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MedSurg 2 > TBI > Flashcards

TBI Flashcards

1
Q

Expressive Aphasia

A

Difficulty with
* Speaking
* Writing

Broca or motor

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2
Q

Receptive Aphasia

Sensory or Wernicke

A
  • Made up words
  • Cannot understand
  • Meaningless speech
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3
Q

Mixed aphasia

A

Hard time reading or writing

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4
Q

Global aphasia

A

Nothing is understood

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5
Q

Right hemisphere brain damage

A
  • Vision
  • Depth perception
  • Unaffected side faces door of room
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6
Q

Focal brain injuries

A
  • seen on MRI or CT
  • Confined to one area
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7
Q

Postconcussion Syndrome

A
  • HA
  • Impaired cognition
  • Dizziness
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8
Q

Moderate to severe TBI can cause secondary injuries that result from

A
  • Hypoxia
  • Hypotension
  • Cerebral edema
  • Intracranial HTN
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9
Q

Low blood flow & hypoxemia contribute to cerebral edema

A

leads to cycle of deteriorating perfusion & hypoxic damage

Poor prognosis

From moderate-severe injury

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10
Q

Normal ICP is 10-15

  • First response to high ICP is shunted to CSF
  • Cerebral venous blood goes to sinuses or JV

Sustained ICP 20+ is detrimental

A

Leading COD when arrived alive at hospital

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11
Q

Epidural Hematoma

A
  • From temporal fracture
  • Lucid intervals
  • Unconsciousness lapses

Assess q5 min

Loss of consciousness = emergency!

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12
Q

Subdural Hematoma

A
  • Venous bleed
  • Slower than epidural hem
  • Acute within 48 hr
  • Subacute within 2 days - 2 weeks
  • Chronic weeks-mos
  • Common in elderly on anticoags who fall

Highest mortality rate!

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13
Q

Subdural Hematoma S&S

A
  • Worsening HA
  • Confused
  • Seizures
  • ALOC
  • Coma
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14
Q

Traumatic Intracerebral Hemorrhage

High ICP & brain edema result

A

Caused by
* Back of head blow
* Fracture
* Brainstem torsion

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15
Q

Uncal Herniation

Late findings

A
  • Dilated & nonreactive pupils
  • Ptosis
  • Rapid ALOC
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16
Q

Central Herniation

A
  • Cheyne-Stokes
  • Pinpoint & nonreactive pupils
  • Hemodynamic instability

Rapid response called immediately for suspected herniations

17
Q

Communicating Hydrocephalus

A

CSF outflow problem

18
Q

Hypercarbia can lead to

CO2 above 45

19
Q

Earliest indicators of worsening neurologic deterioration

A
  • BP
  • LOC
  • Pupil reaction
20
Q

Mild TBI

A
  • Unconscious <30 mins
  • No brain damage
  • HA
  • Dizzy
  • Behavior change
  • May resolve in 3 days
21
Q

Moderate TBI

A
  • Unconscious 30 min - 6 hr
  • GCS 9-12
  • Focal or diffuse brain injury

Critical care stay req’d to monitor

22
Q

Severe TBI

A
  • GCS 3-8
  • Unconscious 6+ hr
  • Must be monitored for ICP
23
Q

Mild TBI Physical Findings

A
  • Dazed
  • HA
  • N/V
  • Balance issue
  • Vision problems
  • Tired
  • Sensitive to light & sound
  • Unconscious less than 30 min
24
Q

Mild TBI Cognitive Findings

A
  • Foggy
  • Slow
  • Amnesia
25
Mild TBI Sleep & Emotional Changes
* Drowsy * Irritable * Sad * Nervous * Emotional * Depressed
26
C-Collar stays on until
Dx rule out injury to spine
27
Spinal precautions after C-collar is removed, but provider has not indicated that movement is safe
* Bedrest * No extension with pillow * No spinal flexion * Log roll | If needing to change C collar, have another person stabilize ## Footnote Assess under C-collar for breakdown
28
Cushing Triad
1. Severe HTN 2. Wide pulse pressure 3. Bradycardia | Very late ICP sign ## Footnote Indicates near death
29
Pupil assessment with TBI
* Assess for anticholinergic Rx or adrenergics * Pinpoint & nonresponsive: brainstem/pons damage * Ovoid pupil is midsize * Dilated & fixed: poor prognosis
30
Late ICP signs
* Projectile vomiting * Severe HA * Papilledema*
31
Halo Sign
Spot of blood with clear/yellow ring around it
32
Nursing Interventions for TBI
* Vitals every hour * Antihypertensives * ST or T wave changes (monitor) * Fever (higher mortality rate) * Therapeutic hypothermia (89-93) for 1-2 days * Hyperbaric O2 * Lidocaine in trachea to prevent coughing * HOB 30-45 * Mannitol through filtered needle * Foley for strict I&O * Opioids for pain causing agitation * Seizure precautions
33
Large parietal lobe lesions
Loss of pain, temperature, touch
34
Mild Brain Injury
* Tylenol for pain * No sedatives or strenuous activity
35
Mild Brain Injury Family Teaching
Report: * Seizure * Worsening HA * Blurred vision * Clear drainage from nose/ear * Weak * Slurring * Unequal pupils Major weight gain within a year of injury from inactivity

MedSurg 2 (13 decks)

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