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?

Reversible neurological injury Signup and view all the answers

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

Ventriculostomy Signup and view all the answers

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

Glasgow Coma Scale Signup and view all the answers

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

Cushing's Response 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?

Maintaining patent airway Signup and view all the answers

How does mannitol help in managing increased ICP?

By generating an osmotic pressure difference Signup and view all the answers

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

Bradycardia, hypertension, and bradypnea Signup and view all the answers

What could be a potential side effect of administering mannitol?

Electrolyte imbalance Signup and view all the answers

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

Patient is experiencing cerebral ischemia Signup and view all the answers

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

Decreasing systemic blood pressure excessively Signup and view all the answers

What characterizes a patient in a coma?

Unarousable unresponsiveness without purposeful responses Signup and view all the answers

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

Sleep-wake cycles without cognitive awareness Signup and view all the answers

Which statement correctly describes the symptoms of intracranial hemorrhage?

Symptoms can be delayed until the hematoma causes pressure Signup and view all the answers

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

Stabilizing cardiovascular and respiratory function Signup and view all the answers

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

Immediate coma and potential rigidity Signup and view all the answers

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

Control measures and supportive care Signup and view all the answers

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

It helps to measure the depth of coma and responsiveness Signup and view all the answers

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

Systolic hypertension with bradycardia and irregular respirations Signup and view all the answers

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.