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89 Cards in this Set

  • Front
  • Back
Name the 3 meninges in order of closest to skull to closest to brain
- Dura mater
- Arachnoid
- Pia mater
List the order of layers and spaces from skull to brain

Hint: ED'S A Super Person
Epidural Space
Dura Mater
Subdural Space
Arachnoid
Subarachnoid space
Pia Mater
True or False
CSF circulates in the subarachnoid space
True
True or False
Intracerebral bleed is above the level of the pia mater
False, it is below the pia mater
Name the 3 kinds of blunt head injury
- Deformation
- Acceleration- deceleration
- Rotation
What is a coup-contracoup head injury?
Injury on the side of the head that was hit and the opposite side secondary to the brain moving around in the skull
What does PERRLA stand for?
Pupils equal round reactive to light and accommodation
What is the difference between perforating and penetrating injury?
-Perforating enters and exits
- Penetrating enters but does not exit
Why do head wounds bleed profusely?
Vessels can not vasoconstrict
Generally what meds do patients get with a head injury to stop bleeding and help with pain?
Epi and Lidocane
What are the four types of skull fractures?
- Linear
- Comminuted
- Depressed
- Basilar skull fracture
Linear skull fractures are described as? what do you normally see with them?
- crack in the skull
- hematomas
Comminuted skull fractures are?
Multiple linear fractures, "egg shell fracture"
Depressed skull fracture is described as?
"step off" where skull fragment is resting on brain below
Depressed skull fractures can be closed or open, explain the difference and needs of both
- Closed: dura is intact, if depression is greater than thickness of the skull surgery is needed
- Open: dura is torn, focal brain injury and seizures common, infection can get into wound
True or False
Basilar skull fractures are linear and usually heal themselves but are serious bc of proximity to brain stem.
True
What are the 2 kinds of basilar skull fracture?
- Anterior fossa
- Posterior fossa
What are the s/s of an anterior fossa fracture?
- Raccoon eyes
- Rhinorrhea
If a patient with a head injury has clear liquid and/or blood coming from their nose, what would we want to test for? how?
CSF
If clear, test for glucose
If bloody, test for halo sign
What are the s/s of a posterior fossa fracture?
- Battle's sign
- Otorrhea
- may have hearing loss, nausea, vertigo, nystagmus
Would you put an NG tube in a patient with a head injury?
NO
Decreased Na and Ca, increases the risk for?
Seizures
What is the difference between primary and secondary head injury?
- Primary is the mechanical injury to the brain
- Secondary is caused by oxygen and nutrient supply/demand mismatch
What is the difference between concussion and contusion?
- Concussion is transient, temporary neurogenic dysfunction caused by mechanical force on the brain
- Contusion is bruising of the surface of the brain
What are the characteristics of a mild concussion?
- No loss of consciousness
- Sensation of having "bell rung", dazed thinking
What are the characteristics of a moderate concussion?
- May have brief loss of consciousness and neuro deficits that clear quickly
What are the usually D/C instructions for a patient with a moderate concussion?
- Wake patient every 3-4 hrs for first 12 hrs
- Look for difficulty to arouse, change in behavior, vomiting, problems hearing, speaking, or seeing
Any loss of consciousness requires what?
ED evaluation
What are the characteristics of a severe concussion?
- Prolonged loss of consciousness and/ or neuro deficits that last minutes to hours
True or False
A severe concussion requires admission to hospital for observation and evaluation.
True
Describe post concussion syndrome
- Usually happens after several concussions but can occur after only one
- Behavioral changes: forgetful, confusion, loses temper easily, acts w/out thinking
- Visual and hearing disturbances
- May continue for months or years
What are some teaching points for patient and family with a head injury?
- Notify MD if: increased drowsiness, N/V, worsening headache, stiff neck, seizures, blurring vision, behavior changes, heart rate below 60
- abstain from alcohol
- avoid driving, playing contact sports, and taking hot baths
Is a contusion worst than a concussion?
YES
What is the main problem with a contusion? how long can the coma last?
- Increased ICP
- days to weeks
Epidural hematoma is where? what kind of bleed?
- Between the skull and the dura
- Arterial bleed
What is worst an epidural or subdural hematoma?
Epidural
What is the classic presentation of an epidural hematoma?
- Momentary loss of cosciousness followed by a lucid period lasting mins to few hours, then rapid deterioration
What are the s/s of an epidural hematoma?
- decreased LOC
- ipsilateral sluggish, dilated, fixed pupils
- possible seizures
- hemiparesis or hemiplegia
- posturing
Where is a subdural hematoma? what kind of bleed?
- Between the dura and arachnoid
- Venous bleed
True or False
Subdural hematomas are slower to develop than epidural hematomas.
True
What are the s/s of an acute subdural hematoma?
- s/s occur within 48 hrs
- gradual LOC changes
- hemiparesis or hemiplegia
How long does it take for s/s of a sub acute subdural hematoma to show? what is it usually associated with?
- s/s occur between 3 days to 3 weeks after injury
- associated with less severe underlying contusions
How long does it take a chronic subdural hematoma to present itself? why?
- symptoms take 3 weeks to several months to develop and the injury may not be recalled
- s/s develop slowly bc bleed is so slow the brain can accommodate it to a point
Why does chronic sudural hematoma occur more in elderly and alcoholics?
Brain atrophy
What is the treatment for subdural hematomas?
Craniotomy to evacuate the hematoma
If there is a bleed in the arachnoid or pia mater would the lumbar and ventricle puncture show blood? Why or why not?
Yes, bc CSF flows in the spinal column and the subarachnoid space
What are the s/s of subarachnoid hemorrhage?
- Nuchal rigidity
- decreased LOC
- headache
- hemiparesis or hemiplegia
- ipsilateral dilated pupil
With an aneurysm and/or subarachnoid hemmorrhage, what do the patients usually state?
"The worst headache I've ever had"
What is a sentinel leak?
A warning leak that usually manifests by one or two headaches with vomiting
Can a lumbar puncture be done if there is increased ICP?
NO
If a LP is done and there is a bloodly apperance to the CSF that is dark amber in color, what does that tell us?
Bleed happened about 5 days ago
When does the highest incidence of rebleeding occur on a patient with an aneurysm?
1st day after intial hemorrhage and again in 7 days if no surgery has been done
What are the s/s of rebleeding?
- increased headache
- n/v
- changes in BP and respirations
What are two surgeries done for rebleeding?
- Aneurysm clipping
- AVM excision, depending on size and location
What are two complications of a bleed?
- Rebleeding
- Vasospasm
Vasospasm does not occur when what procedure is done?
AVM
When is the highest incidence for vasospasm?
3-5 days post bleed and continues for up to 3-4 weeks
What are the s/s of vasospasm? how is it dx?
- change in LOC and pupils
- Dx by doppler and/or angiogram
What is the treatment/prevention for vasospasm?
- HHH therapy
- Nimotop
What is Nimotop? why is it used for vasospasm?
- Calicum channel blocker
- has an affinity for cerebral arteries
What is HHH therapy? why is it used for vasospasm?
- Hypertensive, Hypervolemic, Hemodilution
- Keeps blood vessel walls tense so they can't spasm and keeps blood flowing
What is used in HHH therapy to get the results needed? give examples of each
- Vasopressors (Neo-synephrine, Dopamine, Levaphed)
- Volume expanders (albumin, dextran)
- Reducing the Hct to 30%
In HHH therapy, why is the Hct reduced?
gets increased oxygen delivery related to increased blood flow
What do vasopressors do?
- Increase HR, BP, urinary output
- dilated pupils
What is the Fisher Scale?
Grades SAH based on size and location
What is the Hunt and Hess Scale?
Grades SAH on client symptoms, 1 being the best and 5 being the worst
What are the s/s of meningitis?
- fever, headache, n/v, nuchal rigidity, photophobia
- Kernig's sign
- Brudzinski's sign
What is Kernig's sign?
Painful spasm in hamstring when hip is flexed and leg straightened at knee
What is Brudzinski's sign?
Flexes at hip and knees in response to passive flexion of neck
What does the nurse do for a patient with bacteria meningitis?
- Start antibiotics after LP
- Assess for increased ICP
- Give codeine bc its less sedating
- Patient should go in isolation
- Temp management
- Seizure control/ management
What does the nurse do for viral meningitis?
Treat symptoms
True or False
Meningitis can be caused by bacteria, virus, chemical, or fungus.
True
In bacterial meningitis the CSF would look cloudy or clear?
Cloudy
Encephalitis is usually caused by virus or bactieria?
Virus
S/S of encephalitis are similar to meningitis but more _______ onset
Gradual
How does a person get encephalitis?
- Ticks, mosquitos (West Nile)
- complications of measles, chickenpox or mumps
- common in AIDS patients
What is the treatment for encephalitis?
- Supportive care
- Mannitol
- Lasix
- Antivirals: Acyclovir
What kind of needle do you need for Mannitol?
Filtered
Do you want to give D5W to a patient with encephalitis?
No
What are the s/s for a brain tumor?
- Headache
- papilledema
- vomiting
- seizures
What does the prognosis of a brain tumor depend on?
- Location
- Cell involvement
- Size
Why is general IV chemotherapy not successful for brain tumors?
Doesn't cross blood/brain barrier
What is done to treat brain tumors?
- Radiation
- Polymer wafers inserted into tumor
- Ommaya reservoir
- Surgery
What happens in Diabetes Insipidus?
Decrease in ADH leading to dehydration and seizures
How is Diabetes Insipidus treated?
- IV fluids adjusted to output
- DDAVP admin intranasally
What is a warning sign for Diabetes Insipidus?
Urinary output of greater than 200 mL/hr for 2 hrs
What happens in SIADH?
Increased production of ADH leading to overhydration and coma
How is SIADH treated?
- Strict fluid restriction
- 3% saline, very hypertonic
- Monitor Na levels carefully
What is a warning sign for SIADH?
Output less than 30 mL/hr for 2 hrs