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57 Cards in this Set
- Front
- Back
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Do you want to apply a lot of pressure while covering a head injury?
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No, just cover DO NOT APPLY HEAVY PRESSURE AS YOU WOULD WITH A BLEED
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What is a concussion?
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A whack in the head
“seeing stars” Immediate and transitory impairment of neurological function because of mechanical force |
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What are some s/s of a concussion?
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N/V
Blurred vision Recent loss of memory H/A gets worse with increased ICP |
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What is a contusion?
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Bruise
Bruising without tearing of tissues May be at site of impact or opposite Coup Contracoup Usually worse than concussion Cool clammy skin |
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What is a laceration?
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They bleed a lot
Usually do not hemorrhage Tearing of tissues that may be caused by sharp fragments, sharp objects, or shearing force |
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What is an epidural hematoma?
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Blood collects between the dura and the skull
After one hour will be drowsy with unequal pupils ARTERIAL BLEEDING - MEDICAL EMERGENCY |
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What is a subdural hematoma?
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Forms as venous blood collects below dura (Since it is venous it bleeds slower)
May take 6 months to cause problem Treat with burr holes |
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What is a basilar skull fracture?
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Serious because of site
May have permanent damage Bleeding from nose and ears suggests basilar skull fracture Located at base of skull |
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What is a subarachnoid hemorrhage?
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Trauma or ruptured aneurysm
Sudden severe headache Usually say it is the worst h/a they ever had before they pass out Nuchal rigidity 50% of all fatal CVA’s Usually < 45 years old |
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How do you properly care for someone with a head injury at the scene of the accident?
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Keep quiet
Apply LIGHT pressure Keep warm Assure Patent airway Support head Watch closely Check Vital Signs |
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How do you care for a patient with a head injury in the hospital?
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Seizure precautions
HOB elevated Rest and control of convulsions VS and Temp control TX of Respiratory insufficiency Drainage from ear and nose Pain medicine, What type? Codeine Lumbar puncture Control of cerebral edema - Mannitol I&O Bowel function Convalescense |
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Why do head injury patients usually get codeine for pain?
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Morphine dilates blood vessels increasing pressure and constricting pupils
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Is someone usually different after a head injury?
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Yes, they are usually never the same after severe brain injury
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What type of brain abscesses are there?
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Primary - Penetrating injury
Secondary to infection - Most common |
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What are some common infections that can later cause a secondary brain abscess?
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Ear
Mastoid sinus Lung Heart Pelvis Teeth |
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What organisms can cause a brain abscess?
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Strep
Staph |
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What is the process of a brain abscess forming?
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First there is localized inflammation of the brain and exudate is formed
Septic thrombosis of some vessels occur and surrounding brain tissue turns necrotic and edematous |
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How is a brain abscess treated?
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Antisiezure medications
Antibiotics - Penicillin or Flagyl Vancomycin |
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What is meningitis?
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Acute inflammation of meninges
Usually caused by: Pneumococci Staphylococci Streptococci H. influenzae Viruses - Meningococci |
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Why is meningitis worse when caused by meningococci?
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It can be an epidemic caused by droplet infection because the virus can spread
Very big concern for areas where people are in close contact such as dorm rooms |
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When is meningitis more common?
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During fall and winter when upper respiratory infections are common
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Who is more apt to have a meningitis infection?
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Children because of frequent colds and ear infections
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How is meningitis diagnosed?
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Lumbar puncture:
Fluid is cloudy Isolate organism |
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What are the s/s of meningitis?
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Sudden onset - Within 24 hours
Severe h/a Nuchal rigidity Irritability Malaise Restlessness High pitched restless cry Positive kernig’s sign (Won’t let you stretch their leg out) Positive brudzinski’s sign (If you lift the head the knee goes up) Opisthotonos (Bowing of the back like a back bend) Photophobia - Not liking the light |
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How is meningitis treated?
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Large doses of antibiotics
Respiratory isolation for 24 hours after antibiotics are started Prevent or treat dehydration Dark room Quiet environment Seizure precautions Osmotic diuretics |
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What medication can decrease the incidence of deafness after a meningitis infection?
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decadron
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What are the three types of brain neoplasms are there?
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Gliomas - Little tenticles that reach out so you can’t get them out surgically
Meningiomas Usually benign May have malignant changes May cause seizures due to pressure Metastatic lesions - Primary brain tumors rarely metastisize |
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What are the s/s of a brain neoplasm?
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Seizure
Change in personality or judgment (ex. Impulsiveness) Weakness of eyelid Paresthesia or anesthesia Loss of visual acuity Unexplained hearing loss s/s of increased ICP |
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How can you treat a brain neoplasm?
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Surgical extraction
Radiation chemotherapy |
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What are the two types of surgical extraction for a brain neoplasm?
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Supratentorial - Above dividing line between brain stem and cerebrum
Infratentorial - Below cerebrum |
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What pre-op care should be given to someone getting a brain neoplasm removed?
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No narcotics
Keep hair Anticonvulsants - Reduce risks of siezures Steroids - Decadron Hyperoxomotic agent Foley |
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What post-op care should be done for a pt that had a brain neoplasm removed?
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Seizure precautions
TRY NOT to suction Place on side Not on operative side Infratentorial can turn on either side HOB Supratentorial - HOB UP Infratentorial - Bed flat Inspect dressings regularly Record response May have fluid restriction I&O Treat H/A |
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What are some complications that can happen from a head surgery?
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Meningitis - Because of open skull
Respiratory collapse Cunfulsions Loss of corneal reflex - Teach to blink & Wear an eye patch Diplopia - Double vision |
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What is epilepsy?
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Chronic disorder of the brain characterized by tendency to have recurrent seizures
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What is a seizure?
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Sudden uncontrolled episodes of excessive electrical discharges of brain cells
A short in the brain Can be caused by fluid balance |
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Is there anything that can help the prognosis of seizures?
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The longer someone goes without control of seizure the harder they are to control, so treat early
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Do having parents with epilepsy increase a child’s risk of having epilepsy?
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Yes
Having one parent with epilepsy increases risk by… 6% Having 2 parents with epilepsy increases risk by… 20% |
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What can cause epilepsy?
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Inherited diseases…Such as PKU
Problems during fetal development Problems during birth - Such as hypoxia Problems in early infancy Head injuries Infectious diseases Toxic factors Tumors Strokes |
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What are the phases of a seizure?
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Not everyone will have:
Prodromal signs (Activity which precedes seizures) Such as changes strobe lights Aural (A warning to let you know that you are about to have a seizure) Flashing lights Smells Everyone will have: Ictal - Time during a siezure Postictal - Period of recovery |
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What is status epilepticus?
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Having a lot of seizures in a small amount of time so that full consciousness is not regained between seizures
Complications: Builds up lactic acid and can die from exhaustion in 30 minutes |
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How do you treat status epilepticus?
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Valium
Ativan Dilanton Cerabex Eosphyniton If unsuccessful will paralyze with anesthesia |
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What is a Simple partial seizure?
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Stiffening or Jerking in JUST ONE EXTREMITY or ONE SIDE OF THE BODY
Pt does not lose consciousness May turn into generalized tonic clonic Also called focal siezures |
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What is a complex partial seizure?
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Purposeless activity
May very greatly from person to person Most likely to have aura Not violent, but may struggle if restrained Usually lasts from 1-3 minutes Also called psychomotor seizures |
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What are generalized tonic-clonic seizures?
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Formerly known as grand
Affects entire body Bite tongue Apnea Body stiffens Jerks Hypoxic Usually lasts 1-3 minutes Falls and unconscious Loss of urine or stool Tonic (contraction of all muscles) Clonic (jerking – alteration of contraction and relaxation of opposing muscle groups) |
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What are Absence seizures?
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Formerly known as petit mal
Brief loss of consciousness 1-10 seconds Symptoms Staring Eye blinking Mild facial twitching No aura Maintains posture and doesn’t fall Frequently not diagnosed Just think kids are daydreaming May have several hundred absence seizures in a day Absence seizures usually stop before adulthood Sometimes change into tonic-clonic seizures |
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How are absence seizures diagnosed?
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History
Description of episode General exam Neurological exam EEG CT Blood Tests |
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How are absence seizures treated?
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Antiepileptic drugs
Ketogenic diet - Diet high in fat Surgery - Take out the part of the brain that causes seizure |
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How can you document a seizure?
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What was the patient doing before the seizure
What did the patient do during the seizure How long did the seizure last What happened after seizure |
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What types of follow ups do you need after seizures?
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Routine follow up in 6 months to one year
Physical and neuro exam Drug levels CBC Liver function tests Additional tests |
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What do you need to keep in mind when having a patient that is having a seizure?
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Never leave alone
Keep calm Protect from injury Remain in attendance Help maintain airway Don’t Restrain Force mouth Offer food or drink |
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What should you do if you have a patient that is having a tonic-clonic seizure?
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Have pt lie down, place something under head
Remove glasses Loosen tight clothing Clear area of hard or sharp objects Turn to one side |
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What should you do if you have a patient complex partial seizures?
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Don’t restrain
Remove harmful objects from path, because they wander Gently guide away from danger |
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What should you do if you have a patient that has absence seizures?
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Be aware of seizure
Give them information they missed |
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What kind of effect does pregnancy have on epilepsy?
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It usually makes it worse
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How long should someone wait after being seizure free to drive a car?
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One year
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What are some common antiepileptic drugs?
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Clonipin
Depakote Dilantin Phenobarbital Tegretol |
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What are the unique side effects of some antiepileptic medications?
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Clonopin
Increase salivation Increase in bronchial secretion Depakote Indegestion Hair loss Tremor Changes in liver functions |
