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NUR4630 > Week 6: Cerebral Alterations Part 2 > Flashcards

Week 6: Cerebral Alterations Part 2 Flashcards

1
Q

In Head injury death occurs at what three points in time after injury?

A
  • Immediately after the injury
  • Within 2 hours after injury (related to initial ischemia and hypoxia)
  • 3 weeks after injury (related to reprofusion)
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2
Q

Major complication of scalp laceration?

A

infection (but also profuse bleeding)

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3
Q

Types of Head Injury

A
  • Linear (very small line) or depressed skull fracture
  • Simple, compound, or comminuted
  • Closed or open
  • Direct and Indirect
  • Coup (head goes forward quickly and the injury goes to the back of the brain) and Countercoup (head goes back quickly and injures the front of the brain)
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4
Q

Minor injury vs. Severe

A

Minor

  • May loose conciousness
  • transient period of confusion
  • somnolence
  • listlessness
  • irritability
  • pallor vomiting

Severe

  • Increased ICP
  • Bulging fontanel (infants)
  • reinal hemorrhages
  • extraocular palsises (CN111)
  • hemiparesis
  • quadraplegia
  • increase temperature
  • change in gait
  • papilledema
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5
Q

Basal Skull fractures

A
  • CSF leakage through nose or ear
  • high risk for infection
  • battle signs (bruising behind ear)
  • raccoon sign (bruising around the eyes)
  • possible injury to internal carotid artery
  • permanent CSF leakage
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6
Q

Nursing Care of Skull Fractures

A
  • Minimize CSF leak: bed flat, never suction orally, never insert NG tube, never use q-tips in nose/ears, caution patient not to blow nose
  • Place sterile gauze/cotton ball around area
  • Verify CSF leak: dextrosestik:positive for glucose
  • Monitor closely: *respiratory status*
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7
Q

Temporary loss of consciousness

A

Mild Head Injury

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8
Q

obtunded for several hours

A

moderate head injury

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9
Q

in a coma

A

severe head injury

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10
Q

minor head trauma

A

sudden transient mechanical head injury that disrupts nerve actvity

  • amnesia, headache, short duration, brief disruption in LOC
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11
Q

Post concussin syndrome

A
  • 2 weeks to 2 months
  • persistent headache
  • lethargy
  • personality and behavior changes
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12
Q

Concussion grading scale: Grade 1

A
  • Transient confusion
  • no loss of consciousness
  • symptoms resolve in less than 15 minutes
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13
Q

Grade 2 concussion grading scale

A
  • transient confusion
  • no loss of consciousness
  • symptoms last more than 15 minutes
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14
Q

concussion grading scale: Grade 3

A
  • Any loss of consciousness, brief or prolonged
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15
Q

Concussion symptoms

A
  • fatigue
  • amnesia
  • headache
  • dizziness
  • irritability (behavioral changes)
  • memory disturbances
  • seizures (rarely associated with later epilepsy)
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16
Q

Diagnostic testing for concussion

A

Ct of the head, EEG if suspicion of seizures, neuropsychological evaluation for memory issues

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17
Q

Contusion

A

bruising of brain tissue withing a focal area that maintains the integrity of the pia mater and arachnoid layers

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18
Q

lacerations

A

involve actual tearing of the brain tissue. Intracerebral hemorrhage is generally associated with cerbral laceration

19
Q

Epidural hematoma

A

results from bleeding between the dura and the inner surgace of the skull. It is a neurologic emergency and of venous or arterial origin

20
Q

Subdural hematoma

A

Occurs from bleeding between the dura matter and arachnoid layer of the menigeal covering of th ebrain

21
Q

Types of subdural hematoma

A
  • Subdural hematoma: usually venous in origin. Much slower to develop into a mass large enough to produce symptoms. May be caused by an arterial hemmorrhage
  • Acute subdural hematoma: high mortality, signs within 48 hours of the injury. Associated with major trauma (Shearing forces). Patient appears drowsy and confused. Pupils dilate and become fixed
  • Subacute subdural hematoma: Occurs within 2-1 days of the injury. Failure to regain consciousness may be an indicator
  • Chronic subdural hematoma: Develops over weeks or months after a seemingly minor injury
22
Q

Nursing interventions

A
  • Monitor neurological status: GCS score, neurologic status, presence of CSF leaks
  • Assist with ADLs
  • Decrease Stimuli
  • Patient/family teaching
23
Q

Head injury nursing diagnosis

A
  • Ineffective tissue perfusion
  • Hyperthermia
  • Acute pain
  • Anxiety
  • Impaired physical mobility
24
Q

Head injury nursing management planning

A
  • maintain adequate cerebral perfusion
  • remain normothermic
  • be free from pain, discomfort, and infection
  • attain maximal cognitive, motor, and sensory function
25
Q

Head Injury Nursing management nursing implementation

A
  • Health Promotion: precent car and motorcycle accidents, wear safety helmets
  • Acute Intervention: Maintain cerebral perfusion and prevent secondary cerebral ischemia. Monitor for changes in neurological status
  • Ambulatory and Home Care: Nutrition, bowel and bladder management, spasticity, dysphagia, seizure disorders, family participation and education
26
Q
  • Bleeding into the fluid-filled areas (ventricles ) inside the brain
  • IVH, the most common type
  • Occurs mainly in preterm infants under 32 weeks of gestation
A

Intraventricular Hemorrhage of the Newborn

27
Q

IVH causes

A
  • Infants born before 30 weeks of pregnancy are at highest risk for such bleeding (smaller and younger, higher the risk bc blood vessels are premature and fragile)
  • IVH is more common in premature babies who have had: respiratory distress syndrome, high BP, can occur in healthy premature babies born without injury
28
Q

IVH Causes

A
  • Rarely present at birth
  • Develops in first several days of life, and rare after one month of age
  • Falls into 4 grades, the higher the grade the more severe the bleeding
  • Grade 1 &2 involve small amounts of bleeding and do not usually cause long term problems
  • Grade 3 & 4 involve more severe bleeding
  • Presses on or leaks into the brainm, blood clots form around that, leads to increased fluid volume creating hydrocephalus
29
Q

Intravascular Patho of IVH

A
  • Immature cerebral autoregulation
  • Fluctuating cerebral blood flow (related to fluctuating arterial blood pressur)
  • Increased cerebral blood flow due to hypercarbia and excess volume expansion
  • Increased venous pressure
  • Hypotention and reperfusion
  • Coagulation abnormalities
30
Q

Extravascular Patho of IVH

A
  • Increased fibrinolytic activity
  • poor vascular support in the cerebral tissue
  • increased risk of hypoxia, hypercarbia, and acidosis due to immature respiratory system
31
Q

IVH symptoms

A
  • There may be no symptoms
  • Breathing pauses
  • Changes in BP and heart rate
  • Decreased muscle tone
  • Decreased reflexes
  • Excessive sleep
  • Lethargy
  • Weak Suck
32
Q

3 stages of clinical presentation of IVH

A

Catastrphic

  • Acute IVH with bulgin fontanel, spil sutures, change in level of consciousness, pupillary and cranial nerve abnormalities, decerebrate posturing, and often with rapid decrease in blood pressure andor hematocrit.

Saltatory

  • Gradual deterioration in neurological status, may be subtle abnormalities in level of consciousness, movement, tone, respiration and eye/position movement

Asymptomatic

  • 25-50%, discovered on ultrasound. Fall in hematocrit or failure of hematocrit to rise wiht tranfusion should cause concern
33
Q

IVH Treatment

A
  • No current way to stop bleeding. Keep infant stable, treat symproms
  • If swelling develops, spinal tap to relieve pressure. Surgery may be needed to place a tube or shunt to drain fluid
34
Q

Grade 1 IVH

A

bleeding condined to periventricular area (germinal matrix)

35
Q

Grade 2 IVH

A

Intraventricular bleeding less than 50%

36
Q

Grade 3

A

intraventricular bleeding greater than 50%

37
Q

Grade 4 IVH

A

Intra-Parenchymal echodensity (IPE) reperesents periventricular hemorrhagic infarction

38
Q

psychogenic seizures triggers

A
  • results from traumatic psychological experiences, sometimes from the forgotten past
  • anxiety
  • stress-induced
39
Q

treatment for psycogenic seizures

A

psychotherapy and meds to treat underlying anxiety/stree. 70% resolve with treatment

40
Q

Causes of meningitis and types and transmission

A
  • inflammation of the membranes and the fluid space surronding the brain and spinal cord

Types:

  • Septic: due to bacteria (strep pneumoniae, neisseria meningitis)
  • Aseptic: due to viral infection, lymphoma, leukemia, or brain abscess

Transmission

  • N. meningitis is transmitted by secretions or aerosol contamination and infection is most likely in dense community gorups such as college campuses
41
Q

diagnostic testing for meningitis

A
  • bacterial culture and gram staining of csf and blood are key diagnostic tests
  • the presence of polysaccharide antigen in csf futher supports the diagnosis of bacterial meningitis
42
Q

medical managment of meningitis

A
  • prevention by vaccination against haemophilus influenzae and s pneumoniae for all children and all at-risk adults
  • early administration of high doses of appropriate iv antibiotics (should cross bbb) for bacterial meningitis
  • dexamethasone
  • treatment dehydration, shock, and seizures
43
Q

nursing managmenet of meningitis

A
  • frequent/continual assessment including vs and LOC
  • protect patient form injury related to seizure activity or altered LOC
  • monitor daily weight, serum electrolutes, urine volume, specific gracity, and osmolality
  • prevent complications associated with immobility
  • infection control precautions
  • supportive care
  • measures to facilitate coping of patient and family

NUR4630 (34 decks)

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