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Nursing Acutely Ill > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

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1
Q

What does AVPU stand for

A

Alert
Responsive to verbal stimuli
Responsive to painful stimuli
Unconscious

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2
Q

Actions to carry out when pt has altered level of consciousness

A

GCS
PEARL
FLP
Full neurological assessment by dr

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3
Q

What are the 6 lobes of the brain?

A 
Frontal 
Parietal 
Occipital 
Temporal 
Limbic 
Lumbar cortex
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4
Q

Normal ICP value

A

<15mmHg

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5
Q

Cerebral perfusion pressure equation

A

CPP= mean arterial pressure -intracranial pressure

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6
Q

Nausea and vomiting is caused by pressure in which area of the brain?

A

Vomit receptors in the 4th ventricle on the medulla oblongata

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7
Q

3 factors that make up cushings triad

A

Decreased heart rate
Increased blood pressure
Wide pulse pressure

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8
Q

Definition of tonsillar herniation

A

Brain stem pushes down into the vertebral column aka coning

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9
Q

What are the early signs of tonsillar coning?

A

Pupil changes
Confusion
Headache

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10
Q

What is meant by the term haematoma?

A

Solid swelling of clotted blood between tissues

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11
Q

Areas of the brain susceptible to haematoma formation

A

Subdura
Cerebral epidural
Spinal epidural

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12
Q

How quickly should a pt with suspected head injury be seen?

A

<15minutes

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13
Q

4 tools of neurological assessment

A

GCS
Obs
Pupillary reaction
Limb powers

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14
Q

What are the three aspects of response that GCS measures?

A

Eye opening
Best verbal response
Best motor response

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15
Q

In GCS what is eye opening scored out of?

A

4

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16
Q

In GCS what is best verbal response scored out of?

A

5

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17
Q

In GCS what is best motor response scored out of?

A

6

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18
Q

With a diagnosis of traumatic brain injury what should the:
SaO2
PaCO2
CO2 be?

A

SaO2 normal 95-100%
PaCO2 normal 4.5-6
CO2 normal 23-29mEq/L

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19
Q

What degree should a pt with traumatic brain injury be nursed at?

A

30 degrees to reduce ICP

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20
Q

What is the function of the cerebrum?

A

Interpretation of sensory data.
Co-ordination of muscular movement
Intellectual and emotional processes.

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21
Q

What is the function of the cerebellum?

A

Co-ordination

Skilful movement, posture and balance

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22
Q

What is the function of the brain stem?

A

Communication centre between spinal cord and brain.
Houses 10/12 cranial nerve pairs.
Reflex centres for respiration, cardiovascular system and consciousness.

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23
Q

What is the function of the hypothalamus?

A

Controls autonomic nervous system.
Emotion and behaviour.
Temperature.
Maintaining circadian rhythm

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24
Q

What are the 4 functions of the frontal lobe?

A

Behaviour
Intelligence
Memory
Movement

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25
Q

What are the 4 functions of the parietal lobe?

A

Intelligence
Language
Reading
Sensation

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26
Q

What are the function of the occipital lobe?

A

Vision

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27
Q

What are the 5 functions of the temporal lobe?

A 
Behaviour 
Hearing 
Memory 
Speech 
Vision
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28
Q

What are the 5 functions of the brain stem?

A 
BP 
Breathing 
Consciousness 
Heartbeat 
Swallowing
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29
Q

What are the 2 functions of the cerebellum?

A

Balance

Co-ordination

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30
Q

What are the two pairs of arteries that supply blood to the brain?

A

Carotid and spinal arteries.

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31
Q

Name 4 of the main arteries in the brain?

A

Internal carotid artery
Middle cerebral artery
Circle of Willis
BAsilar artery

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32
Q

What are names of the 3 meninges of the brain? From outter to inner most.

A

Arachnoid membrane
Dura mata
Pia mata

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33
Q

What is the Monro-Kellie Hypothesis? What are the 3 compartments?

A

That the intercranial volume is fixed between three compartments within the brain:
Brain/intracellular water
Cerebral blood volue
Cerebrospinal fluid

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34
Q

What does the Monro-Kellie hypothesis mean in terms of volumes within the brain changing?

A

If volume in one compartment increases or decreases the other compartments compensate.. If compensation doesn’t occur ICP increases.

35
Q

What are 4 examples of factors that influence ICP?

A

Cerebrospinal fluid displacement
Cerebral blood displacement Brain volume displacement
Vasoconstriction reducing cerebral blood volume

36
Q

What is cerebral perfusion pressure?

A

Pressure required to maintain adequate cerebral blood flow.

37
Q

What is the definition of cerebral perfusion pressure (CPP)? What is CPP equivalent to?

A

Blood pressure gradient across the brain.

Equal to the difference between mean cerebral arterial and venous blood flow.

38
Q

What is the calculation for cerebral perfusion pressure (CPP)?

A

CCP= Mean arterial pressure (MAP) - Inter Cranial Pressure.

39
Q

What is the acceptable value for cerebral perfusion pressure in mmHg?

A

> 70mmHg

40
Q

Cerebral perfusion pressure below ?mmHg may lead to reduced cerebral blood flow?

A

<30mmHg

41
Q

What are the 5 stages of the cycle that increases ICP in traumatic brain injury?

A 
Increased ICP. 
Reduced cerebral blood flow. 
Tissue hypoxia. 
Increased PaCO2, decreased pH. 
Vasodilation and oedema. 
Increased ICP.
42
Q

What are the 5 common symptoms of increased ICP?

A 
Headache
Nausea and vomiting 
Pailloedema (swelling of optic disk) 
Reduced consciousness 
Cardiorespiratory signs
43
Q

What is cushing reflex?

A

Rising BP
Decreased HR
Creating wide pulse pressure
Compensatory response in an attempt to keep adequate CPP.

44
Q

What causes Cushing reflex?

A

ICP >33mmHg reducing cerebral blood flow. Simulating vasomotor centre in brain stem.

45
Q

What are the three components of Cushing’s triad?

A

Hypertension
Bradicardia
Abnormal resp rhythm

46
Q

What is Cushing’s triad a imminent sign of?

A

Brain stem herniation known as tonsillar herniation aka coning

47
Q

What is tonsillar herniation? What does it pass through?

A

Decent of brain through foramen magnum

48
Q

What are the 5 early signs of tosillar herniation?

A 
Pupil changes
Confusion
Motor weakness 
Nausea and vomiting 
Headache
49
Q

What are the 5 late signs of tonsillar herniation?

A 
Pupil changes 
Increased confusion/coma
Increasing weakness/paralysis 
CVS changes/arrest 
Respiratory changes/arrest
50
Q

What are the 4 different mechanisms of traumatic brain injury?

A

Stretching
Shearing
Contusion
Haemorrhage

51
Q

What is the mechanism of a shearing injury?

A

Pulling of nerve fibres causing damage

52
Q

What is the mechanism of a shearing brain injury?

A

Damage due to nerve fibres rubbing over one another

53
Q

What is the mechanism of a contusion brain injury?

A

Bruising on brain surface

54
Q

What is the mechanism of a haemorrhage?

A

Bleeding.

55
Q

What is a coup, contracoup injury?

A

Brain impacting on skull at point of impact (coup) then rebounding backwards to hit skull on opposite side (Contrecoup)

56
Q

What are 3 examples of a diffuse traumatic brain injury?

A

Concussion
Diffuse axonal injury
Traumatic subarrachnoid haemorrhage

57
Q

What are 3 examples of a focal traumatic brain injury?

A

Extradural haematoma
Subdural haematoma
Contusions/intracerebral haematoma

58
Q

What is concussion?

A

Mild traumatic brain injury involving a temporary impairment of neurological function which quickly self-resolves. No structural brain damage occurs.

59
Q

What occurs to cause diffusion axonal injury (DAI)? Examples of the accident in which it occurs

A

Result of shearing forces that occur due to the head rapidly accelerating and decelerating e.g. car accidents, falls, assaults.

60
Q

What is commonly the outcome of DAI?

A

Coma

61
Q

How many traumatic brain injuries are as a result of diffuse axonal injury?

A

50%

62
Q

What is a subarrachnoid haemorrhage?

A

A bleed into the subarrachnoid space.

63
Q

What are the 3 common symptoms of a subarrachnoid haemorrhage?

A

Rapid onset of a thunder clap headache
Vomiting
Altered consciousness

64
Q

What are the 4 components of a neurological assessment?

A

Vital signs: temp, pulse, resp, BP and SpO2
GCS
Limb powers
Pupillary function

65
Q

What are the three behavioural aspects of GCS?

A

Eye opening
Best verbal response
Best motor response

66
Q

What are the highest and lowest scores for GCS?

A

Highest 15

Lowest 3

67
Q

What is the eye opening aspect of GCS scored out of?

A

4

68
Q

What is the verbal response aspect of GCS scored out of?

A

5

69
Q

What is the motor response aspect of GCS scored out of?

A

6

70
Q

What GCS score requires intubation?

A

Equal or <8

71
Q

From best to worst, what are the 4 options for GCS eye opening?

A

Spontaneous
To speech
To pressure
None

72
Q

From best to worst, what are the 5 options for GCS verbal response?

A 
Orientated
Confused 
Words only
Sounds only 
None
73
Q

From best to worst, what are the 6 options for GCS motor response?

A 
Obeys commands 
Localises to pain 
Withdraws from pain 
Flexion to pain 
Extension to pain 
None
74
Q

What is the system of decreasing frequency for GCS testing for a pt following traumatic brain injury with GCS 15/15?

A

Every half an hour for two hours
Every hour for four
Every two hours after

75
Q

If GCS decreases in a traumatic brain injury patient what should be the frequency of neurological obs?

A

Every half an hour

76
Q

How soon following a CT scan for traumatic brain injury should a interpretation by a neuro consultant be provided?

A

<1 hour

77
Q

What is a primary injury?

A

Occurs at the time of injury or accident, is unable to be intervened with.

78
Q

What is a secondary injury?

A

Physiological injury that can be managed to avoid exacerbation of primary injury.

79
Q

What are 5 examples of secondary injuries?

A 
Hypoxia 
Hypotension 
Raised ICP 
Infection 
Seizures
80
Q

What are the 4 primary aims of management in traumatic brain injury?

A

Maintenance of cerebral perfusion.
Adequate oxygenation
Avoidance of hyper/hypocapnia
Avoidance of hyper/hypoglycaemia

81
Q

What is a neuromusular blockade?

A

Neuromuscular drugs used in anaesthesia known as muscle relaxants. Block the neuromuscular junction relaxing muscles of abdomen and diaphragm allowing for intubation.

82
Q

What 4 factors need to be taken into account/done in the positioning of a traumatic brain injury patient?

A

Maintain neutral head and neck alignment by log rolling pt.
Elevate head to 15-30 degrees.
Avoid uncontrolled repositioning and hip flexion
Observe and document all effects of repositioning on CPP, MAP and ICP

83
Q

What is hemiparesis?

A

Weakness to one side of the body

84
Q

What is hemiplegia?

A

Paralysis to one side of the body

Nursing Acutely Ill (11 decks)

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