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Medsurg > TBI/SCI & ABD > Flashcards

TBI/SCI & ABD Flashcards

Traumatic brain and spinal cord injury

1
Q

Explain how to do a neurological exam for a traumatic Brian injury

A

ABC
GCS : obj level of patients conscious state : eye opening, verbal response, motor response ( 8 or less is comatose)

Pupils:
Movement (in coma patient check for gag or corneal reflex)

observe for signs of trauma

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2
Q

what is motor strength scaling

A

range motor strngth out of 5

motor exam assessment is these results:

1 - no response
2 - abdominal extension
3- abdominal flexion
4 - withdraw from pain
5 - localizes pain
6 - obeys commands

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3
Q

what are the trauma signs of traumatic brain injury (posturing)

A

posturing = severe brain damage
flexor posturing (cerebral hemispheres)

extensor posture (deeper brain structures, including the midbrain, pons, and brain stem)

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4
Q

what are the mild vs severe signs of traumatic brain injuries?

A

mild:
- loss of consciousness for seconds to min
- headache
- nausea / vomiting
-fatigue
- speech problems

mod to servere:
- loss of consciousness for several minutes to hour s
-headache
- repeated nausea and vomitting
- seizures
- dilation of one or both pupils
- clear fluid from nose or ears
- weakness
- agitation
- slurred speech

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5
Q

What are the classification and types of injury (how are each presented and treated)

A

penetrating injury - a head injury in which the dura mate (outer layer of menaces is breached) :

     - perforating - through and through injury 
     - tangential - victim of a blast injury 
     -  penetrating - object is lodged in the skull

concussion : low velocity injury resulting in function deficit without pathology injury , balance and coordination may be affected. most common symptom is a headache

Acceleration & Deceleration Injuries
coup : site of impact
counter coup : when the brain hits the back of the head when it moves back after impact

Diffuse Axonal Injury - long connecting fibers in the brain are sheared as the brain accelerates and decelerates

bleeds :

epidural

subdural

subarachnoid

intracerebral :
- intraparenchymal - blood in brain tissues
- intraventricullar - blood in ventricles
decompress brain by removing skull

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6
Q

what are the 4 potential complications of a head injury

A
  1. cerebral edema & herniation
    herniation is Cushing triad ,
    treat the underlining edema first
  2. seizures
    - antiepileptic medication for prophylaxis ( keppra 500 mg BID)
  • any suspicion for subclinical seizures requires continuous eeg
  1. hydrocephalus
    normal flow of csf in brain is obstructed causing abuld up of fluid and inc size of ventricles

treated with a diversion of csf with conversion to a shunt is needed
- External Ventricular Drain

  1. alterations of neuroendocrine function of hypothalamus and pituitary system
  • diabetes insipidus ( oc diuresis)
  • syndrome of inappropriate antidiuretic hormone (makes body hold water)
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7
Q

what is Cushing triad and how do nurses manage it?

A

Acute herniation : EMERGENCY

  1. increased BP
    pulse pressure: SYSTOLIC BP - DIASTOLIC
    causes edema
  2. Decreased HR
  3. Decreased RR or irregular pattern (compression of respiratory center in brain)

treat underlining cause of edema

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8
Q

traumatic vs non traumatic spinal cord injury

A

traumatic :
- flexion/extension/compression
- fractures
-hematomas

non traumatic:
- tumors
- infection
- stenosis (narrowing of blood vessel)
- ischemic injury
- AVMSs

Neuromuscular disease can present with weakness

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9
Q

etiology of a spinal cord injury

A

fractures
dislocation
tumors
hematomeas
abscesses
ischemic injuries (spinal stroke)

penetrating injuries accounts for half of spinal injuries in urban centers

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10
Q

major cause of death for spinal cord injury

A

aspiration and shock

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11
Q

mechanisms of injury for a SCI (what are the ways you can injure yourself)

A
  • compression - weight of head driven into neck
  • flexion - excess anterior movement of head to ches t
  • extension - excess posterior movement of the head and neck
  • rotation - forcefully rotation of head and neck
  • lateral bending/stress - lateral force to spine
  • distraction - hanging , extension of spine
  • penetration
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12
Q

Explain the ASIA scoring

A

Determine motor and sensory through classification of preserved function

A = COMPLETE , no motor or sensory function is preserved in the sacral segment S4-S5

B - D IS INCOMPLETE

B = sensory but NO MOTOR

C = Motor function but not up to the req level. MORE THAN HALF of muscles have a muscle grade of 3 (active against gravity but not super strong)

D= motor function but not up to the req level. LESS THAN HALF of muscles have a muscle grade of 3 or more

E = youre normal baby

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13
Q

what are some spinal precautions

A
  • dont over extend yourself.

watch out for motor vehicle crashes

be careful about falling

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14
Q

ex of spinal syndromes

A

incomplete injuries (still some residual sensory and motor function, not a complete spinal injury)

Central cord syndrome - MOST COMMON . Injury to the center portion of the cervical cord .
- Weakness of the arms
- from HYPEREXTENSION with CERVICAL STENOSIS

Brown Squared Syndrome - Rare
- Weakness or paralysis on one side of the body and loss of sensation on the opposite side
- Damage to half of the spinal cord FROM TUMOR, TRAUMA , infection, disc herniation, inflammation disease

Anterior Cord Syndrome -
Complete motor paralysis and loss of temp and pain perception distal to the lesion which some sensory
- caused by COMPRESSION of anterior spinal artery
- ASSOCIATED WITH BURST FRAACTURES

Cauda Equina Syndrome - nerve roots of the caudal equine are compressed
symptoms : weakness, difficulty urinating, loss of rectal tone, saddle anesthesia
MEDICAL EMERGENCY

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15
Q

different types of spinal cord injuries

A

Complete
- no residual function more than three levels below the injury affecting both sides equally

Incomplete
- any residual sensory or motor function below the injured level

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16
Q

acute complications of SCI

A

1.) Spinal Shock - transient depression or loss of reflex activity below the level of the injury. Neurogenic Shock - CAN BE LIFE THREATENING form of distributive shock. SUDDEN loss of autonomic tone due to spinal injury.

causes hypotension and bradycardia
1. Neurogenic Shock management :
Fluids and vasopressors obviously girl they’re BRADYCARDIC ,

inc perfusion to spinal cord after injury (Have a high MAP GOAL >65)

atropine for bradycardia (inc HR) OR PACEMAKERS

Airway support if needed

2.) Autonomic Dysreflexia - the sympathetic system works but the parasympathetic system signals are blocked from the site of injury to calm it down (HTN, Bradycardia) typically starts with a headache

  1. Dysreflexia Management :
  • remove cause of stimulation (drain bladder)
  • position position upright
  • loosen tight clothing
  • antihypertensive drugs
  • recognize triggers and avoid stimuli to prevent attacks
17
Q

Nursing and medical management of spinal cord injuries

A
  1. stabilization of spine (surgery, brace, traction)
    C spine - take 2 to 3 nurses to turn

T spine - no bending at the waist , or using arms to support

Full spine - log roll,

  1. distraction shock management : fluids, resuscitation, atropine to inc hr , vasopressors as needed d

-steroids (DONT GIVE)

  1. intensive support card

Management:
Neuro assessments
Pain Management (neuropathic pain)
Resp ( manage secretions, watch for pulmonary toileting)
CV
GI/GU
Skin - freq turns
DVT Prophylaxis

18
Q

cause of spinal tumors

A
  • viruses
  • exposure to certain chemicals and hazardous materials
  • genetic diseases such as tuberous sclerosis
19
Q

clinical manifestations of SCI

A
  • obvious spine deformitive
  • pain or absence of sensation on spine
  • trouble walking
  • numbness
  • bladder and bowel dysfunction
20
Q

Diagnostic approaches of SCI

A

ASIA Score
Motor Strength Exam
MRI

21
Q

Management of spinal tumors

A
  • surgical resection and stabilization of spine

-radiation therapy
- chemo
- steroids to reduce swelling

22
Q

Lead cause of death in spinal cord injury after initial injury

A

pneumonia, pulmonary embolism and sepsis

23
Q

primary prevention of abdominal trauma

A
  • seatbelts
  • helmets
24
Q

golden hour vs platinum 10 ABD Trauma

A

golden hour: the critical time immediately after injury (first hour)

platinum 10 minutes: restrict the time of prehospital care at that location of injury for no more than 10 minutes. they should just stabilize the patient and bring them to the local trauma center IMMEDIATELY. however some life saving things in the field can be done.

25
Q

what is the trauma primary survey and the trauma secondary survey

A

primary survey: access and treat life changing injuries rapidly. for injued but stable patients

Airway ( w/ cervical spine protection)
Breathing (w/ ventilation)
Circulation (with hemorrhage control - stop bleeding)
Diability (neuro status)
Exposure and Environmental control (completely undress patient to ensure that do injuries are missed, then recover to avoid risk of hypothermia)

secondary survey: rapid but thorough head to toe assessment, performed after primary and initial stabilization AMPLE

A allergies
M medications
P Past medical history
L last meal
E events surrounding injury

then do physical assessment in all parts of the body ( head , jaw, neck , chest and, perineum, tubes and fingers etc)

26
Q

with is the etiology of abdominal trauma : blunt vs penetrating

A

blunt:
- motor vehicle crash
- motorcycle crash
- pedestrian vs car
- assault with blunt force
- fall

penetrating
- foreign object perceiving skin and entering the body
- stab wound
- gun shot

27
Q

what is the pre op nursing management

A

pre op:
- prep for OR
- fluid resuscitation
- ABCs
- management of pain
- freq abd assessments (distention, pain & firmness) - could be is signs of intrabdominal hypertension —> and compartilazation )

  • prevent the lethal triad
    severe blood loss/ dec perfusion to the tissues leads to hypothermia which leads to decreased coagulation ( blood clotting problem), hemorrhaging can cause this aswell — coagulopathy leads to inc lactic acid in the blood (acidosis) and decreased heart performance, leads to hypothermia again
28
Q

3 most common complications from pre and post op abdominal surgery

A

abdominal compartment syndrome -
sustained abdominal HTN
- abnormally increased pressure within the abdomen that is associated with multiple organ dysfunction ( brain ischemia, impairing venous return/ blood flow etc)

clinical manifestations - abdominal distension , oc pain, tachypnea or dyspnea

Treatment: RELIEVE THE PRESSURE

renal injury -
AKI (prerenal secondary to hypovolemia)
intra renal (toxins from iv dye and antibiotics, prolonged hypotension)

monitor urine output
0.5mL/kg/hour

monitor creatine, bun , electrolytes

infection -
monitor for sepsis
S- shivering or fevre
E extreme pain
P paleness
S sleepy
I feel like I might die
S SOB

give a infection prophylaxis or exact med

29
Q

what is the FAST exam?

A

focuses assessment with sonography and trauma , access for peritoneal bleeding. its important to do it FAST ( less than 5 minutes)

postivit fast exam in an unstable patient means patient is going to the OR IMMEDIATELY , if its neg, then do a CT scan

30
Q

6 common injuries in blunt abdominal trauma (dont need to know management)

A

Lacerations:
- liver
- spleen
- renal

hematoma:
- bowel
- pelvic
- retroperitoneal

31
Q

what is the post op nurse management for abdominal surgery?

A

respiratory - monitor and protect AB , monitor vitals esp pluse ox and respiratory, monitor lung expansion , monitor vitals

CV - systolic bp above 90 , neuropathy checks, fluid resuscitation
crystalloid for IV fluids like saline

colloid remain introvascular longer, so use for bleeding (albumin, frozen plasma)
I& O’s
Vasopressors

Hematologic
- prevent trauma triad of death (stop the bleeding ) , WAM BLANKETS, ROOM TEMP HIGH , WARM FLUIDS, MAX OUT O2

GI
Frey assessments
palpate for pain or tenderness
BLADDER PRESSURE - used to identify intraabdomianl HTN and potential abdominal compartment syndrome. measure with urinary Cather.

decreased gastric motility ,

give protein , weigh patient daily, replace electrolytes

Skin/surgical sight itself
- incision assessment
dec cap refill , cold extremities

32
Q

how to treat intracrhail hypertension

A
  • track Increased IntraCranialPressure Multimodality Monitors : monitors the pressure . If its more than 15 mmHg,

to reduce:
elevate head of med
minimize hip flexion
proper neck alignment
hyperventilation (rescue measure, not more than 15 minutes)

  • Hyperosmolar Therapy , give hypertonic saline, mannitol or lassie
    Sodium HIGH brain will FRY
    Sodium low brain will BLOW
  • Surgical Decompression , take out a piece of the skull

Medsurg (13 decks)

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