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Critical Care Nursing Exam 3 > TBI's and SCI's > Flashcards

TBI's and SCI's Flashcards

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1
Q

what is a primary injury?

A

effect on the brain at the time of injury

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2
Q

examples of causes of a primary injury?

A

trauma- contusion, damage to blood vessels, axonal shearing, contusion, epidural/subdural hematoma, SAH, DAI

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3
Q

what is axonal shearing?

A

when the axons of neurons are stretched and torn

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4
Q

what is a secondary injury?

A

complications that result in additional changes and dysfunction of brain tissue
after injury resulting in further damage or even death

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5
Q

examples of secondary injuries?

A

hypoxemia, hypotension, hypo/hyperglycemia, increased metabolic demands, loss of auto regulatory mechanisms, increased ICP, hypo or hypercapnia

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6
Q

what is a DAI?

A

diffuse axonal injury, is a form of TBI

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7
Q

when do DAIS occur?

A

when the brain rapidly shifts inside of the skull as an injury is occurring; the axons in the brain are sheared as the brain accelerates and decelerates inside of the skull

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8
Q

what part of the brain do DAI’s occur in?

A

many parts of the brain

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9
Q

what happens to most patients with a DAI?

A

comatose state

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10
Q

how is clinical presentation assessed?

A

using the GCS

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11
Q

what GCS score indicates a mild TBI?

A

13-15

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12
Q

what GCS score indicates a moderate TBI?

A

9-12

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13
Q

what GCS score indicates a severe TBI?

A

<8

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14
Q

what might a mild TBI cause?

A

functional deficits weeks or months following injury

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15
Q

What might we be able to see on a CT?

A

hematomas, bleeding, fractures, cerebral edema

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16
Q

what might we be able to see on an MRI?

A

DAI, brain stem injury, traumatic aneurysms

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17
Q

what does management of TBIs focus on?

A

optimizing functional recovery and prevention of secondary injury

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18
Q

things assessed and monitored to prevent secondary injury?(8)

A 
airway
oxygenation
ventilation 
fluid management
ICP
cerebral perfusion
preventing increased cerebral oxygen demand
preventing complications
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19
Q

ways to support cerebral perfusion?

A 
pressors:
dopamine
levo
neosynephrine
epinephrine
EEG
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20
Q

what are some examples of secondary complications?

A

pneumonia
PE
DVT
skin integrity

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21
Q

Ways to prevent secondary complications?

A

blood thinners
lung assessments
oral care
q2h turns

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22
Q

what are some examples of skull fractures?(3)

A

linear
depressed
basilar

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23
Q

what is a linear fracture?

A

generally not displaced, a hairline fracture

24
Q

what is the treatment for a linear fracture?

A

no tx needed

25
Q

what is a depressed fracture?

A

inward depression of bone fragments

26
Q

what is a treatment for a depressed fracture?

A

surgery

27
Q

what is the main concern with depressed fractures?

A

brain damage

28
Q

what is a basilar fracture?

A

involves the base of the skull

CSF leaks from nose/ears indicates dural tear

29
Q

what is a major indicator of a basilar fracture?

A

battles sign- bruising behind the ears

30
Q

what is the best way to test for a CSF leak?

A

pH paper

31
Q

what are the most common causes of SCI’s?

A
  • MVA
  • falls
  • acts of violence
  • sports-related
32
Q

what is the most common cause of a SCI?

A

MVA with 48% resulting from them

33
Q

what is the most common population to get a SCI from a fall?

A

the elderly

34
Q

what does an SCI result from?

A

bone, disk material, or foreign object entering the spinal canal and disrupting the spinal cord or blood supply

35
Q

What are the mechanisms of injury for an SCI?

A
  • whiplash (hyperflexion/extension)
  • axial loading, compression (diving and hitting head)
  • rotation
  • penetrating trauma (knife, GSW)
36
Q

types of SCI damage?

A
  • concussion (shaking of brain, spinal cord)
  • contusion (bruising)
  • laceration(cut)
  • transection (severing)
  • hemorrhage (bleeding out)
  • blood vessel damage
37
Q

what will you see with secondary injury?

A

HA, changes in LOC, respiratory fx

38
Q

what is neurogenic shock shown by?

A 
MAP, CVP, CPP
loss autonomic nervous system influence (T1-L2)
decreased HR
vasodilation
edema
39
Q

what is an incomplete SCI?

A

varying degree of sensory and motor function disruption because some tracts intact

40
Q

what is a complete SCI?

A

total loss of sensory and motor function below level of injury
caused by complete interruption of pathways

41
Q

what is the presentation with neurogenic shock?

A

hypotension, warm-flushed skin, diaphragmatic breathing

42
Q

treatment for neurogenic shock?

A
  • dopamine
  • vasopressin
  • ephedrine
  • norepinephrine
  • phenylephrine
  • atropine
43
Q

what is the first line treatment for neurogenic shock?

A

phenylephrine

44
Q

what is an example of a muscle relaxant?

A

cyclobenzaprine

45
Q

what is an example of an anticonvulsant?

A

levatiracetam

46
Q

what is an example of an antineuropathic?

A

gabapentin

47
Q

what is autonomic dysreflexia?

A

a life threatening condition in pts with injury at or above T6

48
Q

what can autonomic dysreflexia precipitate?

A

seizure or stroke

49
Q

what is autonomic dysreflexia caused by?

A

unopposed sympathetic response below level of injury

50
Q

when can autonomic dysreflexia occur?

A

anytime after spinal shock resolves, usually in first year after injury

51
Q

what triggers autonomic dysreflexia?

A
  • over distended bladder
  • full rectum
  • infection
  • pressure sore
  • pain
52
Q

what is the most common cause of autonomic dysreflexia?

A

over distended bladder

53
Q

what does the stimulus from causes of autonomic dysreflexia cause?

A

marked elevation in blood pressure

54
Q

symptoms of autonomic dysreflexia?

A
  • severe HA
  • nasal congestion
  • SOB
  • nausea
  • blurred vision
  • facial flushing
  • diaphoresis
  • piloerection
  • anxiety
55
Q

what is the difference between neurogenic shock and autonomic dysreflexia?

A

shock has hypotension and bradycardia

autonomic dysreflexia is a hypertensive crises

Critical Care Nursing Exam 3 (5 decks)

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