Neuro Trauma Flashcards

Question

epidural hematoma

Answer 1

Immediate LOC Skull fx  Rupture or laceration of middle meningeal artery = huge amount of bleeding = Emergency!!! ICP rapidly increases LOC at first, then might be lucid, then rapid decline = classic symptoms Tx: Burr Holes Causes: Accidents (ski, motorcycle, skateboarding etc…)

Answer 2

Symptoms over 24-48 hours if acute/subacute, high mortality Chronic- 3 weeks + Causes: Bleeding d/o, aneurysm rupture, injury Most common, Chronic common in older adults (all types most often in 60’s/70’s) CT scan to diagnose Can reabsorb if small (1 cm)

Answer 3

Assume cervical spine injury until ruled out = initiate c-spine immobilization/precautions C-spine injuries 1.7 – 8% of the time in TBI Suspect if GCS 8 or less, motorcycle accident, or skull base fracture C-spine immobilization/precautions= maintain head and neck midline, hard cervical collar, back board for transport. X-ray to diagnose Time is brain! Preserve as much as possible Secondary Injury = cerebral edema, hypotension, resp. depression

Answer 4

Focus on stabilizing CV and Resp. function, perfusion to brain, control hemorrhage, hypovolemia, blood gas values

Answer 5

Disoriented, not following commands, persistent need for stimuli

Answer 6

alert and oriented to coma

Answer 7

Neuro (e.g., CVA) Toxicologic (e.g., intoxication) Metabolic (e.g., kidney failure)

Answer 8

unarousable, no “purposeful” responses to stimuli, 2-4 weeks duration (varies!)

Answer 9

unresponsive but after coma resumes sleep-wake cycles, no cognitive function

Answer 10

lesion on pons or midbrain  tetraplegia Non-verbal, vertical eye movement and lid elevation remain intact LOC most important indicator of condition

Answer 11

Can cause brain to shift against hard surface of skull and blood supply is decreased which causes… Ischemia (decrease of blood supply) then… Infarction (no blood supply) then… Necrosis (brain tissue death)

Answer 12

80% brain tissue, 10% intravascular blood, 10% CSF

Answer 13

ICP Normal Range: 5-15 mm Hg Treatment starts at 20 mm Hg

Answer 14

slow bounding pulses, resp. irreg., systemic BP increased

Answer 15

Bad sign!!! Bradycardia + HTN + Bradypnea  leads to herniation of brainstem if not treated ASAP

Answer 16

Depends on how far along in the process Subtle changes in behavior (Restless) Sluggish pupillary response  fixed Decreased alertness  coma

Answer 17

Mental status Cranial nerves (I through XII) Cerebellar function (Balance/coordination) Reflexes Motor/Sensory Function GCS: Score 3 (coma), 8 (unconscious), 15 (normal) - Eye opening - Best Verbal response - Best Motor response

Answer 18

Maintain Airway!!! May need ventilator BP/Heart rate = cerebral perfusion IV for fluids/meds/antibiotics Increased ICP is an emergency!!! Goal: Decreased edema, lower volume of CSF, maintain adequate perfusion Treatment: Diuretics (osmotic = mannitol), restrict fluids, drain CSF, control fever, maintain O2/BP

Answer 19

Frequent Neuro assessments Report signs of Increasing ICP:

Answer 20

Change in LOC (Earliest sign) = disorientation, restless, anxious, increased resp. purposeless movements, confusion Pupils – CN II, III, IV, V Weak extremities on 1 side or 1 extremity only HA constant, increasing, with movement/straining

Answer 21

brain death

Answer 22

Stupor or coma, irreg. resp., BP/Temp increase widened pulse pressure, brady to tachy and varies quickly Cheyne-stokes breathing (differing rate, depth, periods of apnea) Ataxic breathing (Irreg. with random deep/shallow breaths + apnea) vomiting (projectile), posturing, flaccidity before death loss of reflexes (pupil, corneal, gag, swallowing)

Answer 23

Need to know baseline, watch trends closely Ventriculostomy (catheter in ventricle) VP Shunt (ventriculoperitoneal) Subarachnoid Bolt/Screw External Ventricular Drain (EVD)

Answer 24

Meningitis, infection, clot (blood or tissue), ICP excessive reduction  ventricular collapse and herniation Altered LOC  pneumonia, resp. failure, pressure ulcers, aspiration, GI decreased function, musculoskeletal atrophy, DVT etc… DI (pee too much) SIADH (retain) from TBI Monitor electrolytes Good oral hygiene! Good Nutrition  Clean environment, still describe steps of care to pt in ALOC, advocate for patient, be vigilant! 1:1 or 1:2 care Fever  Nursing management - Removing bedding (drape or light sheet only) - Acetaminophen - Cool sponge baths, fans, hypothermia blanket - Frequently monitor, shivering = increase in work of body/demand - Rectal or skin continual monitor can be used BP & O2 - Maintain Systolic greater than 100 mm Hg - Maintain O2 Sat > 90% Keep patient calm and comfy (sedation/analgesia) Seizure Precautions Bladder- scan, foley prn Nutrition- Higher caloric needs, begin up to 72 hrs after injury - Protein 15% of all calories, glucose monitored (hyper=worse outcomes), consult dietician Bowel Function- assess! Diarrhea (infection, fluids, feedings) or constipation (meds/lack of fiber) - Straining increases ICP! May need or have Craniectomy to decompress. If flap is stored in abdomen for replacement, need to be aware to assess and protect!

Answer 25

(Mannitol) Draws water across intact membranes to decrease swelling  decrease blood viscosity (check hematocrit), and ultimately increase blood flow If serum osmolality > 320 mOsm = not effective! We can use hypERtonic saline [3% NaCl] (not hypOtonic  more swelling); newer approach

Answer 26

Coma/unresponsiveness Absence of brainstem reflexes Apnea

Answer 27

Irreversible condition with known cause, pt not on CNS depressant or paralytic, no severe electrolyte/acid-base/endocrine abnormality, the 3 above, core body temp >90 F, SBP at least 100 mm Hg, neuroimage of catastrophic CNS damage Possible preparation for organ donation

Answer 28

Damage to spinal cord can be minor (concussive, contusion) to transection of cord (severed) Young people 16-30 yo > half of new SCIs annually Most common: MVAs

Answer 29

Primary- initial trauma Secondary- usually from contusion or tear where nerve fibers swell/die - Secondary reaction- ischemia, hypoxia, edema, hemorrhage damages myelin and axons - Try to prevent permanent damage within 4-6 hrs after injury

Answer 30

Most frequent at C 5,6,7 T 12, L1 (greatest range of mobility in these)

Answer 31

Depends on level of injury Sensory/Motor/Both types of fibers Neurologic level- lowest level that sensory and motor function is normal Complete spinal cord lesion- total loss of sensation/voluntary muscle control below lesion) - loss of spinal reflexes, loss of ability to perspire, dysfunction bowel/bladder, absent visceral/somatic sensations below level of lesion (all) Paraplegia – paralysis of lower body Tetraplegia- (AKA: Quadriplegia) all 4 extremities paralyzed

Answer 32

Respiratory – frequently VS Neuro (sensory/motor) Pain Bowel and bladder - indwelling catheter, loss of control Other injuries (head/chest) Cardiac (brady/asystole common in acute)

Answer 33

X-rays (Cervical spine especially) CT initial MRI- later if ligaments injured or suspected

Answer 34

Emergency! Time is also spine  MVA, sports, falls, violence = suspect SCI until ruled out Rapid assessment, immobilization, extrication, stabilization, transportation Spine board (back board), head/neck neutral = 1 person at head 4-person transfer preferred Log roll Cervical collar Goal- prevent progressive neuro deficits Reduction and traction (tongs, calipers, halo device, chin strap and weighted sandbags) Surgery- for compression, unstable vertebral body, penetrating wound, bone fragments, poor neuro status Laminectomy most common Spinal fusion

Answer 35

spinal shock need NG tube for GI decompression

Answer 36

* Occurs immediately or within hours of an SCI * Caused by sudden cessation of impulses from the higher brain centers * Massive vasodilation; decreased preload, stroke volume, and heart rate, hypotension * Loss of motor, sensory, reflex, and autonomic function below the level of injury with flaccid paralysis * Loss of bowel and bladder function * Loss of temperature control

Answer 37

neurogenic shock * Form of distributive shock in severe cervical and upper thoracic injury * Loss of sympathetic input to the systemic vasculature of the heart; decreased peripheral vascular resistance * Hypotension, severe bradycardia, loss of the ability to sweat below the level of injury Vital organs! BP and HR decrease, peripheral vasodilation and pooling, warm skin No perspiration (sympathetic activity blocked)

Answer 38

Need SCDs, compression stockings, or anticoagulant therapy (if no head injury). Use compression devises for 2 weeks after injury

Answer 39

drop in SBP of 20 mm Hg or drop in DBP of at least 10 mm Hg Vasopressors and abdominal binders can help, slow movement when position changes

Answer 40

Acute emergency!!! Hyperresponsive to stimuli (anything like a crease in the bed sheet!) Severe pounding HA, paroxysmal HTN, diaphoresis, nausea, nasal congestion, bradycardia Sudden BP increase could rupture a blood vessel in the brain  ICP increase Stimuli- bowel, bladder, skin Nursing Management: HOB raised, rapid assessment, empty bladder (in & out cath), rectum check, skin, environment (cold blowing air) May need hydralazine via IV (slow push) Flag in EMR

Answer 41

Cerebral Perfusion Pressure (CPP) * 60‒100 mm Hg Mean Arterial Pressure (MAP) * 50‒150 mm Hg * In the setting of increased ICP, the MAP may need to be higher to maintain CPP Intracranial Pressure (ICP) * Normal is 0‒15 mm Hg * Increased ICP caused by * -Cerebral edema * -Hemorrhage/hematoma/mass * -Excess CSF (hydrocephalus)

Answer 42

Vitals Interventions Primary Exam Pain Prevents hypotension and hypoxia

Answer 43

complete -Injuries that result in total loss of all sensory and motor function below the level of injury incomplete - Recognizable neurological syndromes that are classified according to the area damaged

Answer 44

Diaphram = C3, 4, 5 Accessory muscles = C2-7 External intercostals - T1-11

Answer 45

Internal intercostals T1-11 Abdominal muscles T6-12