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46 Cards in this Set

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Why does scalp laceration result in profuse bleeding
Scalp is very vascular
When might scalp laceration require surgery
Avulsion, otherwise sutured at bedside
how can you assess for skull Fx in scalp laceration
palpate lightly
palpate after scalp lac and feels firm i.e. no Fx. You...
Apply pressure.
palpate after scalp lac and feels soft i.e. Fx. You...
Just cover, no pressure
Main complication of scalp lac
Potential for blood loss
Skull Fx carries potential for what type of hematoma
epidural
Intracranial process that might result in CSF drainage from nose/ears
Basilar skull fracture
Drainage from nose/ears indicates _____ tear.
Dural
-Basilar Fx
What nursing action do you take when you see ottorhea/rhinorrhea
Allow to drain freely
-don't pack
-don't suction
battles sign and racoons eyes assoc with...
Basilar skull Fx
-Late Sx's
Why must you avoid NG/nasotrach insertion in basilar Fx
Dural tear may provide direct entry to brain
Why might basilar Fx pt show signs of meningeal irritation
meninges irritation secodnary to dural tear
Alteration inmental status that may/may not involve loss of consciousness
Concussion
Post concussion syndrome may last up to ?? year following event
1 year
How are brain contusions Tx'd
Agressive Tx if IICP
-Bruising assoc with hemorrhage and edema
Craniotomy indic
Hemorrhage/bleed
Hematoma/Contusion
Aneurysm (coil/clip)
Placement of IVD
Seizure prphylaxis s/p craniotomy
Dilantin
Bleed between skull and dura amter
Epidural hematoma
-Brief unconsciousness after initial insult
-Followed by lucid interval
-Followed by rapid deterioration in neuro status from confusion>coma>death
Epidural hematome
Big complication of epidrual hematoma
Herniation
-Posturing
-Cushings
-Unilateral dilation
Tx of epidural hematoma
Immediate Neurosurgical Surgery
-Neuro 911-resp arrest may occur within minutes
-Craniotomy
Bleeding between dura mater and arachnoid covering the brain
Subdural hematoma
Associated with tearing of veins in head
Subdural hematoma
hematome assoc with elderly and alcoholics
Subdural hematome
Type of subdural hematoma requiring immediate intevention
Acute subdural hematoma
-neuro changes over 24-48 hours
-may progress to herniation
HOB remains flat with this type of hematoma
Subdural
-prevents tension on veins thereby decreasing rebleed
How may a CT differentiate a chronic subdural hematoma from other subtypes
Layering of blood or thickened fibrous membrane
Type of subdural hematoma often seen in elderly with Hx of falling
Chronic subdural
Subarachnoid hematoma complications
Intracerebral bleed
Subdural hematoma
Hydrocephalus
IICP
% of pt's with S&S prior to subarachnoid bleed
50%
-Localized HA
-Lethargy
-Neck pain
-Noise in head
-Pain behind/above eye
-Occulomotor changes
S&S of subarachnoid hematoma after bleeding has occured
Classic Sx=worst HA of life
-Decreased LOC
-hemiparesis, hemiplegia or posturing
-Sx of meningeal irritation
Worst HA of my life assoc with
Sub arachnoid hematoma
Causes of subarachnoid hematoma
Main=aneurysm
Long term coumadin tehrapy also
Aneurysm precautions consist of
Low stim environment
-no visitors
-dim light
-quiet
Why might SAH pt be on analgesia/sedation
Excruciating HA
-Usually NSAID as you don't want to mask neuro Sx's
Endovasc technique
Clip of coil
Coil
-Clipping is craniotomy
Craniotomy/clipping shown to have good outcomes when performed __ from ruprture
24-48 hours
Biggest comlication of SAH
Vasospasm
Occurs in 70-90%
Others include
-rebleed
-hydrocephalus
S&S of vasopspasm
Mimic that of anuerysm
Typically only produce Sx's in 30% of pt's
All late Sx's
-HA
-Altered LOC
-Speech impairment
-Hemiparesis
-Seizures
Vasospasm implications
Reduces cerebreal bf distally>May cause either brain ischemia or infarct
Rx used prophylactically post SAH to alleve abnormal contraction of vascular smooth muscle
CCB
Nimodipine
Nimodipine assoc with
Used in SAH prophylactically to reduce vspospasm potential
Triple H therapy assoc with
SAH/vasospasm
-Used as the vasospasm occurs
Components of Triple H
Hypervolemia
Hemodilution
Induced hypertension
Best precaution against re-bleed post SAH
Early clip/coil