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1538 Exam 3 > Traumatic brain injury > Flashcards

Traumatic brain injury Flashcards

1
Q

What are the most common causes of traumatic brain injuries?

A

falls
motor vehicle crashes
being struck by objects
assaults

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2
Q

What is a primary brain injury?

A

Damage that occurs immediately on impact of mechanical forces and cannot be reversed

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3
Q

What is secondary Brain injury?

A

Trauma that results from inadequate nutrients and oxygen to cells that happens over the next hours or days

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4
Q

What is a coup injury?

A

Brain impact against object

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5
Q

What are contrecoup injuries?

A

Impact within skull, opposite side of the skull, shearing forces cause damage throughout the brain

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6
Q

What are the three types of contents occupying the cranial vault?

A

The brain
Arterial and venous blood supply
Cerebrospinal fluid

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7
Q

The pressure exerted by the brain, arterial and venous blood flow, and cerebral spinal fluid is called?

A

Intracranial pressure (icp)

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8
Q

If the volume of any one of the three components increases, the volume of one or both of the other components must decrease proportionally or an increase in ICP will occur

A

Monro-Kellie Hypothesis

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9
Q

What is the normal value of ICP?

A

0-15 mm Hg

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10
Q

When is increased ICP a life-threatening event?

A

Increased ICP of 20 mm Hg or greater for 5 minutes or longer

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11
Q

What can cause increased intracranial pressure?

A
  1. Increased brain volume or cerebral edema
  2. Increased blood volume
  3. Increase cerebral spinal fluid
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12
Q

What can cause increased brain volume or cerebral edema?

A
  1. Tumors
    2. Abscesses
  2. Hematomas
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13
Q

What can cause increase blood volume in the brain?

A
  1. Loss of autoregulation
  2. Physiological responses to increased or decreased cerebral oxygenation
  3. Increased metabolic demands
  4. Obstruction of venous return to the heart
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14
Q

What can cause an increase in cerebral spinal fluid in the brain?

A

hydrocephalus

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15
Q

What is hydrocephalus?

A

A buildup of fluid in the ventricles deep in the brain that puts pressure on the brain and causes brain damage

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16
Q

What can nurses do to control increased intracranial pressure?

A
  1. Elevate head of bed at 30°
  2. Maintain patient’s head in neutral alignment
    3. Give stool softeners and laxatives to prevent ValSalva maneuver
  3. Maintain O2 to keep SaO2 above 90%
  4. Maintain PaCO2 at 30-35
  5. Maintain cerebral perfusion pressure of at least 70 mmHg
  6. Maintain fluid balance
  7. Avoid overstimulation
  8. Administer sedation
  9. Control post traumatic seizures
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17
Q

What are the ventilator associated pneumonia (VAP) protocols?

A
  1. Tracheal suction as needed
  2. Head of bed at 30°
  3. Good oral hygiene every two hours
  4. Good hand washing
  5. Meds to neutralize stomach secretions
  6. Ted hose or sequential compression devices (SCD’s) to prevent venous thrombi from the legs moving to the lungs
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18
Q

What can prolong suctioning cause and that the nurse should be aware of when treating a patient with ICP?

A

Suctioning can increase ICP

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19
Q

What should the ABG PaCO2 level be kept at for a patient with ICP?

A

33–35

20
Q

What does excess CO2 do to the brain?

A

Causes vasodilation of blood vessels in the brain which in turn causes an increase in blood in the brain.Blowing off excess CO2 will lower risk of increased ICP

21
Q

What will blowing off too much CO2 do to the brain?

A

Cause vasoconstriction of blood vessels within the brain reducing cerebral blood flow

22
Q

Mean arterial pressure (MAP) - ICP =

A

Cerebral perfusion pressure

23
Q

Where do we want to maintain cerebral perfusion pressure?

A

At least 60–70 mmHg

24
Q

Formula for mean arterial pressure (MAP)

A

MAP = SBP +2(DBP)/3

MAP = 120+2(80)/3 = 120+160 = 280/3= 93

25
Q

Calculate cerebral perfusion pressure

BP= 120/80
ICP = 30
A

MAP= 120+2(80)/3= 120+160/3= 280/3 = 93

CPP= 93- 30 = 63

CPP = 63

26
Q

What is the most common type of skull fracture?

A

Linear skull fracture

27
Q

Characteristics of linear skull fracture?

A
  1. Basilar occur at base of skull
  2. May include battle signs
  3. Raccoons eyes
  4. CSF leak from ears or nose
  5. Halo/target sign
28
Q

What does it mean when somebody has a depressed skull fracture?

A

The dura mater may be torn or bruised

29
Q

What is a comminuted skull fracture?

A

Multiple linear fractures that radiate from point of impact

30
Q

What are the two types of focal brain injuries?

A
  1. Contusion

2. Hematomas

31
Q

What constitutes most common type of brain injury?

A

Contusion

32
Q

What is a contusion?

A

Bruising of brain tissue with associated hemorrhage and edema formation

33
Q

What are the three types of hematomas?

A
  1. Epidural
  2. Subdural
  3. Intracerebral
34
Q

A collection of blood between skull and Dura Mater usually caused by arterial from tearing of middle meningeal artery

A

Epidural

35
Q

Collection of blood below Dura Mater caused by Venous bleeding

A

Subdural

36
Q

A hemorrhage into brain tissue that creates a mass lesion

A

Intracerebral hematoma

37
Q

What type of injuries are considered diffuse brain injuries?

A
  1. Concussions

2. Diffuse axonal injuries

38
Q

In diffuse brain injury, what happens to the cells in the brain?

A

The cells in the brain become damaged

39
Q

What are the most common mechanisms of injuries in diffuse brain injury?

A
  1. Acceleration – deceleration injuries

2. Rotational forces

40
Q

What is the definition of a concussion?

A

Transient disturbance of neurologic function

41
Q

What can cause a concussion?

A
  1. Rapid acceleration – deceleration

2. Sharp blow to head

42
Q

Concussions can cause what injuries in the brain?

A
  1. Axonal shear

2. Tension or strain

43
Q

What results in transient loss of function?

A

Concussion

44
Q

How can concussions be classified?

A

As mild or classic

45
Q

Describe what a mild concussion is.

A
  1. Produces no loss of consciousness by brief period of confusion and disorientation
  2. Patient may or may not experience retrograde amnesia (inability to recall events just proceeding injury)
46
Q

Describe what a classic concussion is.

A
  1. Involves a temporary loss of consciousness
  2. Usually less than five minutes
  3. No longer than six hours
  4. Retrograde or post traumatic amnesia always present
    
47
Q

What kind of symptoms can a person with classic concussion show?

A
  1. Headache
  2. Dizziness
  3. Vertigo
  4. Nausea
  5. Visual disturbances
  6. Difficulty in concentration
  7. Poor memory
  8. Behavior disorders
  9. Irritability
  10. Anxiety
  11. Insomnia

1538 Exam 3 (2 decks)

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