neurological disorders: trauma Flashcards
terminology
autonomic dysreflexia
a life threatening emergency in patients with a spinal cord injury that cuases a hypertensive emergency
terminology
concussion
a temporary loss of neurologic function with no apparent structural damage to the brain
terminology
contusion
bruising of the brain surface
terminology
neurogenic bladder
bladder dysfunction that results from a disorder or dysfunction of the nervous system; may result in either urinary retention or bladder overactivity
terminology
paraplegia
paralysis of the lower extremities with dysfunction of the bowel and bladder from a lesion in the thoracic, lumbar, or sacral region of the spinal cord
terminology
primary injury
initial damage to the brain that results from the traumatic event
terminology
secondary injury
an insult to the brain subsequent from the traumatic event
terminology
spinal cord injury (SCI)
an injury to the spinal cord, verterbral column, supporting soft tissue, or intervertebral discs caused by trauma
terminology
tetraplegia
varying degrees of paralysis of both arma and legs, with dysfunction of bowel and bladder from a lesion of the cervical segments of the spinal cord
terminology
traumatic brain injury (TBI)
an injury to the skull or brain that is severe enough to interfere with normal functioning
describe TBI
- insult to brain that may produce physical, intellectual, emotional, social, and voactional changes
- TBI blunt or TBI penetrating
- leading causes include falls (48%), MVC (20%), struck by objects (17%), assaults (10%)
- people most likely to sustain a TBI include children 0-4, adolescents 15-19, and older adults >65
describe blunt TBI
occurs when the head accelerates and then rapidly decelerates or collides with another object and brain tissue is damaged, but there is no opening throuhg the skull and dura
describe penetrating TBI
occurs when an object penetrates the skull, enters the brain, and damages the soft brain tissue in its path, or when blunt trauma to the head is so severe that it opens the scalp, skull, and the dura to expose the brain
name some different types of brain injuries
- contusions (open/closed)
- intracranial hemorrhage
- concussion
- difuse axonal injury (DAI)
what are some different types of intracranial hemorrhage
- epidural hematoma (EDH)
- subdural hematoma (SDH) (can be acute/chronic)
- intracerebral hemorrhage/hematoma
what are some different causes of intracranial hemorrhage
- systemic hypertension, which causes degeneration and rupture of a vessel
- rupture of an aneurysm
- vascualr anomalies
- intracranial tumors
- bleeding disorders such as leukemia, hemophilia, aplastic anemia, and thrombocytopenia
- complications of anticoagulant therapy
what are 3 mechanisms that contribute to TBI
- croup-contracoup injuries (brain slams around)
- penetrating trauma
- scalp injuries (minor)
describe concussions
- loss of cosciousness for 5 minutes or less
- retrograde amnesia
- repeated injuried may lead to chronic traumatic encephalopathy
describe DAI
results from widespread sheering and rotational forces that produce damage throughout the brain
name and describe some different skull fractures
- linear
- comminuted (splintered)
- depressed (skull imbedded in the brain tissue)
- basilar (ecchymosis around eyes, CSF/blood from ears)
whats included in intitial management of TBI
- airway
- breathing
- cirulation
- immobilize neck
- baseline assessment
whats included in ongoing management of TBI
- maintain cerebral perfusion (elevate HOB, maintain BP)
- treat IICP/reduce ICP
- support measures
- medications
- NG tube
- brain death
what are some support measures for TBI
- ventilary support
- seizure prevention
- fluid/electrolyte maintenance
- nutritional support
- management of pain and anxiety
what meds may be sued for TBI management
- anticonvulsants
- benzos (do not affect cerebral blood flow/ICP) for anxiety
- propofol for sedation
what are the three cardinal signs of brain death
coma, absence of brain stem reflexes, and apnea
what testing is done for brain death
- cerebral blood flow studies
- EEG
- transcranial doppler
- brain stem auditory-evoked potential
what may be included in TBI rehabilitation
- may have feeding tubes
- tracheostomies
- teaching/support
- community reintegration
what are some nursing interventions for TBI
- maintaining airway
- monitor neurologic function
- monitor fluid/electrolyte balance
- promote nutrition
- prevent injury
- maintaining thermoregulation
- maintain skin integrity
- improving coping
- maintaining skin integrity
- preventing sleep disturbances
- support family coping
- monitor and managing potential complications
what are some common causes of SCI
MVC, falls, violence, and sports related injuries
78% of SCI patients are
males
whar are some risk factors for SCI
- younger age
- male
- alcohol/drug use
what are some complications from SCI that may result in shorter lifespan
- pneumonia
- pulmonary embolism
- sepsis
- paraplegia/tetraplegia
what are the range of injuries that are associated with SCI
- transient concussion
- contusion
- laceration
- compression
- complete transection
where does paralysis occur with SCI
below the level of injury
where are the most frequent sites of SCI
C5-C7
T12
L1
describe injuries above C4
may be fatal
requires ventilator support
resp failure is leading cause of death
what are some nontraumatic causes of SCI
- cervical spondylosis with myelopathy
- myelitis
- osteoporosis
- central cavitation of the cord
- tumors
- vascular diseases
what are the two categories of SCI
- primary - intial trauma
- secondary - edema or hemorrhage
what are some veteran considerations for SCI
- veterans are a large proportion of those with SCI
- older and predominantly male
- injuries similar to civilians
- war-related SCIs affect younger white males
factors affecting adjustments to SCI:
- high rates of PTSD
- accommodating to civilian life
- burden of not being to serve
- cognitive function better physical independence and mobility
describe SCI clinical manifestations
- dependent on level of injury
- type of injury dependent on severity of injury (complete lesion and incomplete lesion)
- ASIA classification according to area of damage (central, lateral, anterior, peripheral)
what is the leading cause of death with SCI
respiratory failure
——– and above affect respiratory function
T12
whats included in the assessment of SCI
thorough neurological examination
what diagnostics may be used for SCI
- Xrays
- CT
- MRI
- myelogram if MRI is contraindicated
- ECG monitoring
describe emergency management of SCI
- rapid assessment
- immobilization (backboard and headblocks)
- extrication
- stabilization
- transport
- once determined extent and severity of injury and spinal cord stabilized, patient may be moved to conventional bed
what are the goals of medical management of SCIs
- prevent secondary injury
- watch for progressive neurological deficits
- prevent complications
what may be included in medical management of SCIs
- pharmacologic therapy
- respiratory therapy
- skeletal fracture reduction and traction
- surgical management
what are some possible acute complications of SCI
- spinal and neurogenic shock
- venous thromboembolism
- pressure injuries and infections
describe spinal shock
- areflexia
- decreased BP
- bradycardia
- bowel (paralytic ileus) - 2-3 days after injury
- bladder dysfunction
describe neurogenic shock
- loss of autonomic nervous system function
- decreased BP or extremely high, HR, and CO
- no sweating
describe medical management of long term complications of SCI
- health team
- follow up at spinal cord clinic
monitor for following complications:
- s/sx of UTI
- disuse syndrome
- autonomic dysreflexia
- infections
- spasticity
- depression
- sepsis
- osteomyelitis
- fistulas
- heterotopic ossification (bone overgrowth - contractures)
what are some nursing interventions for SCI
- promoting adequate breathing and airway clearance
- improve mobility
- prevent injury due to sensory and perceptual alterations
- maintain skin integrity
- maintain urinary elimination
- improve bowel function
- provide comfort measures if in skeletal traction/halo
- identify symptoms of autonomic dysreflexia
- monitor and mange potential complications
describe improving mobility for patients with SCI
- frequent position changes
- proper positioning of joints
- use of splints and removable casts
- intermittent turning to prone position
- positioning of upper extremities away from the body
- draping linens to keep pressure off of feet
- keeping knee joints flexed 15 degrees when supine
- use of AROM/PROM
what are some goals of nursing interventions for SCI
- develop goals
- promote mobility
- reduce spasticity
- improve bowel and bladder control
- prevent pressure ulcers
- reduce resp dysfunction
- promote expression of sexuality
- control pain
- reduce abnormal brone growth
- promote psychological adjustment
