Other Neuro Alterations Flashcards
Linear skull fracture
Linear crack seen on x-ray
Symptoms of linear skull fracture
Swollen, ecchymotic areas over scalp
May lead to epidural hematoma if in temporoparietal area
Nursing care for linear skull fracture
Observation for clinical manifestations of IICP
Depressed skull fracture
Skull is depressed, pieces of scalp still there
Dura may be intact, bruised or torn
Potential complications of a depressed skull fracture
Laceration of the brain (from the skull fragments)
Intracranial hemorrhage
Infection (*Meningitis)
Seizures (not common)
Basilar skull fracture
Fracture at base of skull
X-ray does not detect
Symptoms of a basilar skull fracture
Battle’s sign (Bruising behind both ears)
Raccoon’s eyes (bruising around eyes)
CSF leakage from nose and ears
Nursing management of a basilar skull fracture
Tape 4x4 under nose/ear to collect CSF drainage
*No NG tubes
*No blowing nose
**This fracture breaks the first line of defense into the cerebral spinal space
Comminuted skull fracture
Occurs from multiple linear fractures
Referred to as eggshell fracture
Not an open fracture
(Without xray, wouldn’t even know it’s there)
Definition of concussion
Mechanical force of short duration applied to skull
Symptoms of concussion
With transient loss of consciousness, some confusion, amnesia
Treatment for concussion
12-24 hour observation
Lasting effects are uncommon
Definition of contusion
Bruising of the brain
Cause of a contusion
Coup-contra-coup injury
S/S of contusion
Depend on location and severity
*change in LOC
Amnesia
Motor deficits (temporary tingling in arms)
Restless and combative
Describe a diffuse axonal brain injury
Example = gunshot wound with scattering bullet
Shearing and tearing of brain tissue
Global injury of gray matter
Results in prolonged coma
Pt has poor prognosis, would need intense rehabilitation, and is often left in vegetative state
Describe a penetrating brain injury
Deep laceration that can occur at low velocity or high velocity.
Clinical manifestations vary with location/extent of injury
Low velocity ex: knife/ice pick
High velocity ex: gun shot
Definition of an epidural hematoma
Arterial laceration and blood clot in epidural space (between dura and skull)
Develops rapidly (mins to hours)
Self limiting (usually stops spreading in first 24-48 hours)
S/S of an epidural hematoma
Pt starts out lucid before neurologic decline (as bleeding continues)
Early signs:
- HA
- Irritability
- Restlessness
Later, as brainstem becomes compressed, more neuro issues arise, but hematoma is usually corrected with surgery before it gets to this point
Treatment of epidural hematoma
Surgical evacuation through burr hole
*Early surgical intervention is key!
Subdural hematoma definition
Clot within subdural space (one layer deeper than epidural)
May be bilateral
Usually from torn cortical vein
May be multiple and associated with contusions
Occurs at all ages
Types of subdural hematomas
Acute: Develops within 48 hrs of injury
Subacute: Occurs 2 days to 2 weeks after injury
Chronic: occurs weeks to months after injury
What is worrisome about a chronic subdural hematoma?
May be missed b/c it’s often attributed to other causes
Pts may have problems with their gate
S/S of an acute subdural hematoma
(Usually similar to epidural hematoma):
- Lucid interval before decline
- Early: HA, irritability, restlessness
- Eventually progresses to unconsciousness without treatment
Treatment of an acute subdural hematoma
- Surgery must be done early
- Evacuation through burr hole
- *Pt will have post-op edema (often refractory) caused by trauma to area during surgery. *Treat with Mannitol
What is an intracerebral hematoma?
Clot deep within brain tissue
Most common cause is chronic HTN
Varied s/s
Small ones may resolve on own, large ones may require surgical excision
What is a secondary brain injury?
A brain injury that is secondary to another problem, causing further damage
Examples of secondary brain injuries
Hypoxia
Fluid and electrolyte imbalance
Hypotension
Cerebral edema
Infection
Treatment for secondary brain injuries
Same as treatment for increased ICP,
Need to focus on ABCs
