neuro pt. 2 (TBI/concussion/hematoma) Flashcards
what stage of TBI is when injury occurs related to the direct force at the time of event
primary
what stage of TBI are problems resulting from the initial wound
secondary
examples of secondary complications of TBI
biochemical changes
inadequate perfusion
hypoxia
what should be assessed with all head injuries?
C spine
describe glasgow coma scale as the patient improves
score goes up
what is response from the initial injury that can worsen the trauma?
secondary injury
what are common causes if secondary injury?
ischemia
hypercapnia
cerebral edema
sustained HTN
how are secondary injuries harmful after TBI
they inc. ICP
what is done to prevent effects of secondary injry in TBI
all things to dec. ICP!
-calm, quiet, neutral position, no clustering, maintain o2, dec. CO2, no trendelenberg, no valsalva, minimal stimulation, visitor restriction
is a skull fracture a TBI?
yes
what kind of skull fracture is an open wound
compound
what kind of skull fracture is a closed wound or where edges don’t meet
dispalced
what kind of skull fracture is a crack
linear
what kind of skull fracture is when depressed bone fragments are pushed into brain tissue
compressed/depressed
which skull fracture typically needs surgical repair and has high risk of infection
compression/depression
what fractures occur at the base o fore of skull
basilar skull fracture
what kind of skull fracture is a basilar skull fracture? (2 options)
linear or displaced
what is important to assess in basilar skull fracture?
extraocular movements from impingement of cranial nerves
what is important to avoid with basilar skull fractures
nasogastric or nasotrachial suctioning
-it increases the chance of tube passing the fracture and going to the brain
what does CSF drainage fromt he ear or nose from a basilar skull fracture indicate?
damage to dura
what does otorrhea (CSF drainage from ear) indicate in basilar skull fracture
fracture in middle fossa
what is a delayed finding of basilar skull fracture
ecchymosis (bruising) behind ear - Battle’s sign
what is battle’s sign
bruising behind ear - late sign of basialr skull fracture
what does rhinorrhea (CSF drainage from nose) indicate in basilar skull fracture?
fracture in anterior fossa
what is a late finding of basilar skull fracture
raccoon eyes (bruising around etes)
what is a layering of yellow fluid when blood is wiped with gauze?
halo sign - indicative of csf
what is an effective test for csf but takes time
test fluid for beta-2 transferrin
treatment of basilar skull fracture
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
any alteration in mental status resulting from trauma
concussion
concussion management
rest the brain! (no stimulants, no screens, no physical activity, no schoolwork)
what is post concussion syndrome
lasting effects 6 mo. to 5 yrs after initial injury
bruising of brain
contusion
complications of contusion
expansion of herneation
cerebral edema
collection of blood between dura and inside of skull
epidural hematoma
what hematoma is caused by laceration of middle of meningela artery
epidural hematoma
what hematoma results from low impact injuries (falls) or high impact (MVC)
epidural hematoma
which condition has manifestations of
-temporal skull fx
-rapid dec. LOC (talk and die)
-uncal herniation
epidural heamtoma
treatment of epidural hematoma
surgical emergency
-burr holes to evacuate clot
what hematoma is accumulation of venous blood bleow the dura and above the arachnoid layer
subdural hematoma
which populatations have higher incidence of subdural hematomas?
elderly and ETOH abusers
-higher fall risks
-cortical atrophy increases tension on veins
describe the lengths of acute, subacute, and chronic categories of subdural heamtoms
acute = 1-2 days
subacute = 2 days - 2 weeks
chronic = > 2 weeks
what symptoms do subdural hematomas cause (when blood accumulates over time)
headache
lethargy
confusion
seizure
surgical intervention of subdural hematoma
burr holes & drain
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
1) tight gauze