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2.0 Adult Nursing Exam 3 > Neuro Trauma > Flashcards

Neuro Trauma Flashcards

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1
Q

What are they two categories of brain injuries

A

Primary
Secondary

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2
Q

Define Primary injury

A

Primary injury occurs at the time of the trauma

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3
Q

Define Secondary injury

A

The indirect additional complications that occur later on that plays a large role in brain damage and death

  • hours or even days later
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4
Q

Primary injury examples (5)

A

Contusion

Epidural Hematoma

Subdural Hematoma

Traumatic Subarachnoid Hemorrhage

Diffuse Axonal Injury

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5
Q

Define Diffuse Axonal Injury

A

Brain rapidly shifts inside the skull and causes shearing of axons

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6
Q

What state are those with Diffuse Axonal Injury left in typically?

A

Coma

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7
Q

Doctor recommends to do a CT and MRI for diffuse axonal injury. What do you know about this and what does that mean for the nruse?

A

Diffuse axonal injury is hard to detect on MRI and CT - which means nurse assessment has to be really good.

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8
Q

Symptoms of diffuse axonal injury?

A

Coma

Confusion

N/V

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9
Q

T/F

Secondary brain injury is not preventable

A

False. We can prevent this

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10
Q

What is the focus of care when it comes to minimizing secondary injury?

A

Increasing oxygen blood to brain

Decreasing metabolic demands

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11
Q

Why do we want to prevent hypoxemia in a patient who has a primary head injury?

A

If there isn’t enough oxygen in the blood, it increases chance of secondary head injury.

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12
Q

Why avoid hypotension to avoid a secondary brain injury?

A

We don’t want there to be hypotension because that can affect how well we perfuse the brain and thus cause the secondary injury.

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13
Q

Why do we need to focus on the blood sugar needs after a patient has a primary head injury?

A

Focus on controlling blood sugar to avoid a secondary head injury

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14
Q

What is meant “respond to loss of auto regulatory mechanisms” if a patient has a primary head injury?

A

Sometimes people’s compensation skills don’t work, and so it is our job to use medications like pressors, diuretics, hypertonics, etc to try to manipulate it

  • loss of compensation like temp, BP, Hr changes
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15
Q

Why do we want to avoid increased ICP after having a primary brain injury?

A

Increased ICP can cause a secondary injury to occur

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16
Q

Why do we want to control the Co2 levels after a patient has a primary head injury?

A

The CO2 dictates the constriction/dilation of the vessels and can cause a secondary head injury if not monitored.

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17
Q

What is the most important indicator of neuro severity and how do we assess it?

A

LOC changes - which we assess for with the Glasgow Coma Scale

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18
Q

Mild Traumatic Brain Injury GCS score

A

13-15 = mild

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19
Q

Moderate Traumatic Brain Injury GCS score

A

9-12 = moderate

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20
Q

Severe Traumatic Brain Injury GCS score

A

Less than 8

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21
Q

What is the nature of deficits for a mild TBI?

A

Functional deficits that lasts weeks or months but usually come back

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22
Q

Diagnostic testing for Hematomas

A

Blood pooling bruise. CT

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23
Q

Diagnostic testing for Hemorrhage/Bleeding

A

CT

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24
Q

Diagnostic testing for fractures

A

CT

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25
Q

Diagnostic testing for cerebral edema

A

CT

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26
Q

Diagnostic testing for severe diffuse axonal injury

A

MRI - but only if the DAI is severe. A lot of times they don’t show up.

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27
Q

Diagnostic testing for brain stem injury and hernation

A

MRI

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28
Q

Diagnostic testing for aneurysm

A

MRI - due to the vessel bulging

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29
Q

What is the danger of an aneurysm?

A

As the bulge grows, it can hemorrhage and then you have a stroke on your hands.

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30
Q

What other injuries do we use diagnostic testing for that can be related to the cause of the TBI?

A

Other bone fractures. Or really anything.

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31
Q

What nursing care will you provide to a patient with a TBI that address respiratory needs?

A

Airway Management

Oxygenation

Ventilation

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32
Q

Explain why you will be managing the patients airway for a TBI

A

Brain injuries can affect the patients ability to maintain their own airway - so again, we want to avoid secondary injury.

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33
Q

Why would you be giving a patient oxygen for a TBI?

A

The TBI may affect their ability to oxygenate themselves but also, the brain needs oxygen to avoid a secondary injury.

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34
Q

Why might a patient with a TBI be on a vent?

A

The TBI can affect someone’s ability to oxygenate themselves and it could be so bad that they need the vent to breathe but also avoid secondary injury.

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35
Q

What nursing care will you provide to a TBI patient that addresses the needs of the brain related to volume?

A

Manage fluids

Manage ICP

Support cerebral perfusion

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36
Q

TBI patient asks why they need to be on fluids. What do you tell them?

A

The fluids can be contributing to either their perfusion or it can be taking volume off.

  • depends on what the brain needs atm
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37
Q

Why do you do ICP management on a TBI patient?

A

Increased ICP can contribute to injury and even death.

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38
Q

Why do we manage the cerebral perfusion?

A

Manage cerebral perfusion because it is what keeps the brain oxygenated and full of blood.

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39
Q

What med can support CPP?

A

Dopamine etc / pressors

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40
Q

Why will we want to prevent an increase in oxygen demand in an ICP patient?

A

Prevent the need for more oxygen because the brain is already working hard to keep itself oxygenated after a TBI

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41
Q

How can we prevent increased cerebral oxygen demand?

A

Sedation meds

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42
Q

What is a secondary complication that can come with any head injury - primary or secondary - related to care?

A

Pneumonia, PE, DVT, skin integrity

  • just because they will be immobile
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43
Q

How do check for the pneumonia & PE?

A

Anticoagulation

Lung sound assessments

  • especially if they’re sedated. Diminished lung sounds are bad
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44
Q

How often do we turn patients?

A

q2hrs

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45
Q

Why do we have to educate the family and be there for them with a TBI?

A

Brain injuries are often acute because of an accident

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46
Q

Linear fracture

A

Generally not displaced. More like a hairline fx that heals on its own

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47
Q

Depressed fracture

A

Inward depression of the bone which needs surgical removal

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48
Q

Basilar fracture

Symptom?

A

Back Base of the skull is involved.

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49
Q

Kiddo who hit the back of their head is complaining of runny nose and ears. What could this mean?

A

Basilar fracture - the runny nose and ears is cerebral spinal fluid from a dural tear.

50
Q

If a kid is having CSF coming out of their nose and ear, what do you need to do?

A

Call the doctor so you can get a pH test for glucose

51
Q

Little kid has bruising behind the ears. What is this and what do you need to be aware of?

A

Battles sign related to basilar fracture.

Caused by shaken baby syndrome.

52
Q

Most common causes of Spinal Cord Injury?

A

Motor vehicle accidents (MVA)

Falls

Acts of violence

Sports-related injuries

53
Q

Which gender has mores spinal cord injuries?

A

80% are males due to reckless behaviors

54
Q

Who is the major population that gets spinal injuries from falls?

A

23% elderly

55
Q

What is meant by acts of violence causing spinal cord injury?

A

Domestic abuse towards females

56
Q

What mechanisms of injury are there for spinal cord injuries?

A

Hyperflexion

Hyperextension

Axial loading/compression

Rotation

Penetrating trauma

57
Q

What causes the hyperflexion and hyperextension of a spinal cord injury?

A

Whiplash - it compresses the spine and causes bruises

58
Q

What mechanism of injury causes axial loading?

A

Diving action

59
Q

What action causes rotation related to the spinal cord injury?

A

From rolling

60
Q

What causes the penetration spinal cord injury?

A

Knife or gunshot wound

61
Q

What happens to the synapse if the spinal cord is pushed, bruised, or compressed from edema?

A

Whatever the case - it blocks the synapse from traveling and you have paralysis.

62
Q

Concussion effects

A

Temporary loss of function

63
Q

Symptoms of Concussion

A

Headache

Vomiting

Decrease LOC

Sensitive to light and sound

  • common in athletes; guardian cap
64
Q

Contusion Effecgts

A

Bruising and bleeding goes into spinal cord causing edema and possible neuronal death

65
Q

Laceration effects

A

The tear in the cord causes a permanent injury

66
Q

What are lacerations caused by?

What do laceration injuries usually involve in addition?

A

Stabbing wound

Can involve contusion, edema, & compression

67
Q

Transection effects

A

Severing of whole cord w complete loss function below the injury

68
Q

Explain how hemorrhage and blood vessel damage can occur with a spinal cord injury and its effects

A

Any injury can cause internal bleeding. Both issues involve bleeding/rupture which can create volume issues.

69
Q

What is the secondary injury caused by in a spinal cord injury?

A

Vascular damage from the initial injury which decreases blood flow

70
Q

Due to a decrease in blood flow often associated with cell and vascular damage with spinal cord injuries , what happens? (2)

A

Metabolic function changes

Cell membrane destruction therefore synapse not functioning

71
Q

What symptoms do you see for a secondary injury to the spinal cord?

A

Respiratory changes

Headaches

72
Q

What happens in the Neurogenic shock?

A

Spinal injury of some sort causes complete loss of autonomic nervous system; parasympathetic and sympathetic

73
Q

What is the blood pressure and HR you see with Neurogenic shock?

How do we treat?

A

Hypotension + Bradycardia

Try fluid challenge

Use pressors; levophed

74
Q

What measurements do we use to assess the Neurogenic shock?

A

CVP

MAP

CPP

75
Q

What to assess with a spinal injury

A

Airway & Breathing

Circulation

Motor and sensory function q4hrs

76
Q

When assessing someone with a spinal cord injury, what do you do position wise?

A

Immobilize spine with C spinal collar

77
Q

Why is baseline assessment so important?

A

You need to be able to compare your findings.

78
Q

What are the main 3 issues that cause decreased functioning related to the spinal cord injury?

A

Edema

Loss of vertebral alignment

Intrathecal hematoma

79
Q

What is spinal shock?

A

Acute injury where there is temporary suppression of the reflexes

80
Q

Is spinal shock caused by something that is repairable or permanent?

A

Repairable

81
Q

What needs to be evaluated in spinal shock?

A

Degree of injury so keep your assessment up

82
Q

Define Complete Spinal Cord injury

A

Total loss of sensory and motor functions caused by a complete interruption

83
Q

Define Incomplete Spinal Cord Injury

A

Varying degree of sensory and motor function disruption due to some tracts being intact

84
Q

Which types of spinal cord injuries are the most common ? (2)

A

Cervical

Lumbar

85
Q

What level of spinal cord injury affects respiratory function?

A

The higher up the insult, the more likely respiratory is involved.

86
Q

What diagnositic tests are there for spinal cord injuries?

A

Xray

CT
MRI

87
Q

What does a CT diagnostic test exam for in relation to spinal cord injury?

A

Bone injury and cord compression

88
Q

What does MRI diagnostic test exam for in relation to a spinal cord injury?

A

Soft tissue involvement

  • can identify ligamentous injury without bone abnormality
89
Q

What steps do we take to manage a spinal cord injury and avoid the secondary injury?

A

Immobilize them

Manage the airway

Add on Respiratory management

Hemodynamic support

Neuroprotection

90
Q

How do we immobilize the patient for an SCI?

A

Hard cervical collar

Bed rest

Log roll

91
Q

How do maintain the airway management if we intubate them for a SCI?

A

Keep them immobilized

Tracheostomy (hole in neck) for severe injuries

92
Q

What happens to patients who have impaired diaphragmatic innervation?

What are concerned about?

A

C2 - decreased cough strength and inability to clear secretions

Aspiration risk

93
Q

Main goal of management for an SCI?

A

Prevent secondary injury

94
Q

How do we provide hemodynamic support for an SCI?

A

Maintain adequate oxygenation and ventilation

Adequate fluids

Rule out any other injuries that could lead to hemodynamic shock!

Neurogenic shock can cause bradycardia and hypotension

95
Q

What do we use for neuroprotection for an SCI?

A

Methylprednisone (steroid) administration for anti inflammatory action

96
Q

An SCI can lead to neurogenic shock. What does this mean for the hemodynamics?

A

We need to treat the hypotension and bradycardia that comes with it

97
Q

How do we treat the hemodynamic instability that can come from a SCI?

A

Adequate oxygenation - vent

Rule out any other injuries that can cause hemodynamic shock

Give adequate fluids

98
Q

What is one way we can supply the brain with glucose tho?

A

Steroids technically since they raise BG

  • point is, there is a balance
99
Q

What meds do we give in addition to the high dose steroids for the SCI neuroprotection?

A

Protonix, Prilosec for the GI ulcers

Blood glucose monitoring for the skyrocketing BS

100
Q

Neurogenic shocks unique presentation includes?

A

Instant hypotension with bradycardia

Warm flushed skin

101
Q

Your patient with neurogenic shock has the injury below the 5th cervical vertebrae. What symptoms will be illicited?

A

Diaphragmatic breathing - due to the loss of control over the intercostal muscles.

102
Q

Neurogenic shock patient has their injury above the 3rd cervical vertebrae. What are the symptoms associated with it?

A

Patient will go into respiratory arrest immediately from loss of control of diaphragm

103
Q

What meds will we use for neurogenic shock?

A

Dopamine

Vasopressin

Levophed

Atropine

Phenylephrine

(trying to drive the pressure)

104
Q

First line treatment for neurogenic SCI patient?

A

Phenylephrine

  • definitely for those who don’t respond to dopamine
105
Q

What bladder and bowel management do you anticipate for a patient with neurogenic shock rt SCI?

And why?

A

Foley insertion hourly output

We want to monitor their output because of the hypotension in neurogenic shock leading need to monitor for the acute renal failure.

106
Q

Patient with history of neurogenic shock , what do we need to monitor if they make it to the point they void on their own?

A

Monitor for residuals. May have to straight cath them.

107
Q

What do you anticipate for a neurogenic shock rt SCI patient who is not able to stool?

A

Stool softener

Digital stimulation

108
Q

Stool softener meds

A

Colace

Miralax

109
Q

What meds can often cause the constipation??

A

Pain meds

  • gabapentin , opiods
110
Q

What pain meds do you anticipate for neurogenic shock patient rt to SCI?

A

Opiates

Muscle relaxants

111
Q

What meds can we use to treat the neuropathic pain from neurogenic shock rt SCI?

A

Antidepressants and anticonvulsants

  • gabapentin
112
Q

Explain the difference between Autonomic Dysreflexia and Neurogenic shock

A

Neurogenic shock is caused by loss of control of the sympathetic and parasympathetic with a SCI - hypotension. .

Autonomic Dysreflexia is due to an insult at or above T6 and is caused by over-distention or other reasons - hypertension.

113
Q

Autonomic Dysreflexia over-distention examples

A

Distended bladder

Full rectum

Infection

Pressure sores

114
Q

Cause examples of Autonomic Dysreflexia

A

Distended bladder

Full rectum

Infection

Pressure sores

115
Q

What BP do you expect for Autonomic Dysreflexia?

A

Hypertension

116
Q

What does Autonomic Dysreflexia often preciptate/lead to?

When does it usually occur?

A

Precipitates Seizure & Stroke

  • put on anticonvulsants

Can actually occur anytime after spinal shock resolves but usually within the first year

117
Q

What position do you move Autonomic Dysreflexia patient

A

Put them in a sitting position to decrease pressure

118
Q

What to vitals monitor in Autonomic Dysreflexia patient?

What medication would you use?

A

BP

Pulse

3-4x a day

119
Q

How is Autonomic Dysreflexia treated?

A

Key is to treat the underlying cause

  • bladder distention, full rectum, infection, pressure sores, pain
120
Q

How to best prevent the Autonomic Dysreflexia

A

Pay careful attention to bladder and bowel - to avoid the distention

Be consistent on turning the patient - to avoid sores

Watch labs and temp - to monitor for infection

121
Q

Since the there is hypertension with Autonomic Dysreflexia, what meds do you anticipate?

A

Antihypertensives

  • beta blockers
  • CCB

2.0 Adult Nursing Exam 3 (8 decks)

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