Neuro

Front 1

concussion

Back 1

With a mild traumatic brain injury there is sometimes a brief loss of consciousness or a feeling of “having your bell rung” after a head trauma.

Lab tests and scans are usually normal; however, personality, memory, physical abilities, or other functions can be affected.

Mild TBI, or concussion, can cause a loss of consciousness, called LOC, loss of memory, or confusion.

Thinking may become slow and disorganized, memory can become unreliable, and concentration often becomes difficult.

The injury blocks the pathways normally used by the brain to send messages. When this trauma occurs, the brain is not able to continue normal function and so it shuts down.

Front 2

contralateral

Back 2

Originating in or affecting the opposite side of the body.

Front 3

contusion

Back 3

a crushing, bruising

Front 4

coup-contrecoup injury

Back 4

An impact or violent motion brings their head to a sudden stop, causing the brain to slam into the skull.also known as an acceleration/deceleration injury.

The brain bounces back and forth inside of the head, causing damage to the brain where it hits the skull. The brain is injured at the point of direct impact, and because it bounces back into the opposite side of the skull, the opposite side of the brain is injured as well.

It’s important to know that coup-contrecoup injuries can happen as the result of trauma without direct impact to the head, since it is the movement of the brain inside of the skull that causes the injury.

Front 5

epidural hematoma

Back 5

A hematoma above the dura mater, usually arterial, except in posterior fossa.

Front 6

hydrocephalus

Back 6

The accumulation of excessive amounts of cerebrospinal fluid (CSF) within the ventricles of the brain, resulting from blockage or destruction of the normal channels for drainage of CSF.

Front 7

Intracerebral hematoma

Back 7

A hemorrhage localized in one area of the brain.

Front 8

ipsilateral

Back 8

On the same side; affecting the same side of the body; the opposite of contralateral.

For example, when the right patellar tendon is tapped, an ipsilateral knee-jerk is observed on the same side.

Front 9

nuchal rigidity

Back 9

Inflexibility of the neck movement, esp. forward flexion of the neck. It is a sign of meningeal irritation.

Front 10

papilledema

Back 10

Swelling of the optic disk with dilated veins, blurred optic disc margins, flame-shaped hemorrhages in the nerve fiber layer adjacent to the disk, and an enlarged blind spot on the visual field.

It is caused by increased intracranial pressure, often due to a tumor of the brain pressing on the optic nerve.

Blindness may result very rapidly unless relieved.

Front 11

quadriplegia

Back 11

Paralysis of all four extremities, usually caused by an injury to or disease of the cervical spinal cord.

Quadriplegia most often results from trauma to the neck, although it may occasionally result from spinal stenosis, infections, aneurysms, vasculitis, autoimmune diseases, neurosurgery, or mass lesions.

The higher the injury (the closer it is to the brainstem) the less function will be present in the arms. Injury above the third cervical vertebra paralyzes the diaphragm.

Front 12

subdural hematoma

Back 12

Bleeding into the space between the dura mater and arachnoid layer, usually the result of a head injury.

Symptoms may be delayed in appearing, but include severe headaches, forgetfulness, disorientation, and confusion. History of a fall, older age, and use of oral anticoagulants all increase the risk for bleeding.

Front 13

subluxation

Back 13

A partial or incomplete dislocation.

Front 14

Describe the types of injuries that result from head trauma.

Back 14

Mild TBI- Concussion

Contusion

Coup-Contrecoup

Diffuse Axonal

Penetration

Moderate Traumatic Brain Injury

Severe Brain Injury

Front 15

Contusion

Back 15

A contusion can be the result of a direct impact to the head. A contusion is a bruise (bleeding) on the brain. Large contusions may need to be surgically removed. (see hematoma)

Front 16

Diffuse Axonal

Back 16

A Diffuse Axonal Injury can be caused by shaking or strong rotation of the head, as with Shaken Baby Syndrome, or by rotational forces, such as with a car accident.Injury occurs because the unmoving brain lags behind the movement of the skull, causing brain structures to tear.

Front 17

Penetration

Back 17

Penetrating injury to the brain occurs from the impact of a bullet, knife or other sharp object that forces hair, skin, bones and fragments from the object into the brain.

Objects traveling at a low rate of speed through the skull and brain can ricochet within the skull, which widens the area of damage.

TBI caused gsw result in a 91% death rate.

Front 18

Moderate Traumatic Brain Injury

Back 18

A loss of consciousness that lasts for more than 30 minutes but less than 24 hours

Memory loss after the traumatic event, called post-traumatic amnesia or PTA, lasting for 24 hours to seven days A Glasgow Coma Score of 9 – 12

Front 19

Severe Brain Injury

Back 19

Loss of consciousness that lasts for more than 24 hours

PTA lasting for seven days or longer A Glasgow Coma Score of 8 or less, which indicates that the patient is in a coma.

Front 20

Compare and Contrast the signs and symptoms of subdural hematoma and epidural hematoma.

Back 20

see below

Front 21

subdural hematoma s/s

Back 21

Collection of clotting blood that forms in the subdural space and blunt head trauma is the usual MOI.

Usually presents shortly after a moderate-to-severe head injury.Loss of consciousness may occur but not always.There may be a 'lucid interval' of a few hours after the injury where the patient appears relatively well and normal but subsequently deteriorates and loses consciousness as the haematoma forms.There may be a gradually evolving neurological deficit such as focal limb weakness, speech difficulties, increasing drowsiness/confusion or personality changes.If there is accompanying and progressive headache, this should raise suspicion of the diagnosis.

Front 22

epidural hematoma s/s

Back 22

Caused by bleeding from an artery or a large vein (venous sinus) located between the skull and the outer layer of tissue covering the brain.

A severe headache may develop immediately or after several hours. The headache sometimes disappears but returns several hours later, worse than before.

Deterioration in consciousness, including increasing confusion, sleepiness, paralysis, collapse, and a deep coma, can quickly follow.

Some people lose consciousness after the injury, regain it, and have a period of unimpaired mental function (lucid interval) before consciousness deteriorates again.

People may develop paralysis on the side of the body opposite the hematoma, speech or language impairment, or other symptoms, depending on which area of the brain is damaged

Front 23

Explain why an epidural hematoma causes an emergency situation.

Back 23

An epidural hematoma has a high risk of death without prompt surgical intervention. Even with prompt medical attention, a significant risk of death and disability remains.

There is a risk of permanent brain injury, even if the disorder is treated. Symptoms may persist for several months, even after treatment. In time they may become less frequent or disappear completely. Seizures may begin up to 2 years after the injury.

Emergency surgery is almost always necessary to reduce pressure within the brain. This may include drilling a small hole in the skull to relieve pressure and allow blood to drain from the brain.

Front 24

agnosia

Back 24

Inability to recognize or comprehend sights, sounds, words, or other sensory information.

Front 25

aneurysm

Back 25

Localized abnormal dilatation of a blood vessel, usually an artery, due to a congenital defect or weakness in the wall of the vessel. As aneurysms dilate, they become more and more vulnerable to rupture.

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aphasia

Back 26

Absent or impaired ability to communicate by speech, writing, or signs because of brain dysfunction. It is considered complete or total when both sensory and motor areas are involved.

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apraxia

Back 27

Inability to perform purposive movements although there is no sensory or motor impairment.

Also inability to use objects properly.

Front 28

ataxia

Back 28

Defective muscular coordination, esp. that manifested when voluntary muscular movements are attempted.

Front 29

aura

Back 29

A subjective but recognizable sensation that precedes and signals the onset of a convulsion or migraine headache.

In epilepsy the aura may precede the attack by several hours or only a few seconds. An epileptic aura may be psychic, or it may be sensory with olfactory, visual, auditory, or taste hallucinations.

Front 30

automatism

Back 30

A tic (stereotyped movement disorder) such as lip smacking, chewing, or gesturing that is not controlled consciously.

Front 31

dysarthria

Back 31

Impairment or clumsiness in speaking due to diseases that affect the oral, lingual, or pharyngeal muscles. The patient's speech may be difficult to understand, but there is no evidence of aphasia.

Front 32

dysphasia

Back 32

Impairment of speech resulting from a brain lesion or neurodevelopmental disorder. The speech impairment in dysphasia is less marked than the severe or global language loss found in aphasia.

Front 33

embolus

Back 33

A mass of undissolved matter present in a blood or lymphatic vessel and brought there by the blood or lymph. Emboli may be solid, liquid, or gaseous. Occlusion of vessels from emboli usually results in the development of infarcts.

Front 34

epilepsy

Back 34

A disease marked by recurrent seizures, i.e., by repeated abnormal electrical discharges within the brain.

Front 35

homonymous hemianopia

Back 35

Blindness of the nasal half of the visual field of one eye and of the temporal half of the other, or right-sided or left-sided hemianopsia of corresponding sides in both eyes.

Front 36

infarct

Back 36

An area of tissue in an organ or part that undergoes necrosis following cessation of the blood supply. This may result from occlusion or stenosis of the supplying artery or, more rarely, from occlusion of the vein that drains the tissue

Front 37

postictal

Back 37

Occurring after a sudden attack or stroke, as an epileptic seizure or apoplexy.

Front 38

ptosis

Back 38

Dropping or drooping of an organ or part, as the upper eyelid from paralysis.

Front 39

scotoma

Back 39

An island-like blind spot in the visual field.

Front 40

status epilepticus

Back 40

Continuous seizure activity without a pause for 30 min, i.e., without an intervening period of normal brain function. Status can include two back-to-back seizures without a lucid interval or any seizure lasting more than 5 to 10 min.

Front 41

Explain why a seizure may be a consequence of a stroke, tumor or infection in the brain.

Back 41

Stroke- Hemorrhagic stroke can occasionally present with seizures, the CVD which caused the stroke may lead to a seizure.

Tumor- space-occupying lesions in the brain In people with brain tumors, the frequency of epilepsy depends on the location of the tumor.

Infection- Meningitis, encephalitis or anything that can cause a significant temperature elevation. (usually 107) or high BP

Front 42

Discuss nursing actions to assist the Pt. who has developed a complication after a CVA.

Back 42

Help patients alter risk factors for stroke; encourage patient to quit smoking, maintain a healthy weight, follow a healthy diet (including modest alcohol consumption), and exercise daily.

Recombinant tissue plasminogen activator (tPA), unless contraindicated; monitor for bleeding.

Management of increased intracranial pressure (ICP): osmotic diuretics, maintain PaCO2 at 30 to 35 mm Hg, position to avoid hypoxia (elevate the head of bed to promote venous drainage and to lower increased ICP)

Neurologic assessment to determine if the stroke is evolving and if other acute complications are developing.

Front 43

Improving Mobility and Preventing Deformities

Back 43

Position to prevent contractures; use measures to relieve pressure, assist in maintaining good body alignment, and prevent compressive neuropathies.Apply a splint at night to prevent flexion of affected extremity.Prevent adduction of the affected shoulder with a pillow placed in the axilla.Elevate affected arm to prevent edema and fibrosis.Position fingers so that they are barely flexed; place hand in slight supination. If upper extremity spasticity is noted, do not use a hand roll; dorsal wrist splint may be used.Change position every 2 hours; place patient in a prone position for 15 to 30 minutes several times a day.

Front 44

Establishing an Exercise Program

Back 44

Provide full range of motion four or five times a day to maintain joint mobility, regain motor control, prevent contractures in the paralyzed extremity, prevent further deterioration of the neuromuscular system, and enhance circulation. If tightness occurs in any area, perform range of motion exercises more frequently.Exercise is helpful in preventing venous stasis, which may predispose the patient to thrombosis and pulmonary embolus.Observe for signs of pulmonary embolus or excessive cardiac workload during exercise period (eg, shortness of breath, chest pain, cyanosis, and increasing pulse rate).Supervise and support patient during exercises; plan frequent short periods of exercise, not longer periods; encourage patient to exercise unaffected side at intervals throughout the day.

Front 45

Managing Sensory-Perceptual Difficulties

Back 45

Approach patient with a decreased field of vision on the side where visual perception is intact; place all visual stimuli on this side.Teach patient to turn and look in the direction of the defective visual field to compensate for the loss; make eye contact with patient, and draw attention to affected side.Increase natural or artificial lighting in the room; provide eyeglasses to improve vision.Remind patient with hemianopsia of the other side of the body; place extremities so that patient can see them.