Traumatic Brain Injury Assessment Quiz
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Questions and Answers

What is an ovoid pupil associated with in terms of TBI assessment?

  • A mid-stage between a normal-size and a dilated pupil (correct)
  • A normal-size pupil
  • A fixed and dilated pupil
  • A dilated pupil

Which type of neurological assessment finding suggests a potential brain herniation due to increased intracranial pressure (ICP)?

  • Constricted pupils
  • Symmetrical pupils
  • Unilateral dilated pupil (correct)
  • Normal light reaction

What is a poor prognostic sign in terms of pupils?

  • Ovoid pupils
  • Pupils that are constricted
  • Pupils with normal light reaction
  • Pupils that are fixed and dilated (correct)

What is papilledema?

<p>Edema and hyperemia of the optic disc (D)</p> Signup and view all the answers

If a patient exhibits a left-sided hemiparesis, what does this suggest?

<p>An injury to the right cerebral hemisphere (A)</p> Signup and view all the answers

What type of posturing involves everything moving towards the "core" and is caused by dysfunction in the brainstem area?

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

What is the "halo sign" in the context of TBI?

<p>A clear or yellowish ring surrounding a spot of blood on a white absorbent material (C)</p> Signup and view all the answers

What is the term for the purplish discoloration around the eyes that can occur after a skull fracture?

<p>Raccoon eyes (D)</p> Signup and view all the answers

What is the primary characteristic of agnosia?

<p>Inability to use an object correctly (B)</p> Signup and view all the answers

How might unilateral inattention manifest in a patient?

<p>Being unaware of the existence of their paralyzed side (D)</p> Signup and view all the answers

What is a key difference between hemianopsia and homonymous hemianopsia?

<p>Hemianopsia affects both eyes unequally, while homonymous hemianopsia affects the same side of both eyes (C)</p> Signup and view all the answers

What is the recommended strategy for managing Homonymous hemianopsia?

<p>Turn head from side to side to expand the visual field (A)</p> Signup and view all the answers

A patient who has difficulty performing previously learned motor skills may have which condition?

<p>Apraxia (D)</p> Signup and view all the answers

Which of the following is NOT a typical element of venous thromboembolism (VTE) prophylaxis upon discharge?

<p>Discharge on statin medication (B)</p> Signup and view all the answers

What is the primary nursing intervention when dressing a patient with unilateral inattention, particularly when affecting the right hemisphere?

<p>Encourage the patient to dress the affected side first. (A)</p> Signup and view all the answers

In a patient with visual perceptual deficits due to a right hemisphere lesion, how should care providers approach and interact with them?

<p>Always approach from the unaffected side, which is facing the door. (C)</p> Signup and view all the answers

What is a key characteristic of a traumatic brain injury (TBI)?

<p>It's a result of an external mechanical force. (A)</p> Signup and view all the answers

A shearing injury in TBI is best described as:

<p>Brain tissue rebounding or rotating on the brainstem, causing damage to nerve axons. (C)</p> Signup and view all the answers

What intervention is used to manage diplopia?

<p>Placing a patch over the affected eye, changed every 2 to 4 hours (D)</p> Signup and view all the answers

Which of these BEST defines a primary brain injury?

<p>Damage that occurs at the time of injury due to physical stress. (B)</p> Signup and view all the answers

A contusion injury in the context of a traumatic brain injury is described as:

<p>Bruising of the brain tissue. (A)</p> Signup and view all the answers

What is a key difference between an acceleration injury and a deceleration injury?

<p>Acceleration injuries involve the head being put into motion by an external force, deceleration injuries when the moving head stops. (D)</p> Signup and view all the answers

Which of the following best describes an 'open' traumatic brain injury?

<p>An injury where the skull is fractured or pierced by a penetrating object. (B)</p> Signup and view all the answers

Direct injuries in TBI result from:

<p>Force produced by a blow to the head (C)</p> Signup and view all the answers

Which intervention is MOST appropriate for a patient experiencing an acute ischemic stroke within 3 hours of symptom onset?

<p>IV fibrinolytic therapy (tPA) (A)</p> Signup and view all the answers

A patient with a stroke is being assessed with the NIH Stroke Scale and is found to have a score greater than 25. According to the text, what treatment should be considered?

<p>Intravenous alteplase is contraindicated. (B)</p> Signup and view all the answers

What is a key nursing consideration when caring for a patient receiving thrombolytic therapy for an ischemic stroke?

<p>Monitoring for hyper-perfusion syndrome (B)</p> Signup and view all the answers

A patient arrives in the emergency department with stroke symptoms 5 hours after onset. The patient has a confirmed occlusion of the middle cerebral artery. Which of the following interventions is likely to be considered?

<p>Mechanical embolectomy (C)</p> Signup and view all the answers

In what circumstances is intra-arterial thrombolysis MOST likely to be considered as a treatment option for stroke?

<p>When the stroke is from a large artery occlusion or patient is outside the window for IV alteplase. (A)</p> Signup and view all the answers

Which patient characteristic(s) would be an exception for administering intravenous alteplase?

<p>A history of stroke and diabetes. (B)</p> Signup and view all the answers

Why is it important to place objects in the patient's field of vision following a stroke?

<p>To help visualize the environment. (C)</p> Signup and view all the answers

What is the primary goal when treating a stroke patient with interventions?

<p>To increase cerebral perfusion and prevent further brain injury. (C)</p> Signup and view all the answers

What are the primary indicators monitored when assessing vital signs in a patient with TBI?

<p>Blood pressure and pulse (B)</p> Signup and view all the answers

Which of the following is a component of Cushing's Triad, indicating increased intracranial pressure?

<p>Bradycardia (D)</p> Signup and view all the answers

What should be the preferred position for a patient under spine precautions?

<p>Supine and aligned in a neutral position (C)</p> Signup and view all the answers

What change in the Glasgow Coma Scale (GCS) score is considered clinically important?

<p>A change of 2 points (C)</p> Signup and view all the answers

Which sign may indicate a decrease in the level of consciousness (LOC) in a TBI patient?

<p>Increased sleepiness and restlessness (B)</p> Signup and view all the answers

What does spine clearance involve in the assessment of a potential spinal cord injury?

<p>Determining absence of acute abnormalities (D)</p> Signup and view all the answers

What is the primary concern when using a bright light to assess pupillary size in a TBI patient?

<p>Presence of facial swelling (C)</p> Signup and view all the answers

What should health care providers immediately report regarding changes in a TBI patient's behavior?

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

Which statement indicates the client's understanding of health teaching for stroke prevention?

<p>I need to cut down a lot on my drinking. (B), I will take aspirin every day. (C)</p> Signup and view all the answers

What is the highest priority assessment finding for the nurse caring for a patient treated with alteplase following a stroke?

<p>Client is having epistaxis. (B)</p> Signup and view all the answers

Which nursing intervention is appropriate for communicating with a client with expressive (Broca's) aphasia?

<p>Provide pictures to help the client communicate. (C)</p> Signup and view all the answers

What is the best response for the nurse regarding long-term psychological effects from a client's mild traumatic brain injury?

<p>Each person's reaction to brain injury is different. (B)</p> Signup and view all the answers

After a surgical removal of a brain stem tumor, what position should the nurse place the client in upon return from the PACU?

<p>Keep the client flat in bed or up 10 degrees. (D)</p> Signup and view all the answers

Which of the following factors is a common risk associated with stroke?

<p>Persistent high blood pressure. (B)</p> Signup and view all the answers

In caring for a client with expressive aphasia, which action should be avoided?

<p>Assuming the client understands without confirmation. (C)</p> Signup and view all the answers

What lifestyle change is critical for someone at risk of stroke?

<p>Reducing stress through relaxation techniques. (D)</p> Signup and view all the answers

Flashcards

Agnosia

Inability to use an object correctly, often due to damage in the brain's parietal lobe.

Apraxia

Inability to perform previously learned motor skills or commands, even though a patient has the physical ability.

Unilateral Inattention Syndrome (Body Neglect)

A syndrome where a patient is unaware of the existence of their paralyzed side, most commonly due to a right hemisphere stroke.

Hemianopsia

Blindness in half of the visual field due to damage to the optic tract or occipital lobe.

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Homonymous Hemianopsia

Blindness in the same side of both eyes, often caused by a stroke or tumor affecting the brain's visual pathways.

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Nystagmus

Involuntary, rapid, rhythmic eye movements, often caused by neurological conditions or inner ear problems.

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Paresthesia

Numbness, tingling, or unusual sensations, often due to nerve injury or sensory disorders.

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Ptosis

Drooping eyelid, often due to nerve damage or muscle weakness.

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Traumatic Brain Injury (TBI)

A type of brain injury caused by a sudden external force. It can be caused by a direct blow to the head or an indirect force that transmits force to the head, like a whiplash.

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Direct TBI

Injury caused by a direct impact to the head.

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Indirect TBI

Injury caused by a force that is applied to another part of the body, but causes a rebound effect to the brain.

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Primary Brain Damage

The initial damage that occurs to the brain at the time of injury. This damage is caused by the physical stress of the impact force.

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Focal Brain Injury

Primary brain damage that occurs in a specific area of the brain.

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Diffuse Brain Injury

Primary brain damage that affects a widespread area of the brain.

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Open Brain Injury

Primary brain damage where the skull is fractured or pierced by a penetrating object.

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Closed Brain Injury

Primary brain damage where the skull is intact but there is damage to the brain tissue.

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Ischemic Stroke

A type of stroke where a blood clot blocks an artery in the brain, interrupting blood flow.

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IV Fibrinolytic Therapy

A treatment for ischemic stroke that dissolves blood clots to restore blood flow to the brain.

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Alteplase (tPA)

A type of fibrinolytic drug used to treat ischemic stroke.

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Hemorrhagic Stroke

A stroke caused by a ruptured blood vessel in the brain, leading to bleeding.

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Endovascular Interventions

Procedures performed directly on the arteries to remove clots or widen narrowed arteries.

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Intra-arterial Thrombolysis

A procedure involving injecting a clot-dissolving drug directly into the blocked artery.

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Mechanical Embolectomy

A procedure that uses a catheter to physically remove a blood clot from an artery.

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Carotid Artery Angioplasty with Stenting

A procedure to widen a narrowed carotid artery using a balloon and a mesh tube (stent).

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Spine Precautions

Precaution taken for patients with possible cervical spinal cord injuries from head trauma, involving keeping the patient supine and with a neutral spine.

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Spine Clearance

A clinical decision made by the healthcare provider, often with a radiologist, to determine the absence of spinal injuries. Based on history, physical exam and imaging.

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Cerebral Autoregulation

The ability of the brain's blood vessels to adjust to changes in pressure and maintain blood flow.

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Cushing's Triad

A triad of vital signs that indicates increasing intracranial pressure (ICP) and is a very late sign of brain injury. It includes bradycardia, bradypnea, and widened pulse pressure indicating imminent danger.

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Glasgow Coma Scale (GCS)

A standardized tool used to assess neurological status, assigning scores based on eye opening, verbal response, and motor response.

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Change in Level of Consciousness (LOC)

A change in LOC (level of consciousness) is a critical sign of neurologic deterioration. Early signs include restlessness, irritability, and disorientation.

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Pupillary Assessment

Pupil size and reaction to light are major indicators of neurological status as they reveal potential brain swelling or damage.

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Hemparesis

A condition where the brain's ability to control movement is impaired, often caused by stroke or brain injury.

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Blown Pupils

Pupils that are fixed (nonreactive) and dilated, indicating a severe neurological problem and a poor prognosis.

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Papilledema

A sign of increased intracranial pressure (ICP), characterized by swelling and increased blood flow in the optic disc.

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Decerebrate Posturing

A neurological sign where the body posture indicates severe brain injury. The arms are extended and rotated internally, and the legs are extended. This is often associated with lesions interrupting the corticospinal pathways.

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Decorticate Posturing

A neurological sign indicating brain damage, where the arms are flexed and the hands are clenched towards the core of the body, while the legs are extended. This is often caused by dysfunction in the brainstem area.

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CSF Leakage

The leakage of cerebrospinal fluid from the ears or nose, often a sign of a skull fracture. It can be identified by the halo sign: a clear or yellowish ring surrounding a spot of blood.

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Raccoon Eyes

A purplish discoloration around the eyes, often a sign of a skull fracture at the base of the skull.

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Asymmetric Pupils

Uneven pupils that react poorly or not at all to light, a sign of increased intracranial pressure (ICP) and possible brain herniation.

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Ovoid Pupil

An intermediate pupil size between normal and dilated, indicating a potential neurological problem.

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Study Notes

Module 2: Care of the Patient with Critical Neurological Dysfunction

  • The priority concepts in this chapter are perfusion, cognition, and mobility
  • The perfusion exemplar is stroke
  • The cognition exemplar is traumatic brain injury
  • Interrelated concepts are sensory perception
  • This module covers transient ischemic attacks, cerebrovascular accidents (CVAs), tumors, and traumatic brain injuries

Types of Strokes

  • Ischemic strokes: A blood clot blocks blood flow to an area of the brain. This type includes thrombotic and embolic strokes
    • Thrombotic: Gradual onset of symptoms due to slow-developing blood clots in the arteries.
    • Embolic: Sudden onset of symptoms from emboli (blood clots that travel), frequently from the heart.
  • Hemorrhagic strokes: Bleeding inside or around brain tissue. This type includes aneurysms, arteriovenous malformations (AVMs), and hypertension.
    • Aneurysms: Weakness in the blood vessel wall leads to a bulge or rupture.
    • AVMs: Congenital malformation of blood vessels causing bleeding.
    • Hypertension: Persistent high blood pressure causes brain bleeding

Warning Signs of TIA and Stroke

  • Warning signs may last 30 minutes but can be up to 24 hours
  • Transient focal neurological dysfunction
  • Interruption in cerebral blood flow
  • Treat TIAs as medical emergencies
  • Single TIAs indicate a higher risk of stroke
  • Multiple and recurring TIAs lead to permanent brain damage

Types of Aphasia

  • Expressive (Broca's): Difficulty with speaking and writing
  • Receptive (Wernicke's): Difficulty understanding spoken and written words
  • Mixed

Stroke Symptoms

  • Symptoms depend on the location and extent of the ischemia
  • Sudden onset of confusion or difficulty speaking
  • Sudden numbness or weakness in the extremities
  • Sudden trouble seeing
  • Sudden difficulty walking
  • Sudden severe headache

Left vs. Right Hemisphere Stroke Symptoms

  • Left Hemisphere Stroke: -Language difficulties (Aphasia, Alexia, Agraphia, Acalculia) -Memory problems -Difficulties with reading, writing, and math -Slowness -Caution -Anxiety -Depression -Feelings of worthlessness -Anger and frustration -Intellectual impairment
  • Right Hemisphere Stroke: -Spatial and perceptual deficits -Lack of awareness of the paralyzed side (inattention) -Unilateral inattention (body neglect) -Loss of depth perception -Deficits in the right visual field -Impulsiveness and poor judgment -Euphoria -Constant smiling -Inability to recognize faces -Disorientation to time, place, and person -Poor recognition of stimuli -Poor personal hygiene
  • Additional info -Changes in personality and behavior

Traumatic Brain Injury (TBI)

  • Damage to the brain from external force
  • Can be temporary or permanent
  • Causes impairments in cognition, mobility, sensory perception, and psychosocial function

Types of Traumatic Brain Injury

  • Direct injury: Force produced by a blow to the head
  • Indirect injury: Force applied to another body part with a rebound effect to the brain

Primary Injury of TBI

  • Focal injury: Damage (confined) to a specific area of the brain
  • Diffuse injury: Damage throughout many areas of the brain

Types of Brain Hemorrhage

  • Epidural hematoma
  • Subdural hematoma

Increased Intracranial Pressure (ICP)

  • Occurs with severe brain injuries
  • Characterized by a raised ICP
  • Can lead to brain herniation

Stroke Treatment

  • Interventions for patients experiencing strokes are determined by the type and extent of stroke.
  • The nurse's immediate role is to manage the patient experiencing the stroke
  • Continuously assess for indications of increasing ICP

TBI Stroke Treatment

  • Nonsurgical management includes maintaining a patent airway, breathing, and circulation.
  • Providing health education and support to the patient and family
  • Interventions focus on preventing secondary brain injury
  • Monitor vital signs every hour
  • Take and record patients' vital signs
  • IV fluids or drug therapy to prevent severe hypertension or hypotension

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Module 2 Critical Neuro Dysfunction PDF

Description

Test your knowledge on the assessment of traumatic brain injury (TBI) and related neurological findings. This quiz covers crucial concepts such as pupil characteristics, brain herniation signs, and the implications of various neurological symptoms. Enhance your understanding of TBI and its presentation.

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