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54 Cards in this Set
- Front
- Back
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What is the difference between a congenital and an acquired brian injury?
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Congenital includes any type of brain injury that occurs before (or during) birth. There is NO period of normal development outside the womb. An acquired brain injury occurs after a period of normal development.
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Severity of a brain injury depends on:
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the primary and the secondary damage
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What is the main type of secondary injury with brain trauma?
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hypoxia
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What occurs during a coup/contracoup injury?
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Shearing and tearing of neurons throughout the brain. There is an initial injury when the brain hits the skill and another injury when the brain bounces off the skull and hits the back of the skull.
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Diffuse axonal injury includes:
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cell miscommunication
neurotoxins inflammatory effects |
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Cell miscommunication is
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trauma disrupts the electronic and chemical communication of cells resulting in cells getting the wrong signals which can damage or destroy the cell
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Neurotoxins are:
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released when cells are damaged
The protective ability the brain cell from these toxins, may also be reduced by the effects of the trauma. |
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Inflammatory effects of diffuse axonal injury are:
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slows brain communication because of extra fluid
Swelling causes an increase in pressure at the cellular level resulting in secondary brain damage |
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Secondary brain injury effects include:
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bleeding- leads to increased intracranial pressure
Swelling- leads to increased intracranial pressure -Hypoxia |
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Primary brain injuries include
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skull fracture, hemorrhages (epidural, subdural, subarachnoid or parenchymal), lesions to brain, contusions, laceration, diffuse axonal injury
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What has occurred physiologically when someone has raccoon eyes?
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Raccoon eyes are the result of a basilar skull fracture. Watch for a 'runny nose' when this occurs, it may be cerebral spinal fluid.
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How can you tell cerebral spinal fluid from snot?
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CSF has a high glucose level. Don't pack the nose or let them blow their nose!
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Can you put an NG tube in someone with raccoon eyes?
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No, you can put an OG tube in
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What is Battle's sign?
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bruising behind the ear over the mastoid process that may indicate a basilar skull fracture
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What is the first thing that should be done for someone with a non emergent head injury?
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Attempt reorientation
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What is the client as risk for if there is an increase in lactate in the cells?
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Metabolic Acidosis
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What is proper management for a traumatic head injury?
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Straighten head/neck
maximize oxygenation and ventilation support circulation/maximize cerebral perfusion pressure decrease intracranial pressure decrease cerebral metabolic rate |
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What is the monroe kelle hypothesis?
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An increase in the volume of one component (blood, brain tissue, CSF) must be accompanied by a decrease in another component if intracranial pressure is to remain constant
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What is normal CSF pressure?
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1-15 mmHg
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What can cause increased CSF pressure?
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val salve, tumor, subdural hematoma, subarachnoid hemorrhage, infections, hydrocephalus
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How can intracranial pressure be lowered?
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-evacuate hematomas
-drain csf with catheter -craniotomy -reduce cerebral metabolic rate -give mannitol (also lowers bp) |
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What is cushing's triad?
(vital sign changes in ICP) |
1. systolic pressure increases (widens pulse pressure)
2. slowing of heart occurs (a result of reflexibe slowing in response to increased systolic pressure) 3. respiration changes- becomes slowed |
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How does hyperosmolar therapy work to decrease ICP?
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fluid moves out of cell to reduce edema (from an area of lower osmolarity to an area of higher osmolarity)
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How should the person be positioned to promote venous drainage?
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HOB elevated to 30 degrees, keep neck at midline
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Does the presence of the family increase the ICP?
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No, it has been shown to decrease the ICP.
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What is the benefit does cooling the body of someone with a head injury?
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Inducing hypothermia reduces the cerebral metabolic rate. This decreases bleeding and promotes relaxation
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What must you do for someone who has a neuromuscular blockade to reduce movement?
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Sedate them!
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What are some nursing interventions that inadvertently increase ICP?
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Suctioning
Turning Bathing Cluster these events |
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What drugs are used for pain and agitation in patients with traumatic brain injuries?
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opioids and benzodiazepines
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How do we measure the severity of a coma?
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Glasgow coma scale, measures along a toncinuum of levels of responsiveness
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Would you intubate a client with a a Glasgow coma score of 8?
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Yes, intubate for an 8 or less on the scale
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What memory is lost with retrograde amnesia?
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Loss of memory for events before the accident
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What memory is lost with anterograde amnesia?
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Loss of memory for events after the accident, also includes problems with new learning.
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What does decorticate posturing look like?
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flexion of the arms, clenched fists, and extended legs. Arms are bent inward toward the body, arms and hands bent on chest. Serious, not as bad as decerebrate.
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What does decerebrate posturing look like?
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Extension of arms and legs, downstard pointing of toes, backward arching of head. Severe injury at level of brainstem as occurred. R.I.P.!
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How are brain/spinal cord injuries managed?
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-ICP monitoring- don't want increase or significant decrease in pressure
-Osmotic diuretics- mannitol but watch for hypotension -loop diuretics -corticosteriods- decadrone for swelling -antacids- tagament -anti hypertensives -anti convulsants -barbiturate tx -hyperventilation- give extra O2 -Nutrition |
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Why do we monitor ABG's in head trauma patients?
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check for acidosis
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Which child is more at risk from being shaken, a 6 month old or a 2 year old?
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The younger the child, the worse the prognosis.
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What causes papilledema?
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Result of increased intracranial pressure and the swelling of the optic nerve.
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What causes most spinal cord injuries?
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Most spinal cord injuries, including complete injuries, result from bruising of the spinal cord or loss of blood flow to the cord and not from cutting of the cord.
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At what spinal level is the diaphragm innervated?
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C 3-5
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At what level are the intercostal muscles innervated?
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T 1-11
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What degree of injury results from a complete transection?
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Total paralysis and loss of sensory and motor function although arms are rarely completely paralzed
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What degree of injury results from an incomplete transection?
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mixed loss of voluntary motor activity and sensation
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What does more damage, cutting of the spinal cord or bruising of the spinal cord and subsequent loss of blood flow to the cord?
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bruising and blood flow loss
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When do we intubate someone who has a spinal cord injury?
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When their injury involves C3 and above, or when there is fatigue of innervated resp muscles, hypoventilation, secretion retention. If their injury is below C5, their diaphragm should be okay
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At what level of spinal injury is the cough reflex intact and fully functional?
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T 11 and below. There increasing levels of impairment in the cough reflex as you travel up the spinal cord
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Spinal shock occurs when and lasts how long?
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Occurs immediately after injury It is the temporary suppression of all reflex activity below the level of injury.
It may last days to months and its reversal is indicated by the return of reflex activity. |
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Neurogenic shock occurs when, how and lasts for how long?
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Occurs in the first 24 hours after injury. It is manifested by hypotension and bradycardia.
It is most often associated with cervical spinal injuries. It is caused by a loss of autonomic function. |
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What is the clinical triad of neurogenic shock?
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-Hypotension- because of dilation of the vasculature
-bradycardia- because of parasympathetic system stimulation -Hypothermia- because of loss of sympathetic nervous system function |
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What is the first line intervention for hemodynamic instability (hypotension)?
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Volume resuscitation 1-2 Liters
Ringer's Lactate Then give vasopressors to counter loss of sympathetic tone and provide chronotropic support |
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What can a nurse do to prevent bradycardia in a patient?
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-avoid vagal stimulation
-hyperventilate and hyperoxygenate prior to suctioning (it stimulates the vagus nerve) -pre medicate patients with known hypersensitivity to vagal stimuli |
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When would you want to maintain a high mean arterial pressure?
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During the first 7 days of a spinal cord injury, it is common to maintain the MAP at or above 85-90 mmHg to promote tissue perfusion. Normal MAP (Diastolic+1/3(Systolic-Diastolic) =MAP) is 60mmHg
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How can a nurse avoid respiratory complications in her spinal cord injury patients?
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1. Give patient the flu vaccine
2.Aggressively treat any symptom of respiratory complication 3. Avoid secretion buildup in the lungs |
