Neuro (Brain Injuries)

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1

Primary Injury

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2

Secondary injuries

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3

What type of assessments do you do for a pt that has a secondary injury?

GCS

assessment of airway and oxygenation status to ensure CBF

Assess for abnormal respiratory patterns and report if noted.

ICP/CPP/hemodynamic monitoring

4

What type of labs and diagnostics would you do for an increased ICP?

Arterial blood gas

CBC

Coagulation profile: INR and PTT

electrolytes

CT/MRI

Trans-cutaneous doppler to check CBF

EEG: checks brain activity for seizures

5

What is the goal for a pt with TBI?

reducing ICP

maintain airway

providing O2

maintain cerebral perfusion

and preventing secondary TBI

6

What types of managment is there for TBI?

Hypothermia: decreases cerebral metabolic rate and 02 consumption & decreases ICP

eg: cooling systems/antipyretics/hypothermia blankets

Nutritional support:

7

What are some surgical interventions that can be done for these pts?

Craniotomy: assess drainage for CSF (if CSF then ventric might be necessary)

8

What are some signs and symptoms of an increased ICP?

Early: changes in LOC, pupil changes, vomitting

Late: cushings triad, herniation

9

how can we measure the ICP and get rid of the CSF? it is a medical intervention

Ventric- EVD

craniectomy:

10

What is the range for CPP?

pressure that drives cerebral blood flow.

70-100

11

What are ways that we can decrease ICP?

reduce stimuli: lights/sound/temp & suction/pain shivering

Sedatives

Mannitol (you need a filter straw/rapid bolus/keep osmolalty 320)

hypertonic solution

decadron for inflammation (monitor glucose carefully b/c steriod)

BP/CO2 managment

reduce metabolic demands

12

What is epidural sensor or trasnducer? and what are the advantages and disadvantages of using this monitoring devices for ICP?

between the skull and the dura

Advantages: least invasive; low risk for infection/hemorrhage

recommended for pt at risk for meningitis

disadvantages: CSF drainage not possible; indirect measure of ICP

13

What are the signs and symptoms of a basilar skull fracture?

raccoon eyes and bruising behind the ear

14

what are some complications that can arise with a basilar fracture and what can you do and not do?

you can have CSF drainage.

do NOT block the drainage ( you can put bandages to collect the fluid)

do NOT blow nose

if a halo sign is noted on the bandage (yellowish stain) send off to lab for testing.

NO ng tubes in nose (everything in mouth) because of possible dura tear)

15

What is the difference between a Epidural hematoma and a Subdural?

Epidural occurs mostly on the temporal bone and happens suddenly; decreased LOC followed by lucid period then ipsilateral (pupil on the side of the lesion becomes fixed and dilated)

Subdural hematoma: starts off slowly so you get the S&S later. usually happens in the cerebral cortex.

most common signs are severe headache with possible gradual deterioration of LOC, starting with drowsiness and progressing through confusion, obtundation, and coma. Pupillary signs; most commonly an ipsilateral dilation, and the person may exhibit sluggish reactivity. Hemiparesis of the contralateral arm and leg also may be present.

16

Following a fall, a pt comes in with loss of consciousness, headache, and has vomited twice. Has a dilated pupil on the side of the hematoma and is currently having a seizure. What type of hematoma is this?

Epidural hematoma

17

What are the signs and symptoms of an Absence seizure?

blank stare, unresponsiveness to questions, and abnormal behavior such as smacking of the lips.

18

What type of sign/assessment is this called?

elicited by placing the patient in a supine position and flexing the neck toward the chest. A positive result would be noted if the patient has pain or flexes the hip or knees in response to the neck flexion. A positive response indicates meningeal irritation.

The Brudzinski sign

19

What is the Kernig Sign? and why would you do it?

it is pain in the neck when the thigh is flexed to the abdomen. and you would do this to check for meningitis.

20

What is the Brudzinski Sign? and why would you do it?

to check for meningitis

21

What is the FOUR score consciousness scale and why would you use it?

This scale evaluates four components: eye, motor, brainstem, and respiration. Each component has a maximal score of 4. This scale provides greater neurological detail than the GCS does. In contrast to the GCS, verbal response is not a component of the FOUR Score Consciousness Scale, making it fully applicable to intubated patients.

22

What is the name of this assessment?

Using a moderately sharp object, such as the handle of the percussion hammer, to stroke the lateral aspect of the sole of the foot from the heel to the ball of the foot, curving medially across the ball. The nurse observes the movement of the toes, which are normally in flexion

Babinski reflex

23

Damage to the frontal lobe changes what in a pt?

changes in personality and behavior