Term
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Definition
| • Traumatic Brain Injury - TBI is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. |
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Term
| How does severity range with TBI? |
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Definition
| • The severity of a TBI may range from “mild,” i.e., a brief change in mental status or consciousness to “severe,” i.e., an extended period of unconsciousness or amnesia after the injury. |
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Term
| What TBI causes death in 65+? |
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Definition
| o Falls were the leading cause of death for persons 65 years or older. |
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Term
| What TBI causes death in 5-24 y/o? |
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Definition
| o Motor vehicle crashes were the leading cause for children and young adults ages 5-24 years. |
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Term
| What TBI causes death in <5? |
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Definition
| o Assaults were the leading cause for children ages 0-4 |
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Term
| What disorders can TBI cause? |
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Definition
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Term
| What is a primary injury? |
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Definition
| the initial damage to the brain such as contusions, lacerations, torn blood vessels |
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Term
| What is the secondary injury? |
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Definition
the damage from the sequelae of the primary injury (eg, increased intracranial pressure)
o Happens over ensuing hours or days and can include:
• Cerebral edema
• Ischemia
• Seizures
• Infection
• Hyperthermia
• Hypovolemia
• Hypoxia |
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Term
| What is a skull fracture? |
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Definition
A break in the continuity of the skull caused by forceful trauma
• May occur with or without damage to the brain |
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Term
| What is a non depressed skull fracture? |
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Definition
| generally do not require surgical treatment |
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Term
| What is a depressed skull fracture? |
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Definition
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Term
| What is a fracture of the base of the skull? |
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Definition
basilar or basal fracture
• Brain stem herniation can result in impaired cellular activity, permanent neurologic dysfunction, and death. |
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Term
| What should be suspected when CSF is draining from nose and ears? |
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Definition
| • Basilar skull fractures |
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Term
| What may appear on sheets and pillows with a basilar skull fracture? |
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Definition
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Term
| What should liquid that drains from ears and nose be tested for? |
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Definition
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Term
| What are the physical manifestations of a basilar skull fracture? |
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Definition
-Leaking CSF from ears and nose
-Battle's Sign
-Raccoon eyes
vision changes, CSF rhinorrhea or otorrhea, hearing loss, facial paralysis, facial numbness. |
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Term
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Definition
| Bruising over the mastoid bone |
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Term
| What position should BSF patients be in? |
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Definition
| strict bedrest, HOB > 30 degrees, no cough, sneezing, and straining. |
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Term
| What is the teaching for a BSF w/ CSF leak? |
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Definition
o HOB elevated to 30° to reduce ICP and spontaneous closure
o No nose blowing, sneezing
o No coughing, straining
o No nasal suctioning
o Bedrest
If there is facial damage, DO NOT PUT ANY TUBES IN NOSE! |
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Term
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Definition
| An alteration in mental status that results from trauma, and may or may not involve loss of consciousness |
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Term
| How is a concussion treated? |
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Definition
| observing the patient for symptoms, including headache, dizziness, lethargy, irritability, anxiety, photophobia, phonophobia, difficulty concentrating, and memory difficulties |
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Term
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Definition
| : A more severe injury, involving bruising of the brain, with possible surface hemorrhage |
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Term
| What is a diffuse axonal injury? |
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Definition
| Involves widespread damage to axons in the cerebral hemispheres |
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Term
| What is post concussive syndrome? |
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Definition
| symptoms of the concussion that occur after the injury that can lasts for up to a year |
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Term
| What usually causes a diffuse axonal injury? |
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Definition
| acceleration/deceleration injuries |
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Term
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Definition
| (flexion) remember toward the cord, damage to upper midbrain |
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Term
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Definition
| (extension) damage to lower midbrain and pons |
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Term
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Definition
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Term
| What is a countercoup injury? |
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Definition
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Term
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Definition
| • Collections of blood that develop within the cranial vault; the most serious type of brain injury |
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Term
| What is a Epidural hematoma? |
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Definition
| Collection of blood in the space between the skull and the dura. above the dura, emergent with neurologic deficits and can lead quickly to respiratory arrest. |
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Term
| What is a subdural hematoma? |
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Definition
Collection of blood between the dura and the brain. below the dura. Elderly more at risk. Can be taken to surgery to open dura and remove clot
May be acute or chronic |
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Term
| What is a intracerebral hemorrhage? |
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Definition
| Bleeding into the parenchyma (where brain tissue is) of the brain if not due to trauma, may be begin with a headache. Can be caused by HPT which causes rupture of vessel, tumor, coagulation problems. Surgical intervention if possible to remove clot, repair aneurysm. Hemorrhagic stroke |
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Term
| What is treatment of all hematomas directed towards? |
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Definition
| • Treatment of all is directed toward preserving brain homeostasis and preventing secondary brain injury |
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Term
| What is the breakdown of intracranial pressure? |
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Definition
o Brain tissue (80%)
o CSF (10%)
o Blood (10%) |
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Term
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Definition
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Term
| When is increased ICP treated? |
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Definition
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Term
| What is the Monro-Kellie hypothesis? |
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Definition
| o Any increase in one of the volume causes a change in the volume of the others |
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Term
| How does the brain/body compensate for increased ICP? |
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Definition
| Compensation usually increasing absorption or diminishing production of CSF or decreasing cerebral blood volume or ICP will rise. |
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Term
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Definition
| • Exists when a patient is not oriented, does not follow commands, or needs persistent stimuli to achieve a state of alertness |
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Term
| What roots does altered LOC have? |
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Definition
| neurologic, metabolic, or toxicologic causes |
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Term
| What is altered LOC usually result from? |
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Definition
| brain herniation and/or increased intracranial pressure |
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Term
| What is the earliest sign of increasing ICP? |
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Definition
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Term
| What are the other, later signs of increased ICP? |
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Definition
| headache, weakness, and pupillary changes |
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Term
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Definition
| intraventricular catheter (ventriculostomy) or a subarachnoid bolt or screw |
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Term
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Definition
o 1. Hypertension (progressively increasing systolic blood pressure)
o 2. Bradycardia
o 3. Widening pulse pressure (an increase in the difference between systolic and diastolic pressure over time) |
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Term
| How is Cerebral Profusion Pressure calculated? |
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Definition
| Cerebral Perfusion Pressure (want above 70mmHg) = Mean Arterial Pressure (stay above 65mmHg hopefully) – Intra Cranial Pressure (5-15) |
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Term
| How is increasing ICP managed? |
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Definition
• Treating cerebral edema (most often with mannitol)
• Controlling fever
• Maintaining BP and oxygenation
• Reducing metabolic demand
• Preventing seizures
• Preserving the integrity of the skin and corneas
• Promoting nutrition
• Preserving bowel and bladder function |
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Term
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Definition
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Term
| Why don't we hyperventilate anymore? |
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Definition
| increase is CO2 would vasodilate patient and bring down ICP BUT not routinely recommended anymore |
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Term
| What kind of sedation is used for increased ICP? |
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Definition
o Propofol
o Barbiturate Induced Coma to decrease metabolic demand
• Contraindicated in hypotension |
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Term
| What is mannitol used for? |
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Definition
o Reduces ICP by reducing blood viscosity, improves cerebral blood flow
o Serum osmolality should not be > 320
o Bolus dosing |
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Term
| How often are neuro checks done? |
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Definition
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Term
| What is used in ICP monitoring? |
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Definition
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Term
| What is used for CPP monitoring? |
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Definition
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Term
| What other nursing care is used for TBI patients? |
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Definition
• MAP monitoring
• Sedation/analgesia
• Seizure prophylaxis
• Infection prophylaxis
• Skin care |
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Term
| What do manifestations of spinal cord injuries dependent on? |
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Definition
| • Manifestations of SCI depend on the type and level of injury (eg, complete or incomplete spinal cord lesions) |
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Term
| What are the goals of spinal cord injury treatment? |
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Definition
| o Goals are preservations, stabilization, and realignment of the spinal cord |
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Term
| What are the major complications of spinal cord injury? |
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Definition
• Spinal and neurogenic shock
• DVT
• Orthostatic hypotension
• Autonomic dysreflexia |
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Term
| What are the most important complications for SCI patients? |
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Definition
o Altered breathing
o Changes in motor or sensory function
o Spinal shock
o Urinary retention
o Overdistention of the bladder
o Paralytic ileus |
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Term
| What are the goals of treatment of acute SCI? |
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Definition
• Improved breathing pattern and airway clearance
• Improved mobility
• Improved sensory and perceptual awareness
• Maintenance of skin integrity
• Relief of urinary retention
• Improved bowel function
• Promotion of comfort
• Absence of complications |
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Term
• The nurse has observed that clear fluid is leaking from the nose of a patient who has just been admitted with a skull fracture. What conclusion should the nurse draw from this assessment finding?
o The patient is diuresing as a result of the injury.
o The patient is leaking cerebrospinal fluid.
o The patient is leaking blood plasma.
o The basement membrane of the patient’s mucous membranes has been damaged. |
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Definition
| o The patient is leaking cerebrospinal fluid. |
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Term
| • Is the following statement true or false? When assessing a patient using the Glasgow Coma Scale, the nurse will assess the patient’s judgment and insight. |
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Definition
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Term
• Cerebral edema can often be prevented or treated in the brain-injured patient through which of the following interventions?
o Fluid restriction
o Administration of hypotonic IV solutions
o Prone positioning |
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Definition
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Term
| • Is the following statement true or false? The most common effect on bladder function that is caused by acute SCI is urinary incontinence. |
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Definition
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Term
| WHat is an open head injury? |
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Definition
| Also known as a compound fracture, an open fracture is one in which the skin is broken and the bone emerges from it. |
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Term
| What is a closed head injury? |
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Definition
| A closed fracture, also called a simple fracture, is one in which the skin is not broken or cut. |
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Term
| What is a focal head injury? |
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Definition
| injury occurs in a specific location |
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Term
| What is a diffuse head injury? |
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Definition
| diffuse injury occurs over a more widespread area |
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Term
| How is a basilar skull fracture diagnosed? |
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Definition
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Term
| What is a MILD concussion? |
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Definition
| GCS 13-15, < 30min loss of consciousness, any loss of memory, normal CT but results in diffuse and microscopic injury |
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Term
| What is a MODERATE concussion? |
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Definition
| GCS 9-12, CT abnormality, LOC >30 min to 6 hr |
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Term
| What is a SEVERE conussion? |
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Definition
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Term
| Which is worse, a concussion or contusion? |
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Definition
| A Contusion - involves bruising of the brain with possible surface hemorrhage. |
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Term
| When would you not use the GCS to assess someone? |
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Definition
If they are already sedated
If they have a head injury from a week ago, they obviously are fine if they can tell you about it |
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Term
| Why should you not use hypotonic fluids with a TBI patient? |
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Definition
| Causes an INCREASE in cerebral edema = no bueno! |
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Term
| Why is an epidural hematoma emergent? |
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Definition
Because it usually involves the laceration of the meningeal artery, so they bleed really fast.
• Quick CT as soon as they come to hospital
• Surgery – Craniotomy |
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Term
| Why are chronic subdural hematomas seen in the elderly? |
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Definition
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Term
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Definition
• No purposeful response
• Can respond to painful stimuli
Sternal rub more central
• Brainstem function still exist |
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Term
| What is locked in syndrome? |
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Definition
• Tetraplegia
• Vertical eye movement and lid function |
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Term
| What damage can increased ICP cause? |
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Definition
• Decrease Cerebral Perfusion, resulting in ischemia and cell death
• Stimulates further edema
o Can result in brain shift and herniation into spinal column |
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Term
| What is used to decrease cerebral edema? |
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Definition
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Term
| What decreases cerebral blood volume while maintaining adequate cerebral perfusion? |
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Definition
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Term
| Why is it important to control fever in increased ICP? |
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Definition
• Metabolic demand is increased and requires more oxygen so you do not want them to have a fever
• compression on hypothalmus and brainstem |
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Term
| What reduces the cellular oxygen demand? |
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Definition
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Term
| How is Di diagnosed in increasing ICP? |
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Definition
| plasma sodium will be greater than 150 with the polyuria. |
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Term
| What is used to diagnose subarachnoid hemorrhage? |
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Definition
| o Blood in the CSF with increase WBC and protein is elevated |
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Term
| What does frequent swallowing after brain surgery indicate? |
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Definition
| may indicate fluid or blood leaking from the sinuses into the oropharynx |
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Term
| If there is a cervical injury, how is CPR performed? |
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Definition
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Term
| What is a primary SPINAL injury? |
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Definition
Primary is the initial injury
Concussion
Contusion
Laceration
Compression
Transection (severing) |
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Term
| What is a secondary SPINAL injury? |
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Definition
the result of the contusion or tear
Nerve fibers swell and disintegrate
Reversible in the first 4-6 hrs |
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Term
| How are spinal cord injuries classified? |
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Definition
Central
Lateral
Anterior
Peripheral |
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Term
| What is the neurologic level? |
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Definition
| The lowest level at which sensory and motor function are normal |
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Term
| What is a complete spinal lesion? |
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Definition
| Complete is loss of all spinal reflexes below the level of the lesion, loss of ability to perspire below level, dysfunction of bowel and bladder, absence of visceral and somatic sensation |
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Term
| What area of the spine would cause a loss of respirations or trouble with breathing? |
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Definition
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Term
| If using the halo device, what needs to be readily available to perform CPR? |
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Definition
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Term
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Definition
Sudden depression of reflex activity below the injury
Happens immediately after injury
• Spinal muscles below the lesion are without sensation, paralyzed, and flaccid. Affects bladder and bowel function |
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Term
| What is Neurogenic Shock? |
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Definition
Loss of nomnomic nervous system below injury
• Decrease in BP (due to ?), HR, warm skin, no perspiration on paralyzed portion
• decrease CO, venous pooling, peripheral vasodilation |
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Term
| What should be checked prior to PT appointments with Spinal injuries? |
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Definition
o Check BP before PT or anyone comes to sit them up or move them
Orthostatic hypotension |
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Term
| What is autonomic dysreflexia? |
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Definition
| a life-threatening condition that can occur in a person with a spainl cord injury at or above T6 level. Requires immediate attention. |
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Term
| What causes autonomic dysreflexia? |
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Definition
| Something is hurting the pt somewhere they are unable to sense and the sympathetic nervous system kicks in and hyper responds and causes a mess. |
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Term
| What are the symptoms of autonomic dysreflexia? |
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Definition
o Pounding HA
o Seeing spots in eyes
o Blurred vision
o Slowed HR
o Goosebumps above SCI level
o Nasal stuffiness
o Anxiety
o Bronchospasm or respiratory distress
o Cardiac irregulatories
o Patchy erythema above level of SCi
o Metallic taste in mouth
o Seizure
o Note: BP can go as high as 330/160 |
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Term
| Generally, what kind of sensations cause autonomic dysreflexia? |
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Definition
Distended bladder or bowel
Stimulation of skin (tactile, thermal, pain) |
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Term
| How do we treat autonomic dysreflexia? |
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Definition
Elevate HOB to sitting position
Bladder emptied via catheter
Rectal assess (if found lidocaine used prior to manipulation)
Examine skin (hot or cold), sores
Hydralazine if cause not corrected
Goal is to control BP and fix whatever is causing the pt "pain" |
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Term
| How is DVT prevented for SCI? |
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Definition
| o anticoagulation, compression hose, range of motion |
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Term
A patient with a spinal cord injury at the T1 level complains of a severe HA and an “anxious feeling.” Which is the most appropriate initial reaction by the nurse?
Try to calm the patient and make the environment soothing
Assess for a full bladder
Notify the healthcare provider
Prepare the patient for diagnostic radiography |
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Definition
| Assess for a full bladder |
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Term
Which intervention should the nurse’s plan of care include to help prevent autonomic dysreflexia in patient with SCI?
Check for fecal impactions
Monitor B/P for hypotension
Check urinary drainage system for any obstruction
Keep patient in side-lying recovery position |
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Definition
| Check urinary drainage system for any obstruction |
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Term
The nurse is caring for a new patient diagnosed with a T-2 spinal cord injury. Before the PT consult, what is the nursing priority?
Check skin integrity
Maintain NPO status before PT
Check blood pressure
Hold all medications |
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Definition
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Term
A patient presents with a a T10 spinal cord injury. What signs and symptoms would the RN anticipate for this patient?
Inability to sweat below forehead
Inability to move arms
Inability to move lower extremities
Inability to breathe |
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Definition
| Inability to move lower extremities |
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Term
A patient is admitted to the emergency department for a spinal cord injury (SCI). The patient is showing signs of respiratory distress and is receiving respirations via a bag valve mask. The nurse knows that this SCI is most likely at the level of?
T1-T12
C1-C4
C5-C6
L1-L5 |
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Definition
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Term
Which of the following is the priority assessment finding in a paraplegic who sustained an SCI in the last week?
Small amount of skin breakdown on the left heel
BP is 95/70
Patient complains of a pounding headache and blurred vision
Patient has very little appetite and consumed 10% of morning meal |
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Definition
| Patient complains of a pounding headache and blurred vision |
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