Unit 13 ALOA Structural Coma Flashcards
(41 cards)
What is the Monro-Kellie Hypothesis?
What should normal ICP be?
What is auto-regulation regarding this?
How can it be measured?
Pressure exerted by the combined volume of:
- Blood 80%
- Brain 10%
- Spinal fluid 10%
Normal ICP should be 5-15
A change in one of these volumes means a change in another
Can be measured by spinal tap.
What are the types of skull fractures?
Simple- small break, no interference
Comminuted- Complex
Depressed- Complex
Basilar- Life threatening
What are the symptoms of a Basilar fracture?
Where do they usually happen?
Rhinorrhea - bloody nose
Otorrhea - ear damage, CSF
Halo Sign- from CSF leak
Raccoon eyes
Battle’s sign - bruising behind ear/near ear
They usually happen near temporal regions.
What is Basilar Skull fracture collaborative management?
Neuro checks every hr w/VS
Prevent meningitis w/antibiotic prophylaxis
Nothing in the ears
No NGT or nasal suctioning
No blowing nose only wiping
Elevate HOB 30
May need surgery to lift bone
What is the number one cause of traumatic brain injuries?
Falls
What are the two types of traumatic brain injuries?
Closed - head suddenly and violently hits an object
Open - object pierces the skull and enters the brain
What are symptoms of a traumatic brain injury?
Headache
Dizziness
Balance issues
Sensitivity to noise and light
Sleep issues
Anxiety
What are the 2 stages of brain injury?
What is the main goal of brain injury?
Primary: occurs at time of injury, infarction, disruption of blood supply, hematoma
Secondary: Progression of initial injury which leads to cellular and toxic changes causing cerebral edema and increased ICP.
Main goal is to prevent secondary injury from occurring.
What are the types of closed head injuries?
Concussion:
-disturbance of neurological function caused by trauma
Contusion:
-Bruising of brain at site of impact
Laceration:
-Tearing of surface vessels
What are PT considerations with closed head injuries?
Avoid physically demanding activities/ gradually resume
Avoid straining
Avoid sustained electronic use
Avoid alcohol and nicotine
Only take prescribed meds
Allow frequent rest
What is the collaborative management of closed head injury?
Minor injury, PT will be sent home from ED
PT/family education to:
- call if change in behavior, speech, or vomiting
- cognitive/physical rest
Neurocognitive Testing (Impact test) –25 min computer test that measures attention, memory, responses, and reaction times
What are the type of Hematomas?
Epidural Hematoma:
- Extreme emergency!
- Associated w/skull fracture usually in temporal region
- Arterial bleed
Subdural Hematoma: (part of severe brain injury)
- Acute
- Subacute
- Chronic
Intracerebral Hemorrhage
Describe an Epidural Hematoma.
What is the treatment?
Blood collection between the skull and dura
PT may have brief loss of consciousness w/return of lucid state, as hematoma expands ICP will reduce LOC
An emergency situation!! FROM Arterial Bleed!!
Symptoms develop rapidly
Treatment:
- Reduce ICP
- Remove the clot
- Stop bleeding - (burr holes or craniotomy)
- Monitoring of VS
What is a subdural hematoma?
Associated w/ what?
Describe acute and subacute Subdural Hematoma and treatment.
Describe chronic Subdural Hematoma and treatment.
Collection of blood between the dura and the brain.
40-60% fatal
FROM veins!
Associated w/ skull fractures and contusions
Acute: symptoms develop over 24 - 48 hrs
Subacute: symptoms develop 48hrs- 2 weeks
Treatment for both: Immediate craniotomy and control ICP
Chronic:
-Develops over weeks to months
-Causative injury may be minor and forgotten
-Clinical signs and symptoms may fluctuate
Treatment: evacuation of the clot
What is Intracerebral hemorrhage?
What is the treatment?
Hemorrhage occurs into the substance of brain.
May be due to trauma or a non-traumatic cause.
Treatment:
- Supportive care
- Control ICP
- Administer fluids, electrolytes, and antihypertensive medications
- Craniotomy or Craniectomy to remove clot and control hemorrhage (may not be possible due to location)
What is the Secondary Injury (complication of primary injury) Cerebral Edema.
Brain swelling which leads to ICP.
What is the nursing care and prevention of secondary injury cerebral edema?
- HOB 30 degrees
- Log roll when turning
- Analgesics
- Stool softeners to prevent straining
- Prevent coughing/sneezing
- Prevent valsalva maneuvers
- Prevent pain
- Prevent hypoxemia and hypercapnia
- Avoid increased ICP (suctioning and turning can increase, be careful)
What is the treatment of the secondary injury, cerebral edema?
mannitol -osmotic diuretic
Hypertonic solution 2-3% normal saline
Control “neuro fever” w/antipyretics, cooling blankets, etc
Maintain or slightly increase systolic BP
What is hydrocephalus secondary injury?
What is the treatment?
Volume increase in CSF.
- Increased production in ventricles
- obstructed circulation
- decreased absorption
Treatment: Ventriculostomy (external ventricular drain)
What is the earliest indicators of ICP?
What is the latest sign of ICP?
Mental status changes
Cushing’s triad (arterial hypertension and widening PP, bradycardia, bradypnea)
What is the secondary injury Diabetes Insipidus and SIADH?
DI: Lacks antidiuretic hormone to there is urine, urine, urine! very diluted urine!
Syndrome of Inappropriate ADH(SIADH):
- too much ADH
- stops urine/holds onto fluid
Describe DI vs SIADH.
DI:
- Dilute urine
- High serum Na+
- High serum osmolarity
- Low urine gravity
- THIRSTY
- Rx: Vasopressin
SIADH: -Concentrated urine -Low serum Na+ -Low serum osamlarty -High urine gravity -Thirsty Rx: Hypertonic saline, fluid restriction
Describe the secondary injury brain herniation.
-Displacement of brain tissue into the spinal canal.
- Essentially brain pushed down onto brain stem.
- Often results in death
- Presents w/abnormal posturing, GCS 3-5
What are the clinical manifestations of ICP?
Decrease in GCS ALOA Headache Vomiting Abnormal speech Motor/sensory issues Change in cardiac rate/rhythm Change respiratory patterns
