Neuro Trauma and Head Injuries
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Questions and Answers

What is the significance of a serum osmolality exceeding 320 mOsm in the use of mannitol?

  • Mannitol dosage needs to be increased
  • Mannitol becomes ineffective (correct)
  • Mannitol should be avoided completely
  • Mannitol must be used in combination with another drug
  • Which of the following is NOT an early sign of increased intracranial pressure (ICP)?

  • Disorientation
  • Restlessness
  • Pupil changes (correct)
  • Increased respiratory effort
  • In managing increased ICP, which strategy is NOT typically employed?

  • Controlling fever
  • Restricting fluids
  • Administering high-dose steroids (correct)
  • Draining CSF
  • What key condition must be excluded before declaring brain death?

    <p>Reversible neurological injury (C)</p> Signup and view all the answers

    Which procedure involves inserting a fine-bore catheter into a lateral ventricle for ICP monitoring?

    <p>Ventriculostomy (A)</p> Signup and view all the answers

    What is the primary assessment tool used to evaluate a patient's level of consciousness?

    <p>Glasgow Coma Scale (D)</p> Signup and view all the answers

    What physiological change is primarily characterized by an increased systolic blood pressure, widening pulse pressure, and bradycardia?

    <p>Cushing's Response (C)</p> Signup and view all the answers

    What is the first priority in the management of a patient with altered level of consciousness due to increased ICP?

    <p>Maintaining patent airway (A)</p> Signup and view all the answers

    How does mannitol help in managing increased ICP?

    <p>By generating an osmotic pressure difference (D)</p> Signup and view all the answers

    Which of the following indicates a Cushing triad in a patient experiencing increased ICP?

    <p>Bradycardia, hypertension, and bradypnea (B)</p> Signup and view all the answers

    What could be a potential side effect of administering mannitol?

    <p>Electrolyte imbalance (C)</p> Signup and view all the answers

    In what scenario might a low Glasgow Coma Scale score indicate?

    <p>Patient is experiencing cerebral ischemia (C)</p> Signup and view all the answers

    Which of the following management approaches is NOT appropriate for increased ICP?

    <p>Decreasing systemic blood pressure excessively (D)</p> Signup and view all the answers

    What characterizes a patient in a coma?

    <p>Unarousable unresponsiveness without purposeful responses (B)</p> Signup and view all the answers

    Which of the following is a distinguishing feature of persistent vegetative state?

    <p>Sleep-wake cycles without cognitive awareness (A)</p> Signup and view all the answers

    Which statement correctly describes the symptoms of intracranial hemorrhage?

    <p>Symptoms can be delayed until the hematoma causes pressure (D)</p> Signup and view all the answers

    What is the most appropriate first step in managing brain injuries?

    <p>Stabilizing cardiovascular and respiratory function (C)</p> Signup and view all the answers

    In cases of diffuse axonal injury, what immediate response is expected?

    <p>Immediate coma and potential rigidity (B)</p> Signup and view all the answers

    What does the management of increased intracranial pressure (ICP) primarily rely upon?

    <p>Control measures and supportive care (D)</p> Signup and view all the answers

    What is the importance of the Glasgow Coma Scale in assessing brain injuries?

    <p>It helps to measure the depth of coma and responsiveness (B)</p> Signup and view all the answers

    Which best describes Cushing's response in brain injury patients?

    <p>Systolic hypertension with bradycardia and irregular respirations (C)</p> Signup and view all the answers

    Flashcards

    LOC

    Level of Consciousness; a measure of the patient's responsiveness and awareness

    Increased ICP

    Elevated intracranial pressure, a critical condition decreasing cerebral blood flow and potentially causing brain herniation.

    Cushing's Triad

    Bradycardia, hypertension, and bradypnea (slow breathing) - characteristic late signs of increased intracranial pressure.

    Glasgow Coma Scale

    A tool to assess the level of responsiveness in a patient, important for coma or altered sensorium.

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    Mannitol

    An osmotic diuretic used to lower intracranial pressure by drawing fluid from brain tissue into the bloodstream.

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    Cerebral Edema

    Swelling of the brain tissue

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    Patent Airway

    An open and clear airway for breathing

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    Cerebral Perfusion

    Blood flow to the brain tissue

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    Mannitol limitation

    Mannitol becomes ineffective in lowering intracranial pressure when the serum osmolality exceeds 320 mOsm.

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    Controlling ICP: Early signs

    Early signs of increased ICP include disorientation, restlessness, increased respiratory effort, purposeless movements, and mental confusion.

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    Controlling ICP: Late signs

    Late signs of increased ICP include pupil changes, impaired extraocular movements, weakness in one extremity or one side of the body, and a headache that is constant or increasing in intensity, aggravated by movement or straining.

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    Ventriculostomy purpose

    Ventriculostomy is used for monitoring ICP and draining CSF, particularly during acute pressure increases. It can also be used to drain blood from the ventricle.

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    Brain death criteria

    Brain death occurs when a patient has sustained a severe neurologic injury not compatible with life, with cessation of all brain function resulting from an irreversible cause.

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    Contusion

    A brain injury resulting in bruising and potential surface bleeding. It can cause unconsciousness for seconds or minutes, with symptoms varying based on the injury's size and swelling. Long-term recovery may be needed, potentially leading to headaches, dizziness, cognitive impairment, or seizures.

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    Diffuse Axonal Injury

    Widespread damage to multiple brain areas leading to immediate coma. Characterized by brain swelling, rigid posturing, and potential delayed diagnosis. Recovery depends on the severity of the axonal disruption.

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    Intracerebral Hemorrhage & Hematoma

    Bleeding within the brain tissue. It can result from forceful impacts, gunshot wounds, or stabbings. May manifest as neurological deficits followed by headaches.

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    Intracranial Hemorrhage

    Bleeding within the skull. Hematomas (blood clots) form, and symptoms might not appear until they become large enough to cause pressure.

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    Altered Level of Consciousness (LOC)

    A state of reduced awareness and responsiveness. Can range from being disoriented to a complete lack of responsiveness.

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    Persistent Vegetative State

    A condition where a patient regains sleep-wake cycles after a coma but lacks cognitive and emotional function.

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    Locked-in Syndrome

    A condition resulting from damage to the brainstem. Patients are paralyzed and unable to speak, but retain vertical eye movements and lid elevation as a means of communication.

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    Study Notes

    Neuro Trauma

    • Neurologic trauma can be life-threatening or life-altering.
    • Neurologic trauma affects the patient, family, healthcare system, and society.
    • Nurses collaborate with many healthcare team members.

    Head Injuries

    • Includes injuries to the scalp, skull, or brain.
    • Most common cause of death from trauma in the US.
    • Most common cause of TBI are falls.
    • Males aged 15-24 are at highest risk.

    Pathophysiology

    • TBI has two forms:
      • Primary injury: Initial damage from the traumatic event.
      • Secondary injury: Evolves hours or days after the initial injury, often due to cerebral edema, ischemia, seizures, infection, hyperthermia, or hypoxia.

    Skull Fractures

    • Break in the skull, potentially with or without brain damage.
    • Types:
      • Simple: A break in the bone.
      • Comminuted: Splintered fracture line.
      • Depressed: Embedded bone fragments in brain tissue.
      • Basilar: Fracture at the base of the skull (can cause CSF leakage from ears and nose).
    • Fractures can be open or closed.

    Clinical Manifestations

    • Clinical presentation depends on the severity and distribution of injury.
    • Basilar fractures may cause bleeding from the nose, pharynx, ears, or conjunctiva.
    • Assessment and diagnosis include X-rays, physical & neurological exams, and MRI (when stable).

    Nursing Care

    • Close monitoring for changes in neurological status.
    • Depressed fractures usually require surgery.
    • Basilar fractures:
      • Avoid nasal suction and blowing the nose (use oral NG tube).
      • Maintain head of bed (HOB) at 30 degrees.
      • Monitor for infection & CSF leakage from ears & nose.
        • CSF from the nose for 3-5 days may not require surgery.
        • CSF from ears usually does not require surgery.

    Brain Injury

    • Major factor: Brain injury.
    • Open brain injury: Object penetrates skull and enters brain tissue.
    • Closed brain injury: No opening in the skull or dura.

    Types of Brain Injury

    • Concussion: Alteration in mental status (lasting 24 hours or less), headaches, nausea, vomiting, photophobia, amnesia, blurry vision, difficulty speaking, and difficulty awakening. Possible seizures and weakness on one side of the body.
    • Contusion: Bruising of the brain with possible surface hemorrhage, unconsciousness lasting more than seconds/minutes. Symptoms depend on severity & brain swelling. Potential for unconsciousness to return, irritability & disturbance to normal bodily functions.
    • Diffuse Axonal Injury: Widespread damage to multiple brain areas. Immediate coma, cerebral edema, and posturing.

    Intracranial Hemorrhage

    • Hematomas developing in the cranial vault.
    • Symptoms can be delayed until the hematoma is large.
    • Clinical presentation depends on the affected brain areas.
    • Can be due to force, bullet wounds, or stabbings.
    • Supportive care, ICP control, or surgical interventions may be needed.

    Altered Level of Consciousness

    • Unresponsive patients may need persistent stimuli to achieve alertness.
    • Coma: Unarousable, unresponsiveness
    • Persistent vegetative state: Patient resumes sleep-wake cycles but has no cognitive or affective function.
    • Locked-in syndrome: Damage to the pons or midbrain, resulting in quadriplegia, inability to speak, but vertical eye movements remain intact (important indicator of consciousness).

    Intracranial Pressure (ICP)

    • Increased ICP reduces cerebral perfusion, causes ischemia, shifts brain tissue, and can lead to herniation.
    • Early signs of increased ICP include disorientation, restlessness, and increased respiratory effort.
    • Late signs: pupil changes, impaired extraocular movements.
    • Cushing response: Increased systolic BP, widening pulse pressure, and slowed heart rate (grave sign) indicative of significant blood flow decrease.
    • Significant decline in brain status and vital signs, herniation & occlusion of blood flow can occur.

    Glasgow Coma Scale (GCS)

    • Tool for assessing level of consciousness.
    • Components include eye opening, verbal response, and motor response.
    • Scores range from 3 to 15, with lower scores indicating a more serious condition.

    Management of Increased ICP

    • Decrease cerebral edema.
    • Lower CSF volume.
    • Decrease cerebral blood flow while maintaining perfusion.

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    Description

    This quiz covers the essentials of neurologic trauma, including its impact on patients and healthcare systems. Explore types of head injuries, their causes, and the pathophysiology of traumatic brain injury. Understand the various skull fractures and their implications.

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