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MED SURG III
Exam #2 - TBI, SPI, ICP
| Question | Answer |
|---|---|
| Contusion | Bruised brain with damage in a specific area due to severe acceleration-deceleration force or blunt trauma. Often causes loss of consciousness, associated with stupor and confusion. |
| Symptoms of a Contusion | Often causes a loss of consciousness, associated with stupor and confusion. Can cause hemorrhage and edema, peaking about 18-36 hours after injury. |
| Hematoma | Collection of blood in the brain that may be epidural, subdural, or intracerebral. |
| Epidural Hematoma | Occurs above the dura. Between the skull and dura matter. |
| Symptoms of an Epidural Hematoma | Brief loss of consciousness, followed by a lucid interval, restlessness, agitation, and confusion. Results in a coma, with neurological deficits, dilation and fixation of pupils, and paralysis in an extremity. |
| Subdural Hematoma | Below the dura in the brain. Most frequently occurring in venous origin |
| Symptoms of a Subdural Hematoma | Changes in LOC, pupillary signs, ,and hemiparesis. Coma, ,increasing BP, decreasing HR, and slowed RR. |
| Intracerebral Hematoma | Occurs within the brain. Bleeding occurs into the parenchyma of the brain. |
| Symptoms of Intracerebral Hematoma | Neurological Deficits and headache |
| Concussion | Temporary loss of neurological function with no apparent structural damage to the brain. If repeated blows occur, can lead to a syndrome known as chronic traumatic encephalopathy |
| Symptoms of a Concussion | May or may not result in a loss of consciousness. Headache, vertigo, amnesia, usually benign |
| Diffuse Axonal Injury | Widespread shearing and rotational forces that produce damage throughout the brain, axons, corpus callosum, and brain stem. |
| Cardinal Signs of Brain Death | Coma, Absence of Brain Stem Reflexes, and Apnea |
| Primary Brain Injuries | Direct result of trauma. Sheering, ruptured blood vessels, hemorrhage, hematomas, and/or contusions. |
| Examples of Primary Brain Injuries | Lacerations, Bone Fractures, Contusions, Hematomas, and Diffuse Axonal Injuries |
| Secondary Brain Injuries | Develop over a period time (typically hours to 5 days). Pathological cascade occurs due to the biochemical changes in cellular structure. |
| Examples of Secondary Brain Injuries | Cell death, hypoxia, hypotension, hypercarbia, hyperexcitation, cerebral edema, and pathological changes associated with ICP |
| Mild TBI | Brief loss of consciousness (few seconds or minutes) or none at all. Scans & tests may be normal. Most common type (75-85%). Most recover within 6-8 weeks. More than over time increases the chance of deficits. |
| Moderate TBI | Loss of consciousness that can last a few minutes to a few hours. Confusion lasts days to weeks. Physical, cognitive, and/or behavior impairments lasts months or are permanent. EEG/CAT/MRI are positive for brain injury |
| Severe TBI | Prolonged unconscious state or coma that lasts days, weeks, or months. Coma, Vegetative State, Minimally Responsive State, Locked In Syndrome |
| Assessment Findings in a Patient with a TBI | Hypercarbia (PCO2 > 45) can cause cerebral vasodilation & increased ICP. Hypocarbia (PCO2 < 40) is caused by hyperventilation and can lead to profound vasoconstriction resulting in ischemia. Monitor for BP changes, LOC, and Pupillary Responses |
| CT Scan in TBIs | A 3-D detailed anatomic picture of tissues |
| CT Angiography in TBI | Administration of contrast dye before the scan to identify blockages, narrowing blood vessels, aneurysms, and other abnormalities |
| CT Perfusion Studies in TBI | Advanced scanner that evaluates brain tissue perfusion |
| Intrathecal Contrast-Enhanced CT in TBI | Used to diagnose disorders of the spine and spinal nerve roots |
| Magnetic Resonance Imaging (MRI) in TBI | Allows for visualization of the brain, but cannot visualize bony structures |
| Magnetic Resonance Angiography (MRA) in TBI | Used to evaluate perfusion and blood vessel abnormalities |
| Normal ICP in Adults | 5-15 mm Hg |
| Effective MAP Level | 70 mm Hg or above |
| Effective Cerebral Perfusion Pressure level | 50-150 mm Hg |
| MAP Equation | Systolic BP +2 multiplied by diastolic BP / 3 |
| CPP Equation | MAP - ICP |
| What is the Cushing's Triad? | Systolic Hypertension with widening pulse pressure. Irregular respirations, Bradycardia with full and bounding pulse. |
| Nursing Management of a Patient with a TBI | Cervical & Spinal Positioning (Midline, Neutral). HOB elevated 30-45 degrees. Effective Suctioning, Protecting against aspiration. Monitor ABGs. |
| External Ventricular Drainage (EVD) / Ventriculostomy | Device inserted into the lateral ventricle and attached to an external transducer. Used to monitor or relieve ICP. LANDMARK for monitoring is the TRAGUS of the ear. |
| Anticonvulsants (Phenobarbital) in TBI | Given to prevent seizures and secondary brain damage |
| Benzodiazepines (Diazepam, Lorazepam, Midazolam) in TBI | Given for Agitation & Sedation |
| Osmotic Diuretics (Mannitol) in TBI | Dehydrate Brain Tissue and Reduce Cerebral Edema |
| BLACK BOX WARNING for Phenobarbital | Increased risk for Suicidal Ideation |
| BLACK BOX WARNING for Diazepam | Depresses the CNS resulting in serious adverse effects such as respiratory depression or death. |
| BLACK BOX WARNING for Midazolam | Profound respiratory depression, resulting in hypoxia, brain damage, or death |
| Hypnotic / Sedatives (Propofol) | Given for sedation in patients with brain injuries |
| Decerebrate Posturing | Abnormal Extension. Extension/Rigidity of arms or legs, pronation of the arms, plantar flexion. Usually associated with dysfunction in the brainstem area |
| Decorticate Posturing | Abnormal Flexion. Arms flex over chest with internal rotation and plantar flexion of the legs. Usually a result of interruption of voluntary motor tracts in the cerebral cortex |
| Paraplegia | Paralysis of the lower body |
| Tetraplegia | Paralysis of all four extremities |
| Transection | Severing of the spinal cord which results in the patient being paralyzed below the level of injury |
| Nursing Interventions in Spinal Cord Injuries | Maintain stable BP, Monitor cardiovascular function, ensure adequate ventilation and lung function, preventing and promptly addressing infection & complications. |
| Symptoms of Spinal Cord Injury | Extreme pain or pressure in the neck, head, or back. Tingling or sensation loss in hands, fingers, feet, or toes. Partial or complete loss of control over any body part. Urinary or bowel urgency, incontinence, or retention. Difficulty with balance and walking. Impaired breathing. Abnormal bandlike sensations in the thorax with pain and pressure. Unusual lumps on the head or spine. |
| Autonomic Dysreflexia | Occurs after spinal shock has resolved and may occurs years after the injury, in patients with lesions above T6 |
| Symptoms of Autonomic Dysreflexia | Severe Pounding Headache, Sudden increase in BP, Profuse Diaphoresis, Nausea, Nasal Congestion, Bradycardia |
| Triggering Stimuli in Autonomic Dysreflexia | Distended Bladder (most common), Distension or Contraction of Visceral Organs (Constipation), Stimulation of Skin (Drafts, Blanket) |
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