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NURS3007 > traumatic brain injuries > Flashcards

traumatic brain injuries Flashcards

1
Q

Define TBI

A

A form of acquired brain injury, occurs when a sudden trauma causes damage to the brain. Can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue

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2
Q

Outline effects of a TBI located in the brain stem

A

changes in:
- heart rate
- breathing
- blood pressure
- vomiting
- swallowing

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3
Q

Outline effects of a TBI located in the cerebrum

A

changes in:
- intelligence, learning, judgement
- speech and memory
- sense of hearing, vision, taste and smell
- skeletal muscle movements

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4
Q

Outline effects of a TBI located in the cerebellum

A
  • balance and coordination
  • posture
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5
Q

What is the wenicke’s area responsible for?

A

Understanding speech

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6
Q

Outline how and why cerebral blood flow is controlled

A

The brain has the ability to control its blood supply to match its metabolic requirements through vasoconstriction and dilation

CBF increases with metabolic rate, hyperthermia, seizures, pain, anxiety

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7
Q

What is an epidural haematoma?

A

Artery

Middle meningeal artery rupture usually due to blow to the side of the head, area where skull is easiest to fracture

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8
Q

What is a subdural haematoma?

A

Tars in bridging veins that cross the subdural space

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9
Q

What is meningitis?

A

Inflammation of the meninges of the brain, spinal cord or both

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10
Q

What are the 3 compartments of the brain?

A
  • cerebrospinal fluid
  • blood
  • brain tissue
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11
Q

Explain the monro Kellie doctrine

A

Swelling due to an increase in the cranial compartments.

Sum of volumes of brain, CSF, and intracranial blood is constant. An increase in one should cause a decrease in one or both of the remaining two.

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12
Q

What is the formula for cerebral perfusion pressure?

A

Mean arterial pressure - intracranial pressure = cerebral perfusion pressure

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13
Q

What is the normal cerebral perfusion pressure?

A

> 60mmHg

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14
Q

Outline examples of mechanisms of brain injury

A
  • blunt
  • penetrating
  • Motor vehicle collision
  • falls
  • burns
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15
Q

Explain what a primary injury is

A

Primary injury at the time of the event
Only treatment is by prevention

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16
Q

Explain what a secondary injury is

A

Follows initial event - preventable
Occurs as an indirect result of the primary injury and the body’s response to that injury

e.g. hypoxia, hypotension, hypercapnia

17
Q

Identify the 3 different types of TBI

A

mild - GCS 13-15, slight nausea and confusion

moderate - GCS 9-12, amnesia

severe - GCS 8, poor outcomes, secondary brain injury

18
Q

What is a concussion and the effects

A

Mild TBI
- direct blow concussion
- acceleration or deceleration injury
- reticular activating system
- transient amnesia/LOC
- nausea, vomiting, headache, vision loss, concentration

19
Q

What is a diffuse axonal injury?

A
  • severe type of TBI
  • microscopic diffuse bleeding in the brain
  • damage to the reticular activating system - unconscious
  • damage to the axons causing them to not communicate properly
19
Q

What is a diffuse axonal injury?

A
  • severe type of TBI
  • microscopic diffuse bleeding in the brain
  • damage to the reticular activating system - unconscious
  • damage to the axons causing them to not communicate properly
20
Q

What is an epidural haematoma

A

Bleeding between the skull and dura matter

  • focal injury - can be seen under CT scan
  • commonly a torn meningeal artery
  • surgical intervention needed
21
Q

What is a subdural haematoma?

A

Bleeding into the subdural space - rupture of bridging veins

Features: LOC, hemiparesis, fixed + dilated pupils

22
Q

What is a subarachnoid haemorrhage

A

Bleeding into the subarachnoid space

Causes hydrocephalus, cerebral vasospasm, fibrous scarring

23
Q

What is a cerebral contusion?

A

Bruise to the surface of the brain - caused by movement within the cranial vault

24
Q

Outline contributors to poor TBI outcome

A
  • hypoxia
  • hypercapnia
  • hypotension
  • hyperthermia
  • prevent coagulopathy (defection clotting cascade)
24
Q

Outline contributors to poor TBI outcome

A
  • hypoxia
  • hypercapnia
  • hypotension
  • hyperthermia
  • prevent coagulopathy (defection clotting cascade)
25
Q

Identify factors affecting ICP

A
  • cerebral blood flow
  • cerebral venous return
  • oxygen
  • carbon dioxide
  • blood pH
26
Q

Outline the ongoing management of TBI

A
  • sedation/analgesia
  • imaging/diagnosis
  • monitor MAP
  • observe for signs of impending
  • herniation
27
Q

What is the cerebral oedema

A

Cellular response to injury

  • hypoxic-ischaemic injury
  • injured neutrons have increased metabolic needs
28
Q

Outline treatment to reduce ICP

A
  • reduce cerebral oedema - hyperosmolar therapy
  • promote venous return
  • reduce cerebral oxygen requirement
  • reduce hyperthermia
  • management of pain and agitation
  • neurologic exam
29
Q

Outline nursing care of TBI

A
  • Hourly GCS, head positioning
  • temperature
  • cluster care
  • adequate analgesia (prevent ICP)
  • DVT prophylaxis
  • calf compressions
  • positioning

NURS3007 (10 decks)

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