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Module 7 > TBISC > Flashcards

TBISC Flashcards

1
Q

what are the 3 components of the head

A

brain tissue
blood
CSF
*monroe kelly hypothesis is if the volume of one of the 3 increases then the volume of the other two must decrease

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2
Q

when ICP is increases what is the first thing that displaces in the head

A

cerebral spinal fluid
*next thing to go is blood volume then brain tissue herniates into the foreman of monroe because it has no where else to go

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3
Q

what is an ominous sign of potential brainstem herniation and impending death

A

cushings triad

*systolic hypertension with widening pulse pressure

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4
Q

what is a sign of increased ICP

A

when pt is talking and all a sudden vomits or has posturing

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5
Q

why do cranial nerves matter

A

can be compressed as the brainstem is compressed, and warn of impending herniation

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6
Q

what cranial nerve is olfactory (smell)

A

cranial 1

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7
Q

what cranial nerve is vision

A

cranial 2

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8
Q

what cranial nerve is pupillary reaction

A

cranial 3

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9
Q

if patient has vision problems what can you do to help them

A

show them around the room, show them always, leave call light with them, when they are eating describe their plate like a clock

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10
Q

what are the 3 points in time death can occur after a head injury

A

immediately after the injury (massive head injury)
within 2 hours after injury (increase in bleeding or swelling)
3 weeks after injury
(ischemia, been in hospital long enough to become septic)

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11
Q

where is a basilar skull fracture and what are symptoms

A

at the base of skull
CSF leaks from ears, nose, or both
*dont pack ears or nose to stop it, don’t use NG tube either

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12
Q

how long does a mild concussion last

A

30 minutes

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13
Q

how long does a classic concussion last

A

unconscious lasting less than 6hrs

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14
Q

moving force that hits stationary head

A

acceleration injury

*gunshot to stationary head

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15
Q

moving head hits stationary object

A

deceleration injury

*fall and hits ground

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16
Q

moving head hits a moving object

A

acceleration/deceleration injury

*car crash head on

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17
Q

what is coup-contrecoup

A

brain hits skull surface (coupe) brain hits the skull surface opposite of first hit (contrecoup)

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18
Q

tearing twisting of the brain

A

diffuse axonal injury

*know it happens because pt comes in unconscious and stays unconscious

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19
Q

clinical signs of diffuse axonal injury

A

decrease LOC
increased ICP
decerebrate or decorticate
global cerebral edema

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20
Q

results from bleeding between the dura and the inner surface of the skull

A

epidural hematoma

*walking dead man because knocked out at the scene but regains consciousness at some point and becomes unconscious again

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21
Q

occurs from bleeding between the dura mater and arachnoid ayer of the meningeal covering of the brain

A

subdural hematoma
*a tear in the small bridging veins is the most common source
slower than an epidural bleed

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22
Q

after initial bleeding, subdural hematoma may appear to enlarge over time, rebelled, or never really stop is called…

A

subacute subdural hematoma

*can happen to children

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23
Q

subdural that you can’t see any changes due to big amount of space in the head
seen in chronic alcoholics from cerebral atrophy

A

chronic subdural hematoma

*peak incidence in sixth and seventh decade of life as we get older brain shrinks

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24
Q

occurs from bleeding within the parenchyma

A

intracerebral hematoma

*usually occurs within the frontal and temporal lobes

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25
Q

can not evacuate this hematoma but you can open up a skull flap to let swelling go out

A

intracerebral hematoma

26
Q

bleeding into the subarachnoid space

A

subarachnoid hematoma

27
Q

a pt with a subarachnoid hematoma will say they have…

A

migraine, light sensitive, nuchal rigidity, nausea and really high BP

28
Q

what is important to know about a berry aneurysm

A

if we don’t control HTN it will blow

*prevent vasospasm by giving calcium channel blocker nimodipine (give on time every day)

29
Q

what is the nursing assessment of a head injury

A

airway
glasglow coma scale
neuro check
presence of CSF leak

30
Q

what is the best position to have injured head at

A

pt semifowlers (30 degrees) and head midline so they can drain from both sides

31
Q

how do we treat brain injuries

A 
maintain airway
breathing
circulation
start fluids
raise HOB
near check
32
Q

bruising marks behind ear indicate

A

basilar fraction

33
Q

“raccoon eyes” indicate

A

coup-contrecoup

34
Q

chronic subdural hematoma are seen in

A

alcoholics and elderly

35
Q

temporary neurologic syndrome which is decrease of reflexes, loss of sensation, placid paralysis below injury site

A

spinal shock

*these symptoms may last weeks to months, but can resolve from time of injury to when they arrive at hospital

36
Q

loss of vaso motor tone which is venous pooling of blood, decrease CO

A

neurogenic shock
*careful use of IV fluids and use pressors
liters of fluid will do NOTHING for them so we use pressor to constrict

37
Q

hyperflexion occurs from _______ and the head bends _______

A

compression; forward

38
Q

where is the high priority place for hyperflexion

A

cervical neck and below ribs (lower lumbar)

39
Q

hyperextension occurs when the head ______ and _______

A

accelerates and decelerates

*vertebrae may fracture or subluxate

40
Q

axial loading is a ______ force

A

vertical force

*vertebrae shatter into little pieces in spinal cord

41
Q

rotational injury is _______ of the spinal column

A

displacement (rotation)

42
Q

what level of injury is the vertebral level where there is most damage to vertebral BONES and LIGAMENTS

A

skeletal level

43
Q

what level of injury is the LOWEST SEGMENT OF SPINAL CORD with normal sensory and motor function on both sides of the body

A

neurologic level

44
Q

what level of injury is it where there is no or decreased sensation below and normal sensation above

A

sensory level

45
Q

results in total loss of sensory and motor function below level of injury

A

complete cord involvement

46
Q

results in a mixed loss of voluntary motor activity and sensation and leaves some tracts intact

A

incomplete (partial) cord involvement

47
Q

what is the central cord syndrome

A

the central of the central cord is damaged

  • occurs most common in cervical cord region
  • motor weakness and sensory loss are present in both upper and lower extremities
48
Q

in a patient with central cord syndrome is the loss greater in the arms or legs

A

arms

*will still be able to move the legs in bed… eventually may be able to walk again but way later

49
Q

result of damage to one half of spinal cord

A

brown-sequard syndrome

  • loss of motor function and position and vibration sense on same side of injury (paralysis on same side as lesion)
  • the opposite side has loss of pain and temp sensation below level of lesion
50
Q

what makes the vertebral injuries unstable

A

if there is a ligament and tendon damage

*get MRI if not done in first 72hrs you won’t see it because edema will cover it up

51
Q

an atlanto-occupital injury is

A

internal decapitation

52
Q

a C1-jefferson fracture is known as the

A

hang man

53
Q

a C2 odontoid fracture is most common in

A

old people

54
Q

a cervical injury above ___ is almost always going to be on a ventilator

A

C3

55
Q

C3-C5 cervical injury is loss of _____ nerve function

A

phrenic

*phrenic nerve and intercostals are what help us breath

56
Q

C6-T8 injury is loss of _______

A

intercostals

  • these patients will be see saw breathing, using everything they have left to breathe, rocking back and forth
  • make sure they get oxygen, stays sitting up
57
Q

T7-T12 injury is loss of

A

abdominal muscles

*very hard for them to cough

58
Q

in patients with spinal injury urinary retention is

A

common

*make sure they are emptying at regular tines and bowels move at regular times to prevent UTI

59
Q

if cord injury is above T5 GI problems will be related to ______ and injury at T12 or below is decreased _______ tone

A

hypomotility; sphincter

*may need to give enemas to stimulate it to move along

60
Q

in a spinal cord injury they have decreased ability to ____ and ____ below the lesions

A

sweat and shiver

  • lose ability to regulate their body temp
  • make sure temp is suitable for pt because they take on temp of the room
61
Q

what is the BIGGEST complication of cord injuries

A 
autonomic dysreflexia
*hypertension
blurred vision
throbbing headache
marked diaphoresis above lesion level
62
Q

if pt has autonomic dysreflexia what interventions should be done

A

elevate HOB 45 degrees or sit upright
notify physician
immediate catheterization
*major cause of this is full bladder or bowel

Module 7 (8 decks)

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