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Critical Care Nursing > Neurologic Trauma > Flashcards

Neurologic Trauma Flashcards

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1
Q

What are the most common causes of traumatic brain injury?

A
  • falls
  • motor vehicle accidents
  • collisions w/stationary or moving objects
  • assaults
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2
Q

Who is at the highest risk for traumatic brain injury?

A
  • males 15-24 years
  • very young
  • very old
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3
Q

Primary Traumatic Brain Injury

A

initial damage to the brain that results from the traumatic event

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4
Q

Primary TBI’s may include what?

A
  • contusions
  • lacerations
  • torn blood vessels from impact
  • acceleration/deceleration
  • penetration by foreign object
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5
Q

Secondary Traumatic Brain Injury

A

evolves over the ensuing hours/days after the initial injury

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6
Q

Secondary TBI’s can be due to what?

A
  • cerebral edema
  • ischemia
  • seizures
  • infection
  • hyperthermia
  • hypovolemia
  • hypoxia
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7
Q

Increased intracranial pressure can cause what?

A

Herniation of the brain through or against the skull

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8
Q

Herniation of the brain causes what?

A
  • ischemia
  • infarction
  • irreversible brain damage
  • brain death
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9
Q

What are skull fractures?

A

a break in the skull caused by forceful trauma w/ or w/o brain damage

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10
Q

S/S of Traumatic Brain Injury

A
  • altered LOC
  • confusion
  • pupillary abnormalities
  • sudden onset of neuro deficits
  • changes in vitals
  • vision/hearing impairment
  • headaches
  • seizures
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11
Q

When does a Closed (blunt) brain injury occur?

A

when the head accelerates and then rapidly decelerates or collides w/ another object and brain tissue is damaged but there is no opening

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12
Q

When does an Open brain injury occur?

A

when an object penetrates the skull, enters the brain, and damages the soft brain tissue in its path or when blunt trauma is so severe it opens the scalp

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13
Q

What is a Concussion?

A

alteration in mental status that results from trauma and may or may not involve LOC

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14
Q

How long do symptoms of concussions typically last?

A

24 hours

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15
Q

S/S of Concussions

A
  • headache
  • N/V
  • photophobia
  • amnesia
  • blurry vision
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16
Q

Treatment for Concussion

A
  • observing patient for worsening symptoms for next 24 hours
  • woken every 2 hours in order to detect changes
  • advise to resume normal activities slowly
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17
Q

What is a Cerebral Contusion?

A

bruising of the brain, w/ possible surface hemorrhage and the patient is unconscious for more than a few seconds or minutes

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18
Q

S/S of a Cerebral Contusion depend on what?

A

The size of the contusion and the amount of associated swelling of the brain

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19
Q

S/S of Cerebral Contusion

A
  • motionless
  • faint pulse
  • shallow respirations
  • cool, pale skin
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20
Q

If patient recovers consciousness w/ a Cerebral Contusion they may enter a state of what?

A

Cerebral irritability

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21
Q

What is a state of Cerebral Irritability like?

A

Patient is easily disturbed by any form of stimulation such as noises, light, and voices; may be hyperactive at times

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22
Q

What are some after effects of Cerebral Contusions?

A
  • residual headache
  • vertigo
  • impaired mental function
  • seizures
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23
Q

Decorticate Posturing

A

abnormal flexion of the upper extremities and extension of the lower extremities

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24
Q

Decorticate Posturing indicates damage to what part of the brain?

A

Upper midbrain

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25
Q

Decerebrate Posturing

A

extreme extension of the upper and lower extremities

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26
Q

Decerebrate Posturing indicates damage to what part of the brain?

A

lower midbrain and upper pons

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27
Q

What are Hematomas?

A

Collections of blood that develop w/in the cranial vault

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28
Q

What are the most serious types of brain injury?

A

Hematomas

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29
Q

Symptoms of hematomas are frequently delayed until when?

A

The hematoma is large enough to cause distortion of the brain and increased ICP

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30
Q

Where are Epidural Hematomas found?

A

Space b/t skull and the dura

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31
Q

Epidural Hematomas can result from what?

A

Skull fracture that causes a rupture or laceration of the middle meningeal artery

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32
Q

Symptoms of Epidural Hematomas are caused by what?

A

the expanding hematoma

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33
Q

S/S of Epidural Hematoma

A
  • Momentary loss of consciousness occurs at the time of injury followed by an interval of apparent recovery
  • increased ICP
  • signs of compression
  • decreasing LOC
  • dilation/fixation of pupils
  • paralysis of extremity
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34
Q

Why is an Epidural Hematoma considered an extreme emergency?

A

B/c marked neurologic deficit and respiratory arrest can occur w/in minutes

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35
Q

Treatment of Epidural Hematoma

A
  • burr holes into skull to decrease ICP, remove clot and control bleeding immediately
  • Craniotomy
  • drain may be inserted after either procedures to prevent reaccumulation of blood
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36
Q

Where is a Subdural Hematoma located?

A

Between the dura and the brain a space normally occupied by a thin cushion of CSF

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37
Q

What is the most common cause of Subdural Hematoma?

A

Trauma

  • bleeding disorders
  • ruptured aneurysm
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38
Q

Who is at an increased risk for Subdural Hematomas?

A

Elderly b/c of whole brain atrophy

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39
Q

Acute Subdural Hematoma’s are associated w/ what major head injuries?

A

Contusion or laceration

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40
Q

How long does it take S/S of acute subdural hematoma’s to develop?

A

24-48 hours

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41
Q

S/S of Acute Subdural Hematomas

A
  • changes in LOC
  • changes in reactivity of pupils
  • hemiparesis
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42
Q

What are signs of a rapidly expanding Subdural mass that needs immediate intervention?

A
  • coma
  • increasing BP
  • decreasing HR
  • slowing respiratory rate
43
Q

What are Subacute Subdural Hematomas?

A

the result of a less severe contusion and head trauma

-S/S appear b/t 48-2 weeks after the injury

44
Q

Chronic Subdural Hematomas can develop from what?

A

Seemingly minor head injuries

45
Q

Treatment for Chronic Subdural Hematoma

A
  • Surgical evacuation of the clot if the patient is symptomatic and the bleed is at least 1 cm in size
  • smaller bleeds are only monitored
46
Q

Intracerebral Hemorrhage

A

bleeding into the parenchyma of the brain

47
Q

Intracerebral Hemorrhage is commonly seen when?

A

When the force is exerted to the head over a small area

  • bullet wounds
  • stab injuries
48
Q

Intracerebral Hemorrhage can also occur when?

A
  • systemic HTN
  • rupture of saccular aneurysm
  • vascular anomalies
  • intracranial tumors
  • bleeding disorders
49
Q

What is the onset of Intracerebral Hemorrhage like?

A

May be insidious, beginning w/ the development of neuro deficits followed by headache

50
Q

Management for Intracerebral Hemorrhage

A
  • supportive care
  • control of ICP
  • careful administration of fluids/electrolytes, and antihypertensive meds
51
Q

Surgical Intervention for Intracerebral Hemorrhage

A
  • craniotomy

- craniectomy

52
Q

Why may a craniotomy not be successful w/ Intracerebral Hemorrhage?

A

Because of the inaccessible location of the bleeding

53
Q

What are the primary neuroimaging diagnostic tools of choice for evaluating brain injury?

A

CT and MRI

54
Q

What patients are at highest risk for Cervical Spine Injury?

A
  • motorcycle accidents
  • lower Glasgow Coma Scores
  • skull base fractures
55
Q

Altered LOC is apparent in a patient that demonstrates what?

A
  • who is not oriented
  • can not follow commands
  • needs persistent stimuli to achieve state of alertness
56
Q

Coma

A

clinical state of unarousable unresponsiveness in which there are no purposeful responses to internal or external stimuli

57
Q

How long is “coma” limited to?

A

2-4 weeks

58
Q

Persistent Vegetative State

A

condition in which unresponsive patient resumes sleep-wake cycles after coma but devoid of cognitive or effective mental function

59
Q

When is the Cushing Response seen?

A

When cerebral blood flow decreases significantly

60
Q

What occurs during the Cushing Response?

A

When the brain is ischemic the vasomotor center triggers an increase in arterial pressure in an effort to overcome the increased ICP

61
Q

When the brain’s ability to autoregulate becomes ineffective and decompensation begins the deterioration is known as what?

A

Cushing Triad

62
Q

S/S of Cushing Triad

A
  • bradycardia
  • hypertension
  • bradypnea
63
Q

S/S of the patient’s state of alertness and consciousness decreasing will occur in what responses?

A
  • pupillary response
  • eye opening response
  • verbal response
  • motor response
64
Q

Early signs if ICP

A
  • sudden onset restlessness
  • confusion
  • increasing drowsiness
  • pupils become sluggish
65
Q

Glasgow Coma Scale Criteria

A
  • eye opening
  • verbal response
  • motor response
  • rates on scale from 3-15
66
Q

What is the lowest a patient can score on the Glasgow Coma Scale?

A

3 Coma

67
Q

What is the first priority treatment for the patient w/ altered LOC?

A

Obtain and maintain patent airway

  • patient may be orally or nasally intubated
  • tracheostomy
68
Q

What interventions are performed to decrease ICP, cerebral edema, cerebral blood volume and CSF?

A
  • osmotic diuretics
  • restricting fluids
  • draining CSF
  • maintain BP and O2
  • reduce cellular metabolic demands
  • control fever
69
Q

What is the earliest sign of increasing ICP?

A

Change in LOC

70
Q

Early indications increasing ICP are?

A
  • disorientation/restless/increased respiratory effort
  • pupillary changes
  • weakness in one extremity or on one side of body
  • headache that is constant
71
Q

Later S/S of increasing ICP are?

A
  • LOC continues to deteriorate until patient is comatose
  • respiratory rate decreases or become erratic (Cheyne-stokes)
  • BP/temp increase
  • HR goes from brady-tachy
  • projectile vomiting
  • hemiplegia/decorticate/deceberate posturing
  • loss of brain stem reflexes
72
Q

How can ICP be monitored?

A
  • intraventricular catheter-ventriculostomy

- subarachnoid bolt or screw

73
Q

Complications from altered LOC

A
  • respiratory failure
  • pneumonia
  • pressure ulcers
  • aspiration
  • endocrine abnormalities-diabetes insipidus/SIADH
74
Q

Diabetes Insipidus is the result of what?

A

decreased secretion of ADH

75
Q

Diabetes Insipidus causes what?

A
  • excessive urine output
  • decrease urine osmolality
  • serum hyperosmolarity
76
Q

Therapy for Diabetes Insipidus consists of what?

A
  • administration of fluids
  • electrolyte replacement
  • vasopressin
77
Q

SAIDH is a result of what?

A

increased secretion of ADH

78
Q

What happens w/ SIADH?

A

Patient becomes volume-overloaded, urine output diminishes, serum sodium concentration becomes dilute

79
Q

Treatment for minor SIADH

A

Fluid restriction-typically 1 L/day with no free water

80
Q

Treatment for severe SIADH

A
  • administration of 3% hypertonic saline solution

- accompanied w/ lasix

81
Q

Osmotic Diuretics may be administered to do what?

A

Dehydrate the brain tissue and reduce cerebal edema

  • reduce blood viscosity and hematocrit
  • enhance cerebral blood flow
82
Q

What medication is the gold standard in reducing ICP?

A

Mannitol-osmotic diuretic

83
Q

What is another medications that may be used to treat cerebral edema?

A

Hypertonic Saline

84
Q

Hypotonic fluids should be avoided in what patients?

A

Patients w/ TBI because they can cause increase in cerebral edema

85
Q

Why may the patient be hyperventilated to decrease ICP?

A

As the patient hyperventilates PCO2 rises causing vasoconstriction, decreasing cerebral blood flow, which results in decreasing ICP

86
Q

What happens when a patient strains with a BM?

A

it increases intra-abdominal/intra-thoracic pressure which impedes venous return and increases ICP

87
Q

Decompressive Craniectomy

A

removal of a bone flap from the skull to allow expansion of the brain

88
Q

What are the 3 cardinal findings for declaring a patient brain dead?

A
  • coma/unresponsive
  • absence of brain stem reflexes
  • apnea
89
Q

Current Criteria for brain death

A
  • condition is irreversible w/ known cause
  • not under effect of CNS depressants/paralytics
  • no electrolyte/severe acid-base/endocrine abnormality
  • has apnea
  • no brainstem reflexes
  • temp > 90
  • systolic BP at least 100
  • neuroimaging evidence of catastrophic damage
90
Q

Primary SCI

A

result of the initial insult or trauma and is usually permanent

91
Q

Secondary SCI

A

usually result of contusion or tear injury in which the nerve fibers begin to swell and disintegrate

92
Q

Secondary SCI are thought to be reversible for up to how long after the injury?

A

first 4-6 hours

93
Q

What is the leading cause of death in high cervical cord injuries?

A

Acute respiratory failure

94
Q

Central Cord Syndrome Characteristics

A
  • Motor deficits/sensory loss in upper extremities more than lower
  • bowel/bladder dysfunction variable or completely reserved
95
Q

Causes of Central Cord Syndrome

A

Injury or edema of central cord, usually of cervical area, may be caused by hyperextension

96
Q

Characteristics of Brown-Sequard Syndrome (Lateral Cord)

A
  • ipsilateral paralysis, loss of touch, pressure, and vibration
  • contralateral loss of pain and temperature
97
Q

Causes of Brown-Sequard Syndrome

A

transverse hernisection of the cord usually as a result of a knife or missile injury, fracture-dislocation, acute ruptured disc

98
Q

Anterior Cord Syndrome Characteristics

A
  • loss of pain, temperature, and motor function are noted below level of lesion
  • light touch, position, and vibration remain intact
99
Q

Causes of Anterior Cord Syndrome

A
  • acute disk herniation
  • hyperflexion injuries from fractures-dislocation
  • anterior spinal artery
100
Q

Why is continuous cardiac monitoring indicated for SCI?

A

B/c bradycardia and asystole are common

101
Q

Treatment for SCI attempt to achieve what?

A

Decompression, stabilization, and realignment of the spinal cord while preserving or improving neuro function

102
Q

Surgery is indicated for what situations w/ SCI?

A
  • compression of cord
  • fragmented or unstable vertebral body
  • penetrating wound to spinal cord
  • bone fragments in spinal canal
  • deterioration of neuro status
103
Q

Pin Care for patient in Halo Device Traction

A
  • cleaned daily
  • observed for redness, drainage, and pain
  • observe for loosening
  • keep torque screw driver at bedside
104
Q

What should the nurse do if pin comes out of Halo Device?

A

One nurse should stabilize head in neutral position while the other calls neuro surgeon

Critical Care Nursing (14 decks)

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