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Exam 2 - AH > TBI > Flashcards

TBI Flashcards

1
Q

What is the Monroe Kellie hypothesis?

A

the sum of volumes of brain, CSF and intracranial blood is constant, therefore if one increases the other two could compress

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2
Q

What are the S/Sx of IICP?

A
  • change of LOC
  • agitation/confusion
  • delayed responses
  • pupil changes
  • N/V
  • HA
  • loss of reflexes
  • coma
  • CUSHINGS TRIAD
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3
Q

What is cushings triad?

A

LATE sign of IICP:
1. rising BP with widened pulse pressure
2. bradycardia
3. bradypnea

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4
Q

What is decorticate posturing?

A

flex posturing (arms in), indicates damage between brain and spinal cord

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5
Q

What is decerebrate posturing?

A

extensor posturing (arms out), indicated damage to upper brain stem and is WORSE than decorticate

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6
Q

6 Types of TBI’s?

A
  • concussion
  • severe TBI
  • open brain injury
  • basilar fracture
  • hematoma
  • hemorrhage
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7
Q

S/Sx of concussion?

A
  • altered level of consciousness
  • changes in orientation
  • pupil abnormalities
  • change in vital signs
  • headache, vomiting
    visual changes
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8
Q

What assessment is required for concussion?

A

CT is done to rule out bleed

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9
Q

Treatment for concussion?

A

Rest, treat symptoms, pt should be roused and assessed frequently

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10
Q

How is severe TBI determined?

A

Glasgow Coma Scale (3-15)

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11
Q

How can outcomes of severe TBI vary?

A

Can cause emotional changes, problems with cognition, changes in sleep patterns

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12
Q

What is an open brain injury?

A

Injury caused by objects penetrating scalp, blunt trauma

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13
Q

What is a basilar fracture?

A

Fracture at base of skull

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14
Q

S/Sx of basilar fracture?

A
  • raccoon eyes and/or battle’s sign
  • bleeding from nose/ear/pharynx
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15
Q

What is raccoon eyes/Battle’s sign?

A

Raccoon eyes is bruising around eyes, battle’s sign is bruising behind ear

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16
Q

What is there a high risk for with regards to basilar fracture?

A

CSF leak from ears or nose

17
Q

How is CSF leak tested?

A
  • look for halo sign
  • glucose dipstick
  • beta 2 transferrin test
  • note: CSF leak will present with HA
18
Q

Describe epidural hematoma?

A

Blood collection in the space between skull and dura

19
Q

Symptoms of epidural hematoma?

A
  • brief LOC on initial impact
  • then return to lucid state
  • ICP increase/expansion of hematoma occurs
  • pt has second change in LOC
20
Q

Is epidural hematoma an emergency?

A

YES - surgical procedure needed to control ICP

21
Q

Describe Subdural hematoma?

A

Collection of blood between dura and brain

22
Q

Symptoms of subdural hematoma?

A
  • change in LOC
  • pupil changes
  • coma
  • increasing BP
23
Q

Is subdural hematoma an emergency?

A

YES - surgical procedure needed to control ICP via Burr holes/craniotomy

24
Q

Describe subarachnoid hemorrhage?

A

hemorrhagic stroke - bleeding into brain caused by either trauma or non traumatic case

25
Q

Symptom of subarachnoid hemorrhage?

A

‘Worst headache of my life’, sudden and very severe pain

26
Q

Treatment for subarachnoid hemorrhage?

A

control of ICP, craniotomy

27
Q

Respiratory interventions for TBI?

A

-maintain airway and oxygenation
- balance suctioning since it increases ICP

28
Q

Neuro assessment/vitals interventions for TBI?

A
  • initially qh
  • may give meds to manage ICP
  • prevent vasospasm
  • decrease cerebral edema
  • manage temp but avoid shivering
  • avoid hypotension with fluid bolus
29
Q

What medication is given to prevent vasospasm?

A

Nimodipine

30
Q

What meds are given to manage ICP?

A

anti-epileptics, sedation e.g. benzos, morphine

31
Q

What medication is given to decrease cerebral edema?

A

Mannitol as a diuretic

32
Q

What type of meds are given to avoid hypotension?

A

vasopressors

33
Q

Describe positioning interventions for TBI?

A
  • semi fowlers (HOB 30 degrees)
  • neck neutral
  • avoid knee/hip flexion
  • exhale during repositioning
34
Q

Fluid/electrolyte balance interventions for TBI?

A
  • careful I/O’s
  • daily weight
  • monitor for sodium imbalance, hyperglycemia due to stress response
35
Q

Nutrition interventions for TBI?

A
  • tube feedings (watch aspiration risk)
  • adequate protein intake for healing
36
Q

Bowel/bladder interventions for TBI?

A
  • reduce risk of constipation/IICP (stool softeners)
  • avoid enemas
37
Q

What meds are commonly given to reduce risk of constipation/IICP?

A

Colace, Senna

38
Q

Interventions for immobility complications TBI?

A
  • prevent infection
  • prevent pressure ulcers
  • prevent DVT
  • PT/OT consult

Exam 2 - AH (17 decks)

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