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tramatic brain inj.
pn 141 test 3 book burke pg 912, 1019
| Question | Answer |
|---|---|
| what is the most serious form of head injury | a tramatic brain injury (TBI) |
| who is at an increased risk for getting a TBI | males 15-24, kids <5, elderly ppl >75 yo |
| TBI: causes | MVA, falls, violent assaults, sports injuries |
| what do head injuries include | scalp lacerations, skull Fx, concussions, contusion, hematomoas, |
| what head injury is classified as minor; why does this head injury seem more serious | scalp lacerations; they bleed perfusely |
| what is a skull Fx | a break in the skull |
| skulls fx: they are classified as what | open or closed |
| skulls fx: what is a linear one | simple, clean break in the skull |
| skulls fx: what is a comminuted one | the skull is crushed into small fragmented pieces |
| skulls fx: what is a depressed one | bone fragments may be pushed into the brain, usaully caused by a powerful blow to the skull |
| skulls fx: what is a basilar one | it occurs at the base of the skull and may extend to the paranasal siuns of the frontal bone or the middle ear found in the temporal bone |
| skulls fx: basilar- what can leak from nose or ears | blood or CSF |
| skull fx: basilar- s/s of one | CSF leak, battle's sign, periorbital ecchymosis |
| skulls fx: basilar- what is battle's sign | brusing over the mastoid process |
| skulls fx: basilar- what is periorbital ecchymosis | raccoon eyes |
| skulls fx: basilar- what inreases risk for infection | CSF leakage |
| in any head injury is is important to assess what | if the brain has sustained damage |
| can brain damage result from open or closed damage | both |
| open head injuries: how do they occur | severe blunt trauma can create an opening through the scalp, skull, dura to expose the brain (depressed skull Fx), bullet or knife can penetrate the skull and damage the brain |
| open head injuries: this increases the risk for what | meningitis |
| closed head injuries: what is the cause | acceleration-deceleration injury (when the brian hits an object it bounces forward (acceleration) and back (deceleration, concussion or contusion |
| closed head injuries: extensive injury is b/c of why | it has brusing at two points |
| the amount of damage from a head injury depends on what | how the injury occured, the type of injury, and its location |
| how does brain damage develop | from direct trauma or increased ICP and cerebral edema |
| what is intracranial hemmorrhage; it is the most serious type of what | defined as bleeding with in the skull and is the most serious type of brain injury |
| intracranial hemmorrhage: cause | the tearing of cerebral arteries or veins or from direct trauma |
| intracranial hemmorrhage: the bleeding leads to what | the formation of a hematoma |
| intracranial hemmorrhage: where does blood accumulate | in the epidural, subdural, or subarachnoid spaces, or with in the cerebral lobes |
| intracranial hemmorrhage: what leads to increased ICP | pressure on surrounding tissues |
| intracranial hemmorrhage: what happens if the pressure is not relieved | neurological changes can occur |
| intracranial hemmorrhage: how are hemotomas classified | by their location (epidural, subdural, intracerebral) |
| what are the two comlications of a head injury | increased ICP and cerebral edema |
| IICP: what are the three compartments of the cranium; how much space does each take up in cranium | brain 80%, blood 10%, cerebralspinal fluid 10% |
| IICP: what is intracranial pressure | it is pressure exerted w/in the cranium by these contents (brain, blood and cerebrospinal fluid) |
| IICP: what is the normal intracranial pressure | 5-15 mm Hg |
| IICP: if the volume of one component is increased the what should happen to the volume of the other components | they should decrease to keep pressure w/ in its normal range |
| IICP: if one components prssure increases and the others do not decrease what occurs | IICP |
| IICP: what and briefly increase ICP | coughing, sneezing, straining, bending forward |
| IICP: are brief increases of pressure harmful | no |
| IICP: how can it develop | w/ a head injury, brain surgery, and meningitis |
| concussion: what is it | brain injury is caused by violent shaking of the brain |
| concussion: s/s | immediate LOC for <5 min, drowsiness, confusion, dizziness, HA, blurred or double vision, no visible head injury |
| contusions: what is it | bruising of the brain tissue caused by blunt trauma, more severe than a concussion because brain swelling occurs |
| contusions:s/s | varies w/ size and location, initial LOC, combative, while unconscious they lie motionless, pale clammy skin, faint pulse, hypotension, shallow respirations, altered motor response |
| epidural hemotomas: what is it | severe blow to the brain causes ARTERIAL bleeding that collects between the skull and dura mater, may be caused by skull Fx or contusion |
| epidural hemotomas: s/s (what three things happen) | 1brief loss of consciousness followed by short awake period, then pt rapidly progresses into a coma with psoturing, pupil dilation, seizures |
| subdural hematoma: what is it | closed head injury causes VENOUS blood to collect between the skull and dura mater, may be caused by skull fx or contusion, slower than arterial origin |
| subdural hematoma: what is subacute | occurs from less severe head injury |
| subdural hematoma: what is chronic | occurs most often in elderly alcoholics, and those on long term anticoagulant therapy |
| subdural hematoma: s/s of acute | rapid deterioration from drowsiness and confusion to coma, ipsilateral pupil dilation and contralateral hemiparesis (occurs in <24 hours) |
| subdural hematoma: s/s of subacute | manifestations appear 48 hrs to 2 weeks later, alter period followed by slow progression to coma |
| subdural hematoma: s/s of chronic | manis develop weeks to months after initial injury, slowed thinking, confusion, drowsiness, may progress to pupil changes and motor deficits |
| intracerebral hematoma: what is it | bleeding into the brain tissue, may be caused by gunshot wound or a depressed skull Fx |
| intracerebral hematoma: s/s of it | decreasing LOC, pupil changes and motor deficits |
| IICP: what does cerebral blood flow deliver | blood and glucose to the brain |
| IICP: what happens to the veins when ICP increases; what happens to the blood flow | cerebral vasoconstriction occurs, which reduces cerebral blood flow and causes ischemia |
| IICP: if ischemia lasts > _______ minutes the result is irreversable brain damage | 5 min |
| IICP: what does increased carbon dioxide (paco2) and decreased oxygen levels (pao2) do | they cause vasodilation of the cerebral arteries |
| IICP: any increase in ICP causes changes in what | LOC |
| IICP: s/s | LOC, pupil responses, vital sign changes |
| IICP: s/s become more dramatic as ICP ________ | increases |
| IICP: manis are labels as what 4 things | early or late, slow or rapid |
| IICP: what determines the s/s | the location and the cause of IICP |
| IICP: what is a late posturing s/s | decerabate and decorticate posturing |
| IICP: what is the latest s/s | cushing's triad |
| IICP: what is cushings triad | increased SBP, widening pulse pressure, bradycardia |
| IICP: what is the earliest s/s | change in LOC |
| IICP: s/s- early s/s of LOC | irritability, personality changes, restlessness, short term memory changes, disorientation to time, then to place abd person, confusion, |
| IICP: s/s- early s/s of pupils | they will still be equal round and reactive to light |
| IICP: s/s- early s/s of vision | decreased visual activity, blurred vision, diplopia, weakness in one extremity or side, hemiplegia on opposite side of the brain injury |
| IICP: s/s- early s/s of speech | difficulty speaking |
| IICP: s/s- early s/s of BP | elevated BP |
| IICP: s/s- early s/s of pulse | slightly elevated pulse |
| IICP: s/s- early s/s of RR | rate may increase |
| IICP: s/s- early s/s of temperature | may increase or decrease |
| IICP: s/s- early s/s of other symptoms | HA worse on rising in morning, and w/ positions change |
| IICP: s/s- late s/s of LOC | decreased LOC that progresses to coma, no response to painful stimuli |
| IICP: s/s- late s/s of pupils | sluggish response to light progressing to fixed (no response to light), they may be at first dilated on one side, then progress to bilat dilation, |
| IICP: s/s- what is ipsilateral | it is when the pupil is dilated on only one side, happens as a late s/s of IICP |
| IICP: s/s- late s/s of vision | cannot assess do to decreasing LOC or coma |
| IICP: s/s- late s/s of motor function | decorticate or decerebrate posturing |
| IICP: s/s- late s/s of speech | cannot assess due to decreasing LOC or coma |
| IICP: s/s- late s/s of BP | cushing triad: increased systolic BP, widening pulse pressure, and bradycardia |
| IICP: s/s- late s/s of pulse | bradycardia |
| IICP: s/s- late s/s of RR | decreased RR with altered respiratory patterns |
| IICP: s/s- late s/s of temp | significantly elevated |
| IICP: s/s- late s/s of other s/s | projectile vomiting, continual HA, loss of pupil corneal, gag and swallowing relflex |
| cerebral edema: what is it | an abnormal accumulation of fluid, increases the amount of extracellular or intracellular brain tissue volume |
| cerebral edema: what happens as the brain swells in the with in the rigid skull | IICP |
| cerebral edema: causes | brain injury, intracranial surgery, tumors, hemmorrhage, and infection |
| cerebral edema: w/ in how many hours does edema rise to its highest level after insult to the brain | with in 48-72 hours |
| cerebral edema: why is early recognition important | b/c the pt condition can deteriorate rapidly |
| altered LOC: what is the def of consciousness | the pt is oriented to time, place and person ans responds to appropriate external stimulus |
| altered LOC: in order for the brain to maintain nromal LOC what does it need | a constant supply of oxygen and glucose, and an intact reticular activating system (RAS) |
| altered LOC: what is RAS | RAS is located in the brainstem and it keeps the person alert and responsive to the environment |
| altered LOC: why is it usually affected by IICP and cerebral edema | b/c the increased prssure in the cranium reduces the blood supply to the brain |
| altered LOC: what disorders will likely increase ICP and effect the person's ability to remain alert and oriented | head injury, hematoma, CVA, tumors, infections |
| altered LOC: any condition that reduces ______ and _________ can reduce LOC | oxygen and glucose |
| altered LOC: who is at an increased risk | pt with poorly controlled DM and those with long term cardiac and respiratory disorders |
| altered LOC: what drugs can cause it | alcohol, narcotics, sedatives, and anesthetics that depress the CNS |
| altered LOC: what is fully consious | t is alert and oriented to time place and person, fully understands written and spoken word |
| altered LOC: what is confusion | disoriented to time place and person, unable to think clearly, short attention span, poor memory |
| altered LOC: what is delirium | motor restlessness, agitated and irritable, may have hallucinations, combative |
| altered LOC: what is obtunded | appears drowsy and lethargic, respons to verbal and tactile stimuli but quickly drifts back to sleep |
| altered LOC: what is stupor | generally unresponsive, may with draw purposefully with vigorous or painful stimuli |
| altered LOC: what is coma | does not respond to stimuli |
| altered LOC: altered LOC is an early indicator of what | change in IICP |
| altered LOC: what is the glascow coma scale | it is a quick guide for assessing LOC, it measures how well the client responds with eye opening and verbal and motor responses (the lower the score the worse the pt condition) |
| brain herniation: when does it occur in IICP | late |
| brain herniation: what happens | in an attempt to save brain tissue the brain shifts from an area of high pressure to low pressure |
| brain herniation: what is a common site for one | the foreman magnum (the hole at the base of the brain where the spinal cord exits) |
| brain herniation: what happens as pressure rises | the brain is pushed through the foreman magnum |
| brain herniation: what happens to the brainstem | is it compressed and the vital functions such as respiration ceases |
| brain herniation: w/o recognition what happens to pt | they die |
| brain death: when does it occur | when cerebral blood flow stops, resulting in irreversable loss of brain function |
| diagnostic tests: BS- why is it done | when hypoglycemia is suspected |
| diagnostic tests: ABGs- why is it done | to monitor pH and levels of O2 and CO2 |
| diagnostic tests: tox screen- why is it done | of blood and urine to identify drug of ETOH toxicity |
| diagnostic tests: serum creatinine or BUN- why is it done | when renal failure is suspected |
| diagnostic tests: why CBc- why is it done | in case of infection or anemia |
| diagnostic tests: CT/MRI- why is it done | can detect hemmorrhage, edema, hematoma, tumor |
| diagnostic tests: cerebral angiography- why is it done | used if stroke is suspected |
| diagnostic tests: lumbar puncture- why is it done | samples CSF to analyze for meningitis |
| diagnostic tests: lumbar puncture- why shouldn'e CSF be removed during IICP | can greatly increase the risk for brain herniation |
| diagnostic tests: lumbar puncture- nursing considerations | B&B empty b4 procedure, lateral recumberant position, slow deep breaths, monitor VS, monitor puncture site for leakage od CSF, encourage increased fluids, give analgesics, after procedure lay flat in bed for 24 hours |
| meds: what are the most frequent ones used for increased ICP | osmotic diuretics, loop diuretics, corticosteroids, anticonvulsants, antipyretics and histomine agonists |
| meds: why are IV fluids used; what is used and why | to maintain the client's fluid and electrolyte balance and prevent hypotension; normal saline lactated ringers b/c it does not cross the blood brain barrier |
| meds: osmotic diuretics- what are they used for | to draw water out of the edematous brain tissue to be excreted by the kidneys |
| meds: osmotic diuretics- what can large frequant doses cause | dehydration, and electrolyte losses |
| meds: what do loop diuretics do | they decrease cerebral edema and will cause less fluid and lyte losses |
| meds: dexamethasone -what is it | a corticosteroid |
| meds: dexamethasone -what does it do | it decreases inflammation which in turn will decrease cerebral edema |
| meds: dexamethasone - side effects | gi irritation, and gastric ulcers |
| meds: dexamethasone - what is given to prevent gastric ulcers | histamine receptor agonists (zantac), proton pump inhibitor (protonix) or antacids |
| meds: why are antiemetics given | to prevent vomiting and risk for aspiration |
| meds: anticonvulsants- what do they do | treat or prevent seizure activity associated w/ head injury |
| meds: anticonvulsants- what are the common ones given | phenytoin (dilantin), diazapam (valium), phenobarbital |
| meds: what is used to treat hyperthermia | acetaminophen |
| what does hyperthermia do | it raises cerebral metabolism and IICP |
| meds: barbiturates: who gets them | severe TBI, and continually elevated ICP |
| meds: barbiturates: what do they do | they place pt in a coma, and reducing metabolism of injured brain |
| meds: barbiturates: what does lowering the metabolism do | it allows the brain to heal w/ out permanent damage |
| meds: barbiturates: where are they during this therapy | in the ICU |
| ICP monitoring: what is it | a ICP monitoring device is inserted into the skull to assess for IICP |
| ICP monitoring: where is the pt during this | in the icu |
| ICP monitoring: why is pressure constantly monitored | so that immediate tx can be started before brain damage can occur |
| ICP monitoring: increases pt risk for what | meningitis |
| surgery: why is it done | to decrease ICP |
| surgery: what is removed and why | a boem flap may be removed to allow for the brain to expand |
| surgery: what are burr holes | they are holes drilled into the skull to remove a blood clot or evacuate a hematoma |
| surgery: what does a craniotomy do | it relieves pressure of the brain tumor |
| nx dx: ineffective tissue perfusion- cerebral- why should the HOB be elevated 30 degrees | this rpomotes venous drainage from the head so that pressure does not build up |
| nx dx: ineffective tissue perfusion- why give oxygen | the brain needs constant supply of oxygen to prevent brain damage, increased CO2 levels can cause cerebral vasodilation, leading to cerebral edema |
| nx dx: ineffective tissue perfusion- why should hip flexion and abdominal distension be avoided; why should stool softeners be given | those increase ICP |
| nx dx: ineffective tissue perfusion- why is temp monitored q2 hours | to prevent brain damage from IICP |
| nx dx: ineffective tissue perfusion- why should noise be reduced and pt kept quiet | loud noises and bright lights can increase ICP |
| nx dx: ineffective tissue perfusion- why is fluid limited | fluid restriction may prevent and decreaase cerebral edema |
| nx dx: ineffective tissue perfusion- why is urine monitored q 2hours | for s/s of DI or DIADH |
| nx dx: ineffective breathing patterning- why is RR rythm and depth monitored | as ICP increases the risk for respiratory distress rises. IICP is known to cause respiratory arrest |
| nx dx: ineffective breathing patterning- why should client be turned q 2 hours | turning prevents pooling of secretions in one area in the longs, side lying position prevents tongue from obstructing the airway |
| why should gastric residual be checked before each tube feeding | excess gastric residual means that the tube feeding is not beging absorbed |
| when should passive ROM not be performed when there is impaired physical mobility | when there is IICP |
| Nx Dx: risk for infection- why is clear drainage from ear and nose tested for glucose | if it tests positive for glucose, that means the drainage has a presence of CSF |
| Nx Dx: risk for infection- what happens when pt coughs, blows nose, or stops a sneeze | they increase ICP, stopping a sneeze can push bacteria back into the brain |
| TBI: what is the leading cause of | death and disibility in the US |
| TBI: what is the divorce rate | high , 50-80% |
| concussions: what are the three types | contusion, subdural hematoma, subarachnoid bleed |
| hematomas: where does a subarachnoid one occur | deep w/ in the brain (circle of willis), same area as a CVA hemmorhae |
| hematomas:subarachnoid- is it usually venous or arterial origin | venous, it is a massive bleed |
| penetratinf injuries: what are some causes and charecteristics | stabbing et, will invole a skull fx, pt has high risk for infection |
| surgery: why is brain tissue removed | if it is dead tissue |
| ventriculostomy: what is it | with the ICP monitoring the escess CSF is drained into a bag |
| VP shunt: what is it | used more in kids, tubing goes to brain from peritonial cavity and excess CSF is absorbed tehre |
| what can fever do | increase oxygen consumption |
| IICP: why may pt be hypertensive | BP increased pressure |
| IICP: why is pt fluids monitored | we dont want excess fluid going to the brain |
| meds: when are seizure meds prescribed | only if they HAD a seizure |
| brain herniation: what happens when a portion of the brain hits the brain stem | that portion of the brain no longer receives blood flow and it is brain dead |
| brain herniation: if brain matter leaks out into external opeings (eyes, nose and eays) what will it look like | gray or white |
| TX: what do we always start tx wit h | ABC |
Created by:
jmkettel
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