TBISC

Question 1

what are the 3 components of the head

Answer 1

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

Question 2

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

Answer 2

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

Question 3

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

Answer 3

cushings triad

*systolic hypertension with widening pulse pressure

Question 4

what is a sign of increased ICP

Answer 4

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

Question 5

why do cranial nerves matter

Answer 5

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

Question 6

what cranial nerve is olfactory (smell)

Answer 6

cranial 1

Question 7

what cranial nerve is vision

Answer 7

cranial 2

Question 8

what cranial nerve is pupillary reaction

Answer 8

cranial 3

Question 9

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

Answer 9

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

Question 10

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

Answer 10

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)

Question 11

where is a basilar skull fracture and what are symptoms

Answer 11

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

Question 12

how long does a mild concussion last

Answer 12

30 minutes

Question 13

how long does a classic concussion last

Answer 13

unconscious lasting less than 6hrs

Question 14

moving force that hits stationary head

Answer 14

acceleration injury

*gunshot to stationary head

Question 15

moving head hits stationary object

Answer 15

deceleration injury

*fall and hits ground

Question 16

moving head hits a moving object

Answer 16

acceleration/deceleration injury

*car crash head on

Question 17

what is coup-contrecoup

Answer 17

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

Question 18

tearing twisting of the brain

Answer 18

diffuse axonal injury

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

Question 19

clinical signs of diffuse axonal injury

Answer 19

decrease LOC
increased ICP
decerebrate or decorticate
global cerebral edema

Question 20

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

Answer 20

epidural hematoma

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

Question 21

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

Answer 21

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

Question 22

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

Answer 22

subacute subdural hematoma

*can happen to children

Question 23

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

Answer 23

chronic subdural hematoma

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

Question 24

occurs from bleeding within the parenchyma

Answer 24

intracerebral hematoma

*usually occurs within the frontal and temporal lobes

Question 25

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

Answer 25

intracerebral hematoma

Question 26

bleeding into the subarachnoid space

Answer 26

subarachnoid hematoma

Question 27

a pt with a subarachnoid hematoma will say they have...

Answer 27

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

Question 28

what is important to know about a berry aneurysm

Answer 28

if we don't control HTN it will blow | *prevent vasospasm by giving calcium channel blocker nimodipine (give on time every day)

Question 29

what is the nursing assessment of a head injury

Answer 29

airway glasglow coma scale neuro check presence of CSF leak

Question 30

what is the best position to have injured head at

Answer 30

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

Question 31

how do we treat brain injuries

Answer 31

``` maintain airway breathing circulation start fluids raise HOB near check ```

Question 32

bruising marks behind ear indicate

Answer 32

basilar fraction

Question 33

"raccoon eyes" indicate

Answer 33

coup-contrecoup

Question 34

chronic subdural hematoma are seen in

Answer 34

alcoholics and elderly

Question 35

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

Answer 35

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

Question 36

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

Answer 36

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

Question 37

hyperflexion occurs from _______ and the head bends _______

Answer 37

compression; forward

Question 38

where is the high priority place for hyperflexion

Answer 38

cervical neck and below ribs (lower lumbar)

Question 39

hyperextension occurs when the head ______ and _______

Answer 39

accelerates and decelerates | *vertebrae may fracture or subluxate

Question 40

axial loading is a ______ force

Answer 40

vertical force | *vertebrae shatter into little pieces in spinal cord

Question 41

rotational injury is _______ of the spinal column

Answer 41

displacement (rotation)

Question 42

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

Answer 42

skeletal level

Question 43

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

Answer 43

neurologic level

Question 44

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

Answer 44

sensory level

Question 45

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

Answer 45

complete cord involvement

Question 46

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

Answer 46

incomplete (partial) cord involvement

Question 47

what is the central cord syndrome

Answer 47

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

Question 48

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

Answer 48

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

Question 49

result of damage to one half of spinal cord

Answer 49

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

Question 50

what makes the vertebral injuries unstable

Answer 50

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

Question 51

an atlanto-occupital injury is

Answer 51

internal decapitation

Question 52

a C1-jefferson fracture is known as the

Answer 52

hang man

Question 53

a C2 odontoid fracture is most common in

Answer 53

old people

Question 54

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

Answer 54

C3

Question 55

C3-C5 cervical injury is loss of _____ nerve function

Answer 55

phrenic | *phrenic nerve and intercostals are what help us breath

Question 56

C6-T8 injury is loss of _______

Answer 56

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

Question 57

T7-T12 injury is loss of

Answer 57

abdominal muscles | *very hard for them to cough

Question 58

in patients with spinal injury urinary retention is

Answer 58

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

Question 59

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

Answer 59

hypomotility; sphincter | *may need to give enemas to stimulate it to move along

Question 60

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

Answer 60

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

Question 61

what is the BIGGEST complication of cord injuries

Answer 61

``` autonomic dysreflexia *hypertension blurred vision throbbing headache marked diaphoresis above lesion level ```

Question 62

if pt has autonomic dysreflexia what interventions should be done

Answer 62

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