Week 1 Acute Neurological Flashcards
This weeks content covers: acute neurological conditions such as TBI’s, skull fractures, intracranial haemtoma’s, cerebrovascular diseases, spinal cord injuries.
Traumatic brain injuries (TBI) or head injury refers to__
any injury to the scalp, skull (cranium or facial bones) or brain that disrupts the brain’s function. It can be a results of a blow, bump or jolt to the head such as when a person is assulted, in a traffic accident or a fall. Diagnosis and severity is most commonly investigated with CT and MRI.
An open (penetrating) head injury is when ___
the outer layer of the meninges is breached (eg/knife/bullet)
A close head injury is when ___
the integrity of the skull is not compromised.
A concussion is a__
temporary alteration in consciousness related to a closed head injury in the presence of a normal head CT scan.
TBI is also divided into primary and secondary injuries.
Primary___
Secondary___
PRIMARY- occurs at the time of the impact
SECONDARY- develops later in response to the primary injury
Moderate to Severe TBI
Accounts for 10% of all cases
Symptoms
slurred speech
profound confusion
seizures
persistant headaches
coma
Mmild TBI
Accounts for 90% of all cases
Symptoms
headaches
dizziness & fatigue
seizures sleeping difficulties
memory & concentration problems
blurred vision
TBI’s are graded based on:
- The duration of loss of consiousness
- Level of consciousness as per GCS at the time of injury
- Length of time the patient remains in post traumatic amensia.
Nursing Management for TBI
Performing focused neurological assessments, accurately and thoroughly, gives you an indication of the severity of brain injury and any further deterioration, along with any improvements in your patient.
A cerebrovascular event also known more widely as a stroke, is when
blood supply to the brain is interrupted.
Modifiable Risk Factors for stroke
Blood Pressure
Smoking
Diabetes
Diet
Physical Inactivity
High Blood Cholesterol
Carotid Artery Disease
Atrial Fibrillation
Non-Modifiable Risk Factors for stroke
Age
Family History
Race
Gender
Prior stroke, TIA or Heart Attack
An ischaemic stroke occurs when
there is an occlusion to the blood vessel that interrupts the blood flow to that region of the brain. This occlusions leads to irreversible brain damage and is the most common type of stroke experienced.
Ischaemic stroke treatment
The two main stay treatments available include thrombolysis and clot retrieval. Both treatments need to be administered within a 4.5 hours time period from onset of symptoms. The goal for treatment of an ischaemic stroke is reperfusion.
Ischaemic stroke nursing interventions
During the acute phase, focus is on blood pressure managment, dysphagia managment and close observation post interventions. Regular neurological assessments are required, often every 15 minutes and/or National Institue of Health Stroke Scale (NIHSS) assessment, however additional training is required to use this scale. Key observations also needed include monitoring of blood glucose levels, regular vital signs, elimination and psychological support. Early mobility is also key to improve outcomes.
A haemorrhagic stroke occurs when
a blood vessel ruptures within the brain (intracerebral haemorrhage) or into the space surrounding the brain (subarachnoid haemorrhage). The rupture in most cases is caused by chronic hypertension, where the blood in the artery is under pressure and weakens the wall until it ruptures. It may also be caused by overuse of anticoagulants, aneurysm, trauma or an ischaemic stroke.
hemorrhagic stroke treatment
Intensive blood pressure control is required here and/or surgical intervention.
Hemorrhagic stroke nursing intervention
Depending on the treatment plan will depend on nursing interventions. During the acute phase, focus is on blood pressure managment, dysphagia managment and close observation post interventions. Nursing the patient at 30 degrees. Regular neurological assessments are required. You may also be preparing the patient for transfer to another facility or for surgical interventions.
A Spinal Cord Injury is as
an impairment of the spinal cord that leads to multiple physical challenges / disabilities. Spinal Cord Impairment refers to abnormality in one or more of the following body functions – sensory, motor, bladder-bowel, respiratory, sexual, hemodynamic stability and temperature control.
Spinal Cord Injury - Nursing Management
The nurses’ everyday role includes assisting patients activities of daily living; medication administration and education and support for inpatients and families; patient positioning and skin care management as well as bladder and bowel management following a person’s injury. In addition, we assist with rehabilitation and discharge planning focusing on management of the injury, such as, self-care and independence, and collaboration with other members of the interdisciplinary and allied health team to help with lifestyle adjustments and transitioning back into the community. Our primary aim is to encourage the patient and other family members, to explore and help achieve their rehabilitation goal
Spinal injury Potential Complications
Cardiovascular (Ineffective thermoregulation; decreased cardiac output and autonomic dysreflexia);
Gastrointestinal (Bowel incontinence, risk of constipation);
Genitourinary (Urinary incontinence and risk for infection);
Musculoskeletal (Disuse syndrome and Risk for injury);
Integument (Risk of impaired skin integrity;);
Pyschosocial (Anxiety, Fear, Grief, interrupted family processes, risk of caregiver strain, social isolation).
Spinal precautions also known as spinal immobilisation and spinal motion restriction, are efforts to prevent
movement of the spine in those with a risk of a spine injury. This is done as an effort to prevent injury to the spinal cord. Spinal precautions include head holding, application of a cervical collar, patients nursed in neutral alignment on an approved mattress and log rolling for all care. These precautions should be in placeuntil investigations take place to establish that the spine has been ‘cleared’ or a management plan has been made.
Which of the following 3 symptoms may occur in a spinal injury patient during autonomic dysreflexia?
Profuse sweating
Flaccid paralysis
Hypotension
Hypertension
Pounding headache
Hypotension
Flaccid paralysis
Pounding headache
(1/3 correct)
T/F
Secondary traumatic brain injury refers to the damage of neuronal tissue or blood vessels of the brain directly caused by external mechanical force at the time of insult?
False
The two types of osmotic therapies indicated to reduce increased intracranial pressure are:
Atenolol
Hypertonic saline
Hypotonic saline
Sorbitol
Mannitol
Hypertonic saline
Mannitol
Spinal Shock
Immediate temporary loss of total power, sensation and reflexes below the level of injury
Neurogenic shock
Sudden loss of the sympathetic nervous system signals
Complete Spinal Cord Injury
There is no function below the level of injury (sensation & movement) and both sides of body are equally affected.
Incomplete injury
There is partial injury involving injury or compression of the spine that does not comprise the entire cord.
What is the lowest GCS and the highest GCS?
Show answer choices
2 and 14
3 and 15
1 and 15
0 and 13
3 and 15
Your patient who has had an acute brain injury post motor vehicle accident is sound asleep when you walk in to complete her neurological observations. Would you let her sleep or wake her?
Show answer choices
Always wake the patient to detect changes in neurological status
Let them sleep as the brain needs to be able to recover and heal
Always wake the patient as it helps to improve their GCS score
Let the patient sleep, as long as their neurological status was stable when they were awake
Always wake the patient to detect changes in neurological status
What does the ASIA acronym stand for when referring to spinal cord injuries?
Show answer choices
Australian Spinal Injury Association
Australisian Spinal Injury Association
American Spinal Injury Association
Albanian Spinal Injury Association
Austrian Spinal Injury Association
American Spinal Injury Association
The Monro-Kellie hypothesis states that:
Show answer choices
If there is an increase in one of the cranial components, there must be a decrease in another to compensate
If there is an increase in one of the cranial components, then the other components will also increase
If there is a decrease in one of the cranial components, there must be an increase in another to compensate
If there is a decrease in one of the cranial components, then the other components will also decrease
If there is an increase in one of the cranial components, there must be a decrease in another to compensate
T/F
In the nursing tutorial activity you watched a short clip of Dave having a stoke.
Using the FAST acronym can be used to detect symptoms of a stroke. Are these statements correct?
Face- check their face. Has their mouth drooped
Arm- can they lift both arms
Speech- is their speech slurred? Do they understand you?
Time- is critical- call 000 to get medical help immediately.
True
Dave was confirmed as having a right vertebral artery stroke. Information from the patient that would help differentiate a hemorrhagic stroke from an ischaemic stroke includes:
Show answer choices
History of hypertension
Sensory disturbance
Sudden onset of severe headache
Presence of motor weakness
Sudden onset of severe headache
A patient with a history of stroke has impaired comprehension of language but can speak. This clinical manifestation is called:
Show answer choices
Motor aphasia
X Broca’s aphasia X
Expressive dysphasia
Receptive dysphasia
A patient with left-sided hemiplegia and impaired judgement resulting from a stroke most likely has involvement of the:
Show answer choices
Right middle cerebral artery
Brainstem
Left middle cerebral artery
Vertebral artery
Right middle cerebral artery
