Mgmt of Pt w/ Neurologic Trauma
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| A traumatic brain injury (TBI) takes two forms, what are they? | primary injury and secondary
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| 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
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| simple, comminuted depressed or basilar are all terms to describe what kind of head trauma | skull fractures
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| 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
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| 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
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| The duration of ________ is an indicator of the severity of the concussion | unconsciousness
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| Memory lapse or unconsciousness lasting <30min reveal what concussion? | mild
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| Memory lapse, posttraumatic amnesia, lasting < 6h describe what kind of concussion | classic
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| 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
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| A cerebral contusion is defined as | moderate to severe head injury, bruised brain and damage in specific area.
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| Hemotomas can happen in what three areas of the brain? | epidural(above dura), subdural(below dura), intracerebral(w/in brain)
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| 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
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| 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.
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| When assesing unconscious pt and GI system, what should you monitor if pt is getting corticosteroids? | GI hemorrhage, so check for decr hemoglobin
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| 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
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| 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
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| What are paraplegia and tetraplegia in a spinal cord injurcy (SPI)? | para: paralysis of lower body
tetra: (former quadraplegia) paralysis of all four extremities
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| 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
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| What is usual medical tx for SCI in emergency? | methylprednisolone
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| Need for a ventilator is for injury to where in spinal cord? | C1-C3
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| 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
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| 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
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| 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
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| In pt with SCI, and no bladder control, what is used to relieve bladder distention and UTI? | Intermittent catheter or indwelling if needed
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| This is found in pt with cord lesions above T6, bowel/bladder distention, ingrown toe nails noxious stimuli after SCI | autonomic dysreflexia
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| 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
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| What drug helps with spastic muscles? | Baclofen (antispasmodic)
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| What is biggest nsg consideration with paraplegias | skin integrity
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| Paraplegias are at risk for infection in what three ways | urinary tract, respiratory tract, pressure ulcers
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