Traumatic Brain Injury Flashcards
Traumatic Brain Injury could be described as…
Damage to the brain from an external mechanical force. Not caused by neurodegenerative changes or congenitial causes.
What is the most common CAUSE of TBI?
state population of people if applicable
- Falls: elderly, alcohol and drug influecned indiviuals
2. Motor Vehical Accidents
A patient arrives to the ED stating that he got into a fight in the park and got punched in the head. What type of scan is preferred to detect TBI?
CT Scan
A patient is diagnosed in the ED with a mild concussion. After patient education and final assessments are completed, what is the next step for the patients care?
Discharge home
A nursing student is learning about neurological disorders, what five disorders will he/she be learning about?
- Traumatic Brain Injury
- Neurodegenerative Conditions
- Stroke
- Brain Tumors
- Spinal Injury
A family member of a patient who had a traumatic brain injury asks the nurse how often do these patients have long term diabilities. What is an appropiate response of the nurse?
All patient prognosis is different; however, about 1/3 of people with TBI will have long term disability.
A patient in a recent AMA is brought to the Trauma ICU, upon arrival the nurses need to turn the patient to assess a gash coming from the back of the head. What is the safest way to turn the patient to prevent spinal injury?
Log Roll
How is the brain positioned in the skull?
Floating in cerebral spinal fluid
What are the meningeal layers that help protect the brain?
Dura Mater
Arachoid Mater
Pia Mater
A nursing student asks her professor what a head injury is, what is the best definition the professor will provide?
A broad term that is an injury to the scalp, skull, brain or blood vessels.
When is a head injury classified as a TBI?
When the head injury causes brain damage.
A 7 year old child comes to the Pediatric ED bleeding from his forehead. The patient says he feel on a pebble while at recess. When you assess the wound, a thick piece of skin is missing from the child’s forehead and the cut is deep. What type of head injury would you describe this as?
Scalp injury
A patient diagnosed with a linear skull fracture asks the nurse what that means and how to care for it, what is the best response from the nurse?
A linear skull fracture is a simple crack in the skull. It is non-depressed (meaning it doesn’t sink in) and usually is caused by low-impact forces. The staff will monitor for possible hematomas that can occur under the crack, which could cause temporary loss of consciousness. If not hematomas develop, the patient can go home.
What is an important education concept that nurses should teach their patients going home with mild head injuries?
If begin to be symptomatic, seek medical attention.
A patient arrives to your unit with am unopened depressed injury to his frontal bone. The report says the CT scan show multiple cracks in the skull. How would you as a nurse best decribe possible injury?
The frontal bone is more likely to crack. The patient most likely has a comminuted fracture, because of the depression and multiple cracks.
A 26 year old male patient who has a bullet wound to the head is rushed to the ED. Blood is everywhere and the patients fractured skull is exposed. How would you educate the family of this diagnosis?
The patient has a compound head fracture. There is a puncture wound through the skin and cracked bone is exposed.
A patient enters the ED anxious and paranoid. He yells that he has escaped from being murdered. Other than his behavior he seems medically fine, until he passes out, falling forward, and the nurse discoveres a large laceration and depression on the base of his skull. It looks as though the patient was attacked with an axe to the back of the head. What kind of fracture would the nurse determine the patient has? What will the nurse recognize as a common presentation with this diagnosis?
Basilar fracture!
The nurse would expect to see raccoon eyes and possible CSF leakage from the nose or ears.
A nursing student must understand that primary traumatic brain injuries are the result of…
Open head injuries: skull fracture usually from foreign object penetration causing laceration of brain tissue and vessels
Closed head injuries: no skull fracture and skin closed usually from concussion, brain contusion (bruising), diffuse axonal injury, or vessel tearing (resulting in hemmorage)
A 8 week old baby comes to the pediatric ED unconscious and the parents are saying that the child rolled off the couch. After assessing the patient and having a CT scan, it appears that the baby has suffered from contrecoup force to the head. The nurse should detect that the cause to this injury is what?
Shaken Baby Syndrome
This puts the baby at risk for brain contusion, which could result in swelling and possible TBI.
How would a nurse describe a diffue axonal injury to a nursing student?
Nerves are torn b/c of force injury to the head. This could lead to coma or slight vegetative state.
A football player lost consciousness after a play at a game 30 mins ago. The responders say that the patient was unconscious for 15 minutes. Why is the nurse suspecting a concussion?
Football players have the risk of getting hit in the head, with high intensity and force. When people get concussions they may or may not loss consciousness for 0 to 30 minutes.
A nurse has a patient that is diagnosed with traumatic brain injury r/t force. What should the nurse be most concerned about?
*Contusion (bruising, which could lead to swelling)
Intracranial hemorrhage
Diffuse axonal injury
A patient comes in after being in a motor vehical accident. In the accident, the patient felt her head go back and forth a couple times against the steering wheel and then the headrest. What type of brain injury would the nurse suspect?
Contrecoup: another example would be shaken baby syndrome
A patient who describes there injury as whiplash is most likely to have what kind of brain injury?
Acceleration
A patient comes to the ED after running into the newly cleaned glass sliding door. What type of brain injury would the nurse suspect?
Deceleration
Patients diagnosed with a mild TBI would be expected to have a GCS of what?
GCS 13-15
0-30mins loss of consciousness
A patient who got whiplash from a softball hitting him in the jaw without paying attention, passed out for 2 hours and has a GCS of 11. What level of TBI does the nurse believe the patient has? What is the patients plan of care?
Moderate TBI
Hospitalize for a minimum of a day; monitor for risk of hematoma, brain contusion or anxonal injury; really monitoring ICP
GCS 2-12
30mins-6hrs loss of consciousness
The nurse is taking an exam and there is a question on severe TBIs. The nurse understands that severe TBIs…
Have a GCS of 3-8
>6 hours loss of consciousness
Caused by a crushing blow or penetrating injury
Low chance of survival
How would a nurse define a secondary brain injury?
Any process that occurs after inital injury and worsens outcome
In secondary brain injuries intracranial hemmorage and edema both have the negative potential to cause?
Hypoxia: enough blood or edema builds up and compresses the vesses that are giving the brain oxygen
A patient comes to the ED with a head injury from a bar fight. The injury is under control, but a couple days later morning labs are drawn and show a WBC count of 14,000 and the patient has aa temperature of 101.3. The patient complains of a stiff neck and fatigue. What secondary brain injury does the nurse suspect?
Meningitis (infection)
The nurses patient has a fall at home and was diagnosed with an epidural hematoma. What information is important for the nurse to know about this specific intracranial hemorrhage?
Epidural hematoma is a secondary type of injury. When an artery has been torn or damaged and bleeding occurs between the skull and the dura mater. More life threatening becaue arterial blood has more pressue which increase the risk of more blood loss.
Where is a subdural hematoma located? What kind of blood is involved?
Between the dura and arachnoid space. The bleed consists of venous blood which allows the bleed to be slower and s/s may not present fast.
True or false. An intracerebral hematoma is bleeding within the brain. A patient would have s/s of severe headache, vomiting, one sided weakness and LOC changes.
True
What is a common phrase that is used to basically explain the clinical presentation of a patient with a epidural hematoma?
“Wake up and die”
B/c there is an initial loss of consciousness and then the patient regains lucidity and then start to decline again. Have the potential to die within mins to hours.
A patient presents to the ED complaing of headache and the patient appears slightly disoriented. The patient reportedly had a fall 6 days ago at home. The patient admits to a history of alcoholism. What brain injury should the nurse be on alert for?
Subacute Subdural Hematoma.
Alcholics who fall have a higher chance of developing a subdural hematoma b/c of cirrhosis and abnormal clotting factors in the damaged liver. This injury would be subacute because symptoms started to develop 6 days after the injury.
Acute Subdural Hematoma occurs within?
48 hours of injury
Subacute Subdural Hematoma occurs within?
48 hours to 2 weeks
Chronic Subdural Hematoma occurs within?
2 weeks to several months
What would as nurse identify as signs and symptoms of intraccerebral hematoma?
Severe headache
Vomiting
One sided weakness
LOC changes
