answer 32

contusion

Question 33

complications of contusion

Answer 33

expansion of herneation cerebral edema

Question 34

collection of blood between dura and inside of skull

Answer 34

epidural hematoma

Question 35

what hematoma is caused by laceration of middle of meningela artery

Answer 35

epidural hematoma

Question 36

what hematoma results from low impact injuries (falls) or high impact (MVC)

Answer 36

epidural hematoma

Question 37

which condition has manifestations of -temporal skull fx -rapid dec. LOC (talk and die) -uncal herniation

Answer 37

epidural heamtoma

Question 38

treatment of epidural hematoma

Answer 38

surgical emergency -burr holes to evacuate clot

Question 39

what hematoma is accumulation of *venous blood* bleow the dura and above the arachnoid layer

Answer 39

subdural hematoma

Question 40

which populatations have higher incidence of subdural hematomas?

Answer 40

elderly and ETOH abusers -higher fall risks -cortical atrophy increases tension on veins

Question 41

describe the lengths of acute, subacute, and chronic categories of subdural heamtoms

Answer 41

acute = 1-2 days subacute = 2 days - 2 weeks chronic = > 2 weeks

Question 42

what symptoms do subdural hematomas cause (when blood accumulates over time)

Answer 42

headache lethargy confusion seizure

Question 43

surgical intervention of subdural hematoma

Answer 43

burr holes & drain

Question 44

nurse cares for absilar skull fx pt. which is not an appropriate intervention? 1) tight gauze in nose 2) neuro assessment q1h 3) promote incentive spirometer 4) instruct to not blow nose

Answer 44

1) tight gauze