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Pathophysiology and Pharmacology 2 > Neuro: Traumatic Injury > Flashcards

Neuro: Traumatic Injury Flashcards

1
Q

Neurological Assessment

A

cornerstone of trauma care
basis for resuscitation efforts
tests nasal/ear drainage (halo sign) = basilar skull fracture

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2
Q

ABCDE Approach

A 
airway
breathing
circulation
disability
exposure/envirnment
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3
Q

Disability Survey

A

glasgow coma scale

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4
Q

ABC Assessment

A 
airway (skin color, capillary refill, oxygen saturation)
cervical spine examination 
severe bleeding stopped
breathing assessed/managed
circulation assessed/managed
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5
Q

Opening an airway

A

maintain cervical spine stability
avoid hyperextending neck
assess for cervical stenosis or osteoarthritis

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6
Q

spinal cord injury

A 
anaerobic glycollysis
atp depletion
increased intracellular calcium
arachidonic acid cascade
potassium depletion
spinal cord cellular death (ascending up)
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7
Q

Chest Trauma
Pediatric
Pregnant Women
Older Adults

A

varied breathing patterns, diaphragmatic breathers
increased normal tidal bolume, increased respiratory rate, decreased residual volume & functional residual capacity
less pliable lung tissue, reduced pulmonary compliance

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8
Q

Injuries to pleura

A

pneumothorax (collapsed lung, can lead to hemothorax)

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9
Q

Hemothorax

A

blood accumulates in pleural cavity

type of pleural cavity

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10
Q

Bleeding/Shock

A

compromises perfusion/oxygenation
at risk for hypovolemic shock
class IV shock = unsurvivable
death isn’t always immediate, secondary trauma causes organ failure

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11
Q

Bleeding/Shock II

A

look for uncontrolled sources of bleeding
stop all external bleeding
treat hypovolemia

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12
Q

Head Trauma/Acute Brain Injury Primary vs Secondary

A

brain initially injured on impact
injured brain cells swell/reduce blood supply to cells
causes secondary brain death

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13
Q

Monro-Kellie hypothesis

A

brain resides inside fixed skull/contents are constant

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14
Q

Brain conditions caused by trauma

A 
basilar skull fractures
brain herniations
cerebral contusion
coup-contrecoup injury
brain hemorrage
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15
Q

cerebral perfusion causes

A

decreased ATP production
depletion of cellular energy
cellular death

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16
Q

Exposure assessment

A

all areas of body

look for hidden bruises/lacerations/impaled objects/bullet wounds/bleeding/open fractures

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17
Q

Envinment TX

A 
controlled
avoid hypothermia
continuous temperature monitoring 
warm blankets
warm fluids
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18
Q

unilateral dilated pupil

A

one dilated, one small

CNIII compression

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19
Q

bilateral fixed, dilated pupils

A

pupils are stuck dilated

brain herniation

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20
Q

Positive Babinski

A

great toe extends upward and fan out
abnormal
damage to spinal cord thoracic or lumbar
anoxic brain injury or tumor

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21
Q

Aphasia types

A

Broca (expressive) sparse and nonfluent but preserved comprehension
Wenicke (receptive) fluent and voluminous but comprehension greatly diminished)

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22
Q

Unconscious Patient Causes

A 
head trauma
cerebral toxins
shock
hemorrhage
tumor
infection (meningitis)
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23
Q

Unconscious Patient Assessment

A

unresponsive
primitive/no response to painful stimuli
altered respirations
decreased cranial nerve/reflex activity
posturing (decorticate, decerebrate, flaccid)
bilateral, dilated, fixed pupils
pinpoint pupils (pons damage/druge overdose)

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24
Q

Unconscious Patient DX

A

CT
MRI
Lumbar Puncture (needle inserted into subarachnoid space, sample of CSF for suspected meningitis, contra for increased ICP could lead to herniation of brain)
cerebral/arterial angiography (Ids vascular malformations w/ contrast dye through femoral artery)
EEG
Caloric Testing (dx brainstem/cerebellar lesions, cool water infused into ear)

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25
Q

Unconscious Patient Interventions

A

patency of airway
keep emergency equipment ready
monitor BP, pulse, heart sounds, respirations, pulse ox
assess body temp (increased could be hypothalamus/brainstem issue, increased metabolic rate of brain, or infection)
assess reflexes (cranial, cough, gag, corneal blink)
assess autonomic system (SNS/PNS)
monitor I/O
maintain nutrition (IV/enteral)
provide range of motion to prevent contractures

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26
Q

Intracranial Pressure Normal/Monitoring

A

5-15 mmHg

monitoring is invasive

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27
Q

Intracranial Pressure Assessment

A 
altered LOC
pupillary changes
fever
headache
nausea
vomiting
abnormal respirations
elevated SBP
widened pulse pressure
bradycardia
Late: positive babinski, decorticate/decerebrate, seizures
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28
Q

ICP Interventions

A 
management of underlying causes
adequate airway
avoid increasing intra pressure (straining/coughing/deep breathing/incentive spirometry)
head of bed to 30-40 degrees
avoid flexion of neck/hops
no bright lights
limit visitors
quiet nonstimulating environment
keep close to patient
ventriculoperitoneal shunt
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29
Q

ICP Meds

A 
anticonvulsants (increase ICP)
Antipyretics/Muscle Relaxants (decrease ICP)
Blood pressure meds
corticosteroids
IV fluids
Hyperosmotic agents (mannitol)
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30
Q

Head Trauma Immediate Complications

A 
cerebral bleeding
hematomas
uncontrolled increased ICP 
infections
seizures
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31
Q

Head Injuries Long Term

A

changes in personality and behavior

CN deficits

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32
Q

Types of Head Injuries

A

open: scalp lacerations, fractures in skull, interruption of dura mater
closed: concussions, contusions (bruising of brain tissue), fractures

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33
Q

Hematoma

A

collection of blood in tissues as a result of subarachnoid hemorrage

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34
Q

Concussion signs

A

brief disruption in LOC
amnesia regarding event (retrograde amnesia)
headache

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35
Q

Concussion serious s/s

A 
worsening headaches
vomiting
excessive sleep/confusion
visual changes
weakness/numbness
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36
Q

Concussion Reccomendations

A

don’t participate in strenuous or athletic activities min 1-2 days
rest/light diet
observed closely

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37
Q

Diffuse Axonal Injury

A

extensive tearing of nerve tissue throughout brain
tearing disrupts brain’s regular communication/chemical processes
result of acceleration/deceleration motion (not really impact)
axons are stretched & damaged when parts of brain of differing density slide over one another
major cause of unconsciousness & persistent vegetative state after head trauma

38
Q

Diffuse Axonal Injury DX

A

difficult to detect (not really present on injury)

suspected in pts w/ normal CT scans but still unconscious

39
Q

Diffuse Axonal Injury Tx/Prognosis

A

lacks a specific TX

varies depending on damage

40
Q

Coup-Contreoup

A

head strikes an object, brain injured under area of impact (coup), brain rebounds to opposite side of skull, second injury (contrecoup
common in motor vehicle accidents/shaken brain syndrome
usually frontal/occipital lobes (executive fx, memory, speech, motor skills, vision)

41
Q

Epidural Hematomas

A

most serious
forms rapidly
result of arterial bleed
forms between dura/skull from tear in meningeal artery
associated w/ temp loss of consciousness then lucid then progress to coma
surgical emrgency

42
Q

Subdural Hematoma

A

forms slowly from venous bleed

under dura from tears in veins crossing subdural space

43
Q

Intracerebral hemorrhage

A

blood vessels w/in brain ruptures

blood leaks inside brain

44
Q

Subarachnoid Hemorrhage

A

bleeding into subarachnoid space
head trauma/spontaneous
ruptured cerebral aneurysm

45
Q

Hematoma Assessment

A 
s/s usually result of increased ICP
look for seizure activity
assess airway/breathing patterns
asses VS changes
N/V/Headache/visual disturbances/pupil changes
nuchal rigidity
weakness/paralysis/posturing
CSF drainage from ears or nose
blood fluid surrounded by yellowish stain (halo sign) when on white background
\+ for glucose (fluid)
46
Q

Subdural Hematoma Etiology/TX

A

from high-speed impact/injury
spontaneous
sugery

47
Q

Subdural Hematoma s/s

A 
headache
confusion
changes in behavior
dizziness
n
v
lethargy
excessive drowsiness
weakness
apathy
seizures
48
Q

Subdural v Epidural Progression

A

S: slow collection of blood, s/s usually w/in 48 hrs, slow progression of mental deterioration, can become chronic
E: brief loss of consciousness, lucid interval (hallmark), rapid deterioration, increasing ICP, death w/in hours if hematoma not drained

49
Q

Hematoma/TBI Interventions

A 
monitor respiratory status/airway (increased CO2 = cerebral edema/dilated cerebral arteries)
monitor VS/temp/ICP
head elevation
seizure precautions
maintain normothermia
assess CN fx/reflexes/motor/sensory fx
monitor for CSF drainage
monitor for infection
morphine sulfate (decreases agitation but can worsen condition)
surgical interventions
50
Q

Brain Herniations Causes

A 
brain tissue, blood and CSF shifted from normal position
head injury
stroke
bleeding
tumor
medical emergency
51
Q

Brain Herniations s/s

A 
dilated pupils
headache
altered LOC (drowsy > coma)
high blood pressure
bradycardia
seizures
cardiac arrest
52
Q

Brain Herniation Interventions

A 
surgery
ventriculostomy
craniectomy
osmotic diuretics
corticosteroids
53
Q

Head Injury Teaching

A 
ensure responsible adult will check LOC
brain edema/increased ICP may not be evident immediately
return to Ed/HCP if these s/s in 2-3 days
change in LOC
worsening headache
stiff neck
visual changes
motor problems
sensory disturbances
seizures
n/v
bradycardia
abstain from alcohol, watch meds, avoid driving
54
Q

Spinal Cord Injury

A

trauma causes partial/complete disruption of nerve tracts/neurons
contusions, laceration, compression
loss of motor fx/sensation/reflex
loss of bowel/bladder control

55
Q

Spinal Cord Injury Causes & Complications

A

falls, accidents, gunshot/stab wounds
respiratory failure
autonomic dysreflexia
death

56
Q

Transection

A

spinal cord is damaged or severed partially w/ symptoms depending on place/extent

57
Q

Brown-Sequard Syndrome

A

hemidisection of spinal cord that affects half of spinal cord
fx/vibration/proprioception/deep sesation on same side of body as damaged = lost
opposite side of body from damage, pain/temp/light touch =lost

58
Q

Spinal Assessment

A

respiratory status
motor/sensory changes
loss of bowel/bladder control (urinary retention/distension)
no sweat produced on paralyzed areas
injury above C4 causes respiratory difficulty/paralysis of all extremities
Injured thoracic level can mean paralysis of movement of chest/trunk/bowel/bladder and legs
T6 or above = autonomic autonomic dysreflexia (^ sweating, bradycardia, hypertension, nasal stuffiness, gooseflesh)
Lumbar/Sacral Injuries (loss of fx of lower extremities)
s2/3 center on urination (bladder contracts but won’t empty)

59
Q

-plegia

A

stroke/paralysis

60
Q

-paresis

A

weakness

61
Q

-hmi/semi

A

both limbs on one side

62
Q

di-/para-

A

both upper limbs (di) or both lower limbs (para)

63
Q

quadri/tetra

A

all four limbs

64
Q

Quadriplegia

A

lower limbs completely paralyzed complete/partial paralysis of upper limbs
usually due to injury of cervical spinal cord

65
Q

Quadriplegia Assessment

A

frequently assess breath sounds, accessory muscle use, vital capacity, tidal volume, arterial blood gas values

66
Q

Quadriplegia Interventions

A

ROM exercises to affected joints
turning necessary
bladder/bowel training programs
Turn every 2 hours

67
Q

Emergency Management of Spinal Cord Injuries

A

always suspect spinal cord injury until ruled out
immobilize patient
head in neutral position
improper movement can cause further damage
assess resp pattern/maintain airway
don’t twist/turn body
don’t allow in sitting posotion
cervical fracture: c-collar, halo traction

68
Q

Spinal Cord CV

A

monitor for dysrhythmias
assess for hemorrhage/bleeding around fracture site
look for signs of shock
assess lower extremities for DVTs

69
Q

Spinal Cord Injuries GI/GU

A 
assess for distention/hemorrhage
monitor bowel sounds
high fiber diet
admin stool softeners as needed
maybe catheterization
70
Q

Spinal Shock

A

complete but temporary loss of motor/sensory/reflex/autonomic fx
immediately after injury

71
Q

Spinal Shock s/s

A 
flaccid paralysis
loss of reflex below injury
bradycardia
hypotension
paralytic ileus
usually 48 hours but up to several weeks
absent bulbocavernosus reflex
72
Q

Neurogenic Shock

A 
most common in injuries above T6
soon after injury
massive vasodilation
pooling of blood in BV
tissue hypoperfusion
impaired cellular metabolism
73
Q

Autonomic Dysreflexia

common cause

A

high spinal cord injury T6 and above
uncompensated sympathetic nervous system stimulation
bladder irritation due to distention, bowel impaction

74
Q

Autonomic Dysreflexia Classic Signs

A 
hypertension (up to 300 SBP)
throbbing headache
diaphoresis above level of injury
bradycardia (30-40)
piloerection (goose bumps)
flushing 
nausea
75
Q

Autonomic Dysreflexia Life-Threatening Condition

A

hypertensive stroke

seizures

76
Q

Autonomic Dysreflexia Interventions

A 
check bp when headache reported
assess urination (may need catheter)
assess constipation (digital rectal examination)
remove constrictive clothing
notify HCP
alpha-adrenergic blocker
arteriolar vasodilator (amlodipine)
HOB to 45 degrees or high Fowler's to lower BP
don't have patient flat/side-lying
77
Q

Meningitis

A

inflammation of meninges covering brain &spinal cord

78
Q

Bacterial meningitis
classic
s/s
testing

A

fever, severe headache, n/v, nuchal rigidity
photophobia, AMS, other signs of increased ICP
Brudzinski & Kernig’s

79
Q

Meningitis in Infants/Children

A

fever, restlessness, high-pitched cry
bulging fontanels
increasing head circumference

80
Q

Acute Complications of Bacterial Meningitis

A 
hydrcephalus
increased ICP from CSF obstruction
permanent hearing loss
learning disabilities
brain damage
81
Q

pulse pressure

A

difference between sBP & DBP

82
Q

Cushing’s Triad

A

systolic HTN w/ widened pulse pressure, bradycardia, respiratory depression
occur very late if increased ICP not treated

83
Q

Brudzinski/Kernig’s

A

severe neck stiffness cause hips/knees to flex when neck is flared
stiffness of hamstring causes inability to straighten the leg when hip is flexed to 90 degrees

84
Q

Lumbar Puncture

A

CSF assess for color/contents/pressure

85
Q

Normal CSF

A 
clear 
colorless
small amount of protein, glucose, WBCs
no RBCs/microorganism 
pressure is 60 -150 in water
86
Q

Contraindication to Lumbar Puncture

A

Increased ICP

87
Q

Highest Priority Meningitis Intervention

A

fluid resuscitation to counter hypotension

88
Q

Sepsis & Meningitis

A

vasopressors (norepinephrine, phenylephrine, vasopressin, dopamine) once fluid resuscitation adequate
obtain labs & blood cultures prior to admin ABX
administer empiric ABX (w/in 30 min of admin)
prior to a lumbar puncture head CT scan
assist w/ LP for CSF examination & cultures (usually purulent/turbid in clients w/ bacterial meningitis)

89
Q

Bacterial meningitis interventions

A

medical emergency
high mortality (25%) if untreated
empriric ABX started immediately
need peripheral IV to remain in place

90
Q

Viral Meningitis

A

self-limiting
ABX not effective
usually not serious
s/s leave in 2 weeks

91
Q

If suspected bacterial miningitis

A

droplet precaution until bac id’d and tx started

92
Q

Miningococcal meningitis & Haemophilus influenzae type B meningitis

A

highly transmissible to others
precautions discontinued after 24 hours post ABX
viral meningitis usually does not require droplet

Pathophysiology and Pharmacology 2 (27 decks)

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