Week 1 Acute Neurological

Question 1

Traumatic brain injuries (TBI) or head injury refers to__

Answer 1

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.

Question 2

An open (penetrating) head injury is when ___

Answer 2

the outer layer of the meninges is breached (eg/knife/bullet)

Question 3

A close head injury is when ___

Answer 3

the integrity of the skull is not compromised.

Question 4

A concussion is a__

Answer 4

temporary alteration in consciousness related to a closed head injury in the presence of a normal head CT scan.

Question 5

TBI is also divided into primary and secondary injuries.
Primary___
Secondary___

Answer 5

PRIMARY- occurs at the time of the impact

SECONDARY- develops later in response to the primary injury

Question 6

Moderate to Severe TBI
Accounts for 10% of all cases
Symptoms

Answer 6

slurred speech
profound confusion
seizures
persistant headaches
coma

Question 7

Mmild TBI
Accounts for 90% of all cases
Symptoms

Answer 7

headaches
dizziness & fatigue
seizures sleeping difficulties
memory & concentration problems
blurred vision

Question 8

TBI’s are graded based on:

Answer 8

• 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.

Question 9

Nursing Management for TBI

Answer 9

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.

Question 10

A cerebrovascular event also known more widely as a stroke, is when

Answer 10

blood supply to the brain is interrupted.

Question 11

Modifiable Risk Factors for stroke

Answer 11

Blood Pressure
Smoking
Diabetes
Diet
Physical Inactivity
High Blood Cholesterol
Carotid Artery Disease
Atrial Fibrillation

Question 12

Non-Modifiable Risk Factors for stroke

Answer 12

Age
Family History
Race
Gender
Prior stroke, TIA or Heart Attack

Question 13

An ischaemic stroke occurs when

Answer 13

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.

Question 14

Ischaemic stroke treatment

Answer 14

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.

Question 15

Ischaemic stroke nursing interventions

Answer 15

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.

Question 16

A haemorrhagic stroke occurs when

Answer 16

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.

Question 17

hemorrhagic stroke treatment

Answer 17

Intensive blood pressure control is required here and/or surgical intervention.

Question 18

Hemorrhagic stroke nursing intervention

Answer 18

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.

Question 19

A Spinal Cord Injury is as

Answer 19

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.

Question 20

Spinal Cord Injury - Nursing Management

Answer 20

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

Question 21

Spinal injury Potential Complications

Answer 21

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).

Question 22

Spinal precautions also known as spinal immobilisation and spinal motion restriction, are efforts to prevent

Answer 22

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.

Question 23

Which of the following 3 symptoms may occur in a spinal injury patient during autonomic dysreflexia?

Profuse sweating

Flaccid paralysis

Hypotension

Hypertension

Pounding headache

Answer 23

Hypotension
Flaccid paralysis
Pounding headache
(1/3 correct)

Question 24

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?

Answer 24

False

Question 25

The two types of osmotic therapies indicated to reduce increased intracranial pressure are:
Atenolol

Hypertonic saline

Hypotonic saline

Sorbitol

Mannitol

Answer 25

Hypertonic saline
Mannitol

Question 26

Spinal Shock

Answer 26

Immediate temporary loss of total power, sensation and reflexes below the level of injury

Question 27

Neurogenic shock

Answer 27

Sudden loss of the sympathetic nervous system signals

Question 28

Complete Spinal Cord Injury

Answer 28

There is no function below the level of injury (sensation & movement) and both sides of body are equally affected.

Question 29

Incomplete injury

Answer 29

There is partial injury involving injury or compression of the spine that does not comprise the entire cord.

Question 30

What is the lowest GCS and the highest GCS?

Show answer choices

2 and 14

3 and 15

1 and 15

0 and 13

Answer 30

3 and 15

Question 31

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

Answer 31

Always wake the patient to detect changes in neurological status

Question 32

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

Answer 32

American Spinal Injury Association

Question 33

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

Answer 33

If there is an increase in one of the cranial components, there must be a decrease in another to compensate

Question 34

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.

Answer 34

True

Question 35

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

Answer 35

Sudden onset of severe headache

Question 36

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

Question 37

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

Answer 37

Right middle cerebral artery