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NSG 210 Ch. 63

Mgmt of Pt w/ Neurologic Trauma

A traumatic brain injury (TBI) takes two forms, what are they? primary injury and secondary
What is primary injury? What is secondary injury to brain? Primary: initial damage to brain incl contusions/lacerations/torn blood vessels. Secondary: evolves over hours/days from poor nutrient/O2 delivery
simple, comminuted depressed or basilar are all terms to describe what kind of head trauma skull fractures
Define simple vs comminuted vs depressed simple: break in continuity of bone comminuted: splintered/multiple fracure line depressed: bones of skull forcefully pushed downward. Ex. fracture at base of skull or basilar skull fracture
Closed vs open brain injury closed: head collides and brain tissue is damaged but no opening thru skull or dura. Open: obj penetrates and damages soft brain or injury open skull to expose brain
The duration of ________ is an indicator of the severity of the concussion unconsciousness
Memory lapse or unconsciousness lasting <30min reveal what concussion? mild
Memory lapse, posttraumatic amnesia, lasting < 6h describe what kind of concussion classic
Monitoring a pt at home after a concussion would have you look for waht s/s? difficulty in waking/speaking, confusion, severe HA, vomiting, weakness of one side of body
A cerebral contusion is defined as moderate to severe head injury, bruised brain and damage in specific area.
Hemotomas can happen in what three areas of the brain? epidural(above dura), subdural(below dura), intracerebral(w/in brain)
Pt presents with an epidural hemotoma, a brief loss of consciousness followed by lucid interval, if ICP incr what s/s will be pt show? restless, agitated, confused, LOC, dilated/fixed pupils
If ICP gets elevated does the CPP go up or down? down, so oxygenate, elevate head. A decr in CPP can cause a decr in cerebral perfusion and brain hypoxia/ischemia.
When assesing unconscious pt and GI system, what should you monitor if pt is getting corticosteroids? GI hemorrhage, so check for decr hemoglobin
You pt has severe hypotension, how will this affect the CPP and what will be done to correct it? hypotension will cause vasoconstriction, decr in CPP and treated with IV fluids or vasopressin
Ways to control ICP in pt with brain injury elevate HOB Keep head/neck aligned, no twisting prevent Valsava with stool softeners Maintain normal temp Give O2 for paO2>90 Keep fluid balance Avoid excess suction, pain Give sedatives to decr agitation Keep CPP >70 Give seizure meds as prophyl
What are paraplegia and tetraplegia in a spinal cord injurcy (SPI)? para: paralysis of lower body tetra: (former quadraplegia) paralysis of all four extremities
What is affected in an incomplete SCI? complete? sensory/motor/both fibers below lesion Complete: total loss of sensation and voluntary muscle control below lesion
What is usual medical tx for SCI in emergency? methylprednisolone
Need for a ventilator is for injury to where in spinal cord? C1-C3
A pt has motor deficits in upper extremities. There is edema in cervical area, what syndrome is this? central cord syndrome, damage in middle of cord
Pt can feel his left side, but not move it. He can move his right side, but not feel it. What is this incomplete SPI called? Brown-Sequard Syndrome
Pt can't move, feel pain or pressure in his lower extremities, but can feel them vibrate and temperature, this syndrome is? Anterior Cord Syndrome
In pt with SCI, and no bladder control, what is used to relieve bladder distention and UTI? Intermittent catheter or indwelling if needed
This is found in pt with cord lesions above T6, bowel/bladder distention, ingrown toe nails noxious stimuli after SCI autonomic dysreflexia
What is medical mgmt for DVT in SCI 1. fluids 2. dopamine(help heart, not x BBB) 3. Epi/Norepi 4. atropine if bradycardia severe
What drug helps with spastic muscles? Baclofen (antispasmodic)
What is biggest nsg consideration with paraplegias skin integrity
Paraplegias are at risk for infection in what three ways urinary tract, respiratory tract, pressure ulcers
Created by: palmerag