Management of Neurologic Trauma Chapter
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Questions and Answers

Which type of head injury is characterized by damage due to an external force impacting the head?

  • Intracranial injury
  • Secondary injury
  • Primary injury (correct)
  • Repetitive trauma

    • What condition can occur immediately after a traumatic brain injury due to the physical damage?

  • Immediate coma (correct)
  • Increased intracranial pressure
  • Acute cerebral hypoxia
  • Secondary brain death

    • Which factor can contribute to secondary brain injury following an initial traumatic event?

  • Skull fracture
  • Scalp laceration
  • Hematoma evacuation
  • Cerebral edema (correct)

    • Which type of skull fracture is most likely to penetrate the brain tissue?

    <p>Depressed fracture</p> Signup and view all the answers

    What is indicated by a halo sign in a patient with a skull fracture?

    <p>Cerebrospinal fluid leaking</p> Signup and view all the answers

    Which of the following is NOT a common cause of brain injury?

    <p>Sports injuries</p> Signup and view all the answers

    What does the term 'Battle sign' represent in the context of skull fractures?

    <p>Ecchymosis behind the ear</p> Signup and view all the answers

    What is a likely consequence of increased intracranial pressure following traumatic brain injury?

    <p>Cerebral herniation</p> Signup and view all the answers

    What is the characteristic feature of diffuse axonal injury?

    <p>Immediate coma with no lucid interval</p> Signup and view all the answers

    Which diagnostic method is least likely to assess brain function in cases of traumatic brain injury?

    <p>Skull x-rays</p> Signup and view all the answers

    Which symptom is NOT typically monitored for changes in a patient with traumatic brain injury?

    <p>Decreased appetite</p> Signup and view all the answers

    Which management strategy is critical in preserving brain homeostasis in a patient with a traumatic head injury?

    <p>Managing cerebral perfusion</p> Signup and view all the answers

    In addition to the Glasgow Coma Scale, which assessment is crucial for initial evaluation of a patient with traumatic brain injury?

    <p>Health history regarding the injury</p> Signup and view all the answers

    Which nursing diagnosis should prioritize the prevention of further injury in a patient with traumatic brain injury?

    <p>Injury Prevention</p> Signup and view all the answers

    What condition is indicated by the absence of brainstem reflexes in a patient?

    <p>Brain death</p> Signup and view all the answers

    What is a potential complication that requires close monitoring in patients with traumatic brain injury?

    <p>Decreased Cerebral Perfusion</p> Signup and view all the answers

    Which of the following is NOT a supportive measure for a patient with traumatic head injury?

    <p>Immediate surgical intervention</p> Signup and view all the answers

    What is the main consequence of repeated concussive incidents?

    <p>Chronic traumatic encephalopathy</p> Signup and view all the answers

    Which goal is essential for the nursing process in caring for a patient with traumatic brain injury?

    <p>Maintaining skin integrity</p> Signup and view all the answers

    Which strategy should be implemented to promote adequate fluid balance in a patient with traumatic brain injury?

    <p>Monitor blood and urine electrolytes</p> Signup and view all the answers

    What is a critical nursing intervention to prevent complications related to hypothermia in patients with traumatic brain injury?

    <p>Maintain an appropriate environmental temperature</p> Signup and view all the answers

    Which nursing action is important to address the disturbed thought patterns in a patient with traumatic brain injury?

    <p>Reduce environmental stimuli</p> Signup and view all the answers

    Which assessment is vital to ensure effective nutrition and fluid management in a patient with traumatic brain injury?

    <p>Monitoring daily weights and I&amp;O</p> Signup and view all the answers

    Which of the following interventions is most crucial for preventing aspiration in a patient with a traumatic brain injury?

    <p>Positioning with head of bed elevated 30 degrees</p> Signup and view all the answers

    Which factor is NOT associated with predicting a poor outcome in traumatic brain injury?

    <p>Unconsciousness at the scene</p> Signup and view all the answers

    What distinguishes a contusion from a concussion in traumatic brain injury?

    <p>Contusion involves structural damage while concussion does not.</p> Signup and view all the answers

    In cases of epidural hematoma, what is typically observed after the initial loss of consciousness?

    <p>A brief lucid interval followed by decreased level of consciousness.</p> Signup and view all the answers

    Which of the following best describes intracerebral hemorrhage?

    <p>Bleeding into the brain's parenchyma due to localized trauma.</p> Signup and view all the answers

    What is a common consequence of a subdural hematoma as it enlarges?

    <p>Increased intracranial pressure and potential coma</p> Signup and view all the answers

    Which symptom is NOT typically associated with an altered level of consciousness in traumatic brain injury?

    <p>Persistent headache</p> Signup and view all the answers

    What is the primary treatment goal for managing a contusion after a traumatic brain injury?

    <p>Preventing increased intracranial pressure</p> Signup and view all the answers

    Which of the following conditions is most directly associated with poor neurological responses?

    <p>Intracerebral hemorrhage due to systemic hypertension</p> Signup and view all the answers

    Which nursing measure is indicated to reduce the potential for seizures and increased intracranial pressure in a client with a craniotomy for a brain tumor?

    <p>Maintaining the client on strict bed rest with the head of the bed slightly elevated.</p> Signup and view all the answers

    Which activity indicates that a client recovering from a head injury understands measures to prevent elevations in intracranial pressure?

    <p>Exhaling during repositioning.</p> Signup and view all the answers

    What finding would alert the nurse that cerebrospinal fluid is present in a client with clear fluid leaking from the nose following a basilar skull fracture?

    <p>Fluid separates into concentric rings and tests positive for glucose.</p> Signup and view all the answers

    Which sign should alert the nurse to a basilar skull fracture in a client exhibiting altered levels of consciousness?

    <p>Battle’s sign</p> Signup and view all the answers

    What would be an appropriate nursing intervention for a client with suspected increased intracranial pressure after a head injury?

    <p>Administer antipyretics on a PRN basis.</p> Signup and view all the answers

    What diagnostic test will be done to confirm neurologic determination of death in a client with severe brain injury?

    <p>Electroencephalogram (EEG)</p> Signup and view all the answers

    Which of the following symptoms is NOT characteristic of elevated intracranial pressure?

    <p>Sudden loss of appetite</p> Signup and view all the answers

    What complication should the nurse monitor for in a client who experienced a basilar skull fracture?

    <p>Cerebrospinal fluid leak</p> Signup and view all the answers

    What is the primary benefit of using cooling blankets or cool baths for a patient with elevated intracranial pressure (ICP)?

    <p>Support cognitive function</p> Signup and view all the answers

    In supporting a family of a patient with neurologic trauma, which of the following actions is most crucial for effective coping?

    <p>Providing and reinforcing clear information</p> Signup and view all the answers

    Which nursing intervention is most appropriate when caring for a client with increased ICP?

    <p>Elevate the head of the bed to 30 degrees</p> Signup and view all the answers

    A client displays a decreased level of consciousness and a headache within 48 hours post-trauma. What condition should the nurse suspect?

    <p>Acute subdural hematoma</p> Signup and view all the answers

    Upon admission, which assessment takes priority for a client with a severe head injury?

    <p>Assessing the patency of the airway</p> Signup and view all the answers

    Which symptom is most indicative of increased intracranial pressure?

    <p>Bradycardia and hypertension</p> Signup and view all the answers

    What is the most effective way to set patient goals during family support sessions for those with neurologic trauma?

    <p>Set realistic and well-defined short-term goals</p> Signup and view all the answers

    Which client assessment should be prioritized in a unit with multiple patients with neurologic conditions?

    <p>Client with meningitis reporting a severe headache</p> Signup and view all the answers

    Study Notes

    Management of Patients With Neurologic Trauma

    • This chapter discusses managing patients with neurologic trauma, specifically head injuries.
    • The most common causes of brain injury are falls, motor vehicle accidents, and assault.
    • Prevention measures are detailed; however, specific details aren't provided.

    Head Injury

    • A broad classification, covering injury to the scalp, skull, or brain.
    • Falls, motor vehicle accidents, and assaults are common causes.

    Other Definitions

    • Coma: An altered state of consciousness.
    • Vegetative state: A persistent unconscious state.
    • Brain death: Irreversible cessation of brain function.

    Pathophysiology of Brain Damage

    • Primary injury: Damage from the initial impact, including contusions, lacerations, and skull fractures.
    • Secondary injury: Damage happening after the initial insult, caused by intracranial hemorrhage, cerebral edema, intracranial hypertension, hyperemia, seizures, and vasospasm.
    • Death can occur immediately after injury, within 2 hours after, or approximately 3 weeks after injury; depending on the nature and severity.

    Pathophysiology of Traumatic Brain Injury

    • Brain swelling and bleeding increase intracranial volume.
    • Rigid cranium prevents expansion, increasing intracranial pressure.
    • Pressure on brain blood vessels slows blood flow, causing cerebral hypoxia and ischemia.
    • Intracranial pressure continues to rise; the brain can herniate.
    • Cerebral blood flow ceases.

    Clinical Manifestations

    • Symptoms depend on injury severity and location.
    • Scalp wounds: Tend to bleed heavily; also portals for infection.
    • Skull fractures: Can be linear, comminuted, depressed, open, or closed. Usually have localized, persistent pain.
    • Fractures of the base of the skull: Bleeding from nose, pharynx, ears. Battle sign: ecchymosis behind the ear; CSF leak—halo sign—ring of fluid around the blood stain from drainage.
    • Basilar skull fracture diagram: Shows the basilar skull fracture and potential for CSF leakage.

    Manifestations of Traumatic Brain Injury

    • Altered level of consciousness.
    • Pupillary abnormalities.
    • Sudden neurologic deficits (e.g., changes in sense, movement, and reflexes)
    • Changes in vital signs (e.g., blood pressure, pulse, temperature).
    • Headaches.
    • Seizures.

    Factors that Predict a Poor Outcome

    • Intracranial hematoma.
    • Increasing patient age.
    • Impaired/absent motor responses.
    • Impaired/absent eye responses.
    • Early sustained hypotension, hypoxemia.
    • ICP levels higher than 20 mm Hg.

    Types of Traumatic Brain Injury

    • Contusion: Brain is bruised and damaged, typically in specific areas.
    • Epidural hematoma: Bleeding between the dura and inner surface of the skull (often from the middle meningeal artery).
    • Subdural hematoma: Blood collection between the dura and brain (often venous).
    • Intracerebral hemorrhage: Bleeding into the brain parenchyma; commonly from blunt force trauma.
    • Concussion: Temporary loss of neurologic function with no apparent structural damage. Damage is from blunt force trauma.
    • Diffuse axonal injury: Widespread axon damage, often associated with prolonged coma, no lucid interval, and poor prognosis.

    Diagnostic Evaluation

    • Physical and neurologic examination.
    • Skull and spinal x-rays.
    • CT scan.
    • MRI.
    • PET scan.

    Management of the Patient With a Traumatic Head Injury

    • Assume cervical spine injury unless ruled out.
    • Preserve brain homeostasis and prevent secondary damage.
      • Treat cerebral edema.
      • Maintain cerebral perfusion.
      • Monitor and manage ICP.
      • Maintain oxygenation.
      • Manage fluid and electrolyte balances.

    Supportive Measures

    • Respiratory support (intubation and mechanical ventilation).
    • Seizure precautions and prevention.
    • NG tube to manage reduced gastric motility and prevent aspiration.
    • Fluid and electrolyte maintenance.
    • Pain and anxiety management
    • Nutrition

    Brain Death

    • Three cardinal signs: coma, absence of brainstem reflexes, and apnea.
    • Additional tests: cerebral blood flow studies, EEG, transcranial Doppler.

    Nursing Process---Assessment of the Patient With Traumatic Brain Injury

    • Health history (focus on immediate injury details, cause, direction of impact).
    • Baseline assessment (Glasgow Coma Scale to assess LOC).
    • Frequent and ongoing neurologic assessments.
    • Multisystem assessment (see pertinent table).

    Nursing Process---Diagnosis of the Patient With Traumatic Brain Injury

    • Airway clearance
    • Ineffective cerebral tissue perfusion
    • Deficient fluid volume
    • Nutrition
    • Injury prevention
    • Body temperature imbalance
    • Prevention of pressure injuries

    Nursing Process---Diagnosis of the Patient With Traumatic Brain Injury

    • Disturbed thought patterns
    • Disturbed sleep pattern
    • Interrupted family process
    • Deficient knowledge

    Collaborative Problems and Potential Complications

    • Decreased cerebral perfusion
    • Cerebral edema and herniation
    • Impaired oxygenation and ventilation
    • Impaired fluid, electrolyte, and nutritional balance
    • Risk of posttraumatic seizures

    Nursing Process---Planning the Care of the Patient With Traumatic Brain Injury

    • Maintain patent airway; adequate CPP (cerebral perfusion pressure), fluid and electrolyte balance, and sufficient nutrition.
    • Prevent secondary injury.
    • Maintain normal body temperature and skin integrity.
    • Improve cognitive function.
    • Prevent sleep deprivation.
    • Support effective family coping, and increase family knowledge about rehabilitation process, while preventingcomplications.

    Interventions

    • Ongoing assessment and monitoring (airway, vital signs).
    • Airway management (positioning to facilitate drainage, suctioning with caution).
    • Prevention of aspiration, respiratory insufficiency.
    • Monitoring ABG's, ventilation, and mechanical ventilation.
    • Monitoring for pulmonary complications and potential ARDS.
    • Monitoring I&O and daily weights.
    • Monitor blood and urine electrolytes, osmolality, and blood glucose.
    • Implement measures to promote adequate nutrition and prevent injury.
      • Assess oxygenation
      • Assess bladder and urinary output
      • Assess for constriction caused by dressings & casts -Pad side rails; use mittens to prevent self-injury
    • Strategies to prevent injury (Reduce environmental stimuli, Use adequate lighting to reduce visual hallucinations, Implement measures to minimize disruption of sleep-wake cycles, Provide skin care, Implement measures to prevent infection).
    • Maintain appropriate body temperature (coverings, acetaminophen, cooling blankets/baths).
    • Support cognitive function, support family and reinforce and promote effective coping mechanisms, set realistic goals, refer to counseling, and refer to support groups.
    • Patient and family education (see applicable chart).

    Review Questions

    • Some review questions are provided related to patient responses to treatment, diagnoses, and indications to assess.

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    Related Documents

    Week 10 - Management of Patients With Neurologic Trauma (2) PDF

    Description

    This chapter focuses on the management of patients with neurologic trauma, particularly head injuries. It explores causes such as falls and motor vehicle accidents, as well as definitions of key terms like coma and brain death. Additionally, it discusses the pathophysiology of brain damage, highlighting both primary and secondary injuries.

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