Questions and Answers
What is the mortality rate for ischemic stroke?
35%
Which of the following is NOT a risk factor for stroke?
Regular exercise
What is a prevention measure for stroke?
Anti-coagulation for atrial fibrillation
What is a management step for stroke?
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What is a major risk of tPA administration in stroke management?
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What is the 30-day mortality rate for hemorrhagic stroke?
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What is the primary aim of trauma care?
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What is crucial for interventions in trauma care?
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What is included in the pre-hospital resuscitation in trauma care?
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What is involved in the in-hospital care in trauma management?
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What are trauma complications?
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What is involved in the resuscitation phase of trauma care?
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What is the purpose of administering Naloxone in the context of motor responses to pain assessment?
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Which medication is recommended for seizure prophylaxis in the management of brain injury?
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What is the purpose of evaluating cranial nerves and reflexes in monitoring a patient's neurological status?
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Which part of the brain is responsible for functions such as reasoning, planning, and problem-solving?
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What does the Monro-Kellie Hypothesis explain?
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What are the clinical manifestations of increased intracranial pressure?
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Why is cerebral perfusion pressure (CPP) calculation important in head injury management?
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What is the response of cerebral blood flow to changes in metabolic rate, acidosis, and alkalosis known as?
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What is the primary focus of managing brain injury?
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Why is it important to maintain adequate perfusion and oxygenation in brain injury cases?
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Which type of head injury may result in profuse bleeding and require direct pressure to control bleeding?
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What type of skull fracture may require surgery?
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Which condition results in bruising to the brain's surface, with varying degrees of edema and visual disturbances?
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What may diffuse axonal injury result in?
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Which infections require specific diagnostic and treatment approaches?
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What can occur as a secondary effect of various brain injuries?
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Which type of hematoma may require immediate surgical intervention in some cases?
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What may arteriovenous malformations result in?
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What may cerebral aneurysms present with?
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What does nursing care for patients with traumatic brain injuries involve?
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What complications should be monitored and managed in patients with traumatic brain injuries?
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What is a transient, reversible alteration in brain functioning?
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What is the lowest possible score on the Glasgow Coma Scale consistent with brain death?
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What is the primary consequence of increased intracranial pressure?
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What does fixed and dilated pupils typically indicate in the context of head injury?
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What is the main purpose of maintaining a mean arterial pressure (MAP) of over 90mmHg in head injury cases?
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What is the goal range for cerebral perfusion pressure (CPP)?
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What is the recommended position for the patient's head in terms of degrees to maintain intracranial pressure (ICP) below 20-25 mmHg?
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Which medication is recommended for treating hypertension in the context of elevated intracranial pressure?
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What is the effect of hyperventilation on cerebral vasculature?
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Which type of catheter is specific to the area of brain injury and is usually used for large bleeds in monitoring intracranial pressure?
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What is the main function of mannitol in reducing intracranial pressure (ICP)?
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What is the recommended dose of mannitol for reducing intracranial pressure?
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What is the primary effect of hypertonic agents in managing intracranial pressure?
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What is the primary function of neurologic assessment in the context of anticonvulsant therapy?
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What is the goal serum sodium level when using hyperosmolar therapy to manage intracranial pressure?
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What is the recommended range for normal intracranial pressure (ICP)?
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What is the primary purpose of barbiturate coma in the context of managing elevated intracranial pressure?
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What is the lowest score one can have on the Glasgow Coma Scale?
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What is the primary cause of death during an accident, according to the text?
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What does fixed and dilated pupils usually indicate?
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What is the recommended minimum Mean Arterial Pressure (MAP) to be maintained with fluids, as per the text?
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What is the recommended range for serum osmolarity when managing intracranial pressure?
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What is the primary effect of Mannitol in reducing intracranial pressure?
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What is the primary aim of using hypertonic agents in managing intracranial pressure?
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Why is normocapnia essential in respiratory support for managing intracranial pressure?
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Why are steroids like Decadron not recommended by Brain Trauma Foundation guidelines?
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What is a crucial consideration for anticonvulsants in brain injury management?
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When is barbiturate coma used in managing elevated intracranial pressure?
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What is the defined range for hypertension in terms of systolic blood pressure (SBP) when managing intracranial pressure?
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What is essential for the management of intracranial pressure?
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What is a key nursing implication for managing intracranial pressure?
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What is the primary function of opioids and sedatives in managing intracranial pressure?
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What is a critical consideration for blood pressure management in the context of intracranial pressure?
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What is the primary injury mechanism that leads to axonal shearing from cell bodies, resulting in death during accidents?
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What is the lowest possible score on the Glasgow Coma Scale, which is consistent with brain death?
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What does fixed and dilated pupils usually indicate in the context of head injury?
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What is the primary aim when assessing head injuries in terms of C-Spine?
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Which of the following head injuries may result in profuse bleeding and require direct pressure to control bleeding?
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What type of skull fracture may require surgery?
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What is the primary concern in the case of diffuse axonal injury?
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What may brain stem contusion lead to?
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Which condition may require immediate surgical intervention in some cases?
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What may arteriovenous malformations result in?
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What is a key aspect of nursing care for patients with traumatic brain injuries?
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What is a common complication that should be monitored and managed in patients with traumatic brain injuries?
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What are infections such as meningitis and brain abscess in need of?
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What can occur as a secondary effect of various brain injuries?
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What is a specific diagnostic and treatment approach required for cerebral aneurysms?
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What is the primary aim of trauma care for patients with traumatic brain injuries?
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What is the recommended time frame for interventions in trauma care?
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What is the primary focus of pre-hospital resuscitation in trauma care?
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What is the 30-day mortality rate range for hemorrhagic stroke?
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What is the primary aim of management during the resuscitation phase of trauma care?
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What is a major risk associated with tPA administration in stroke management?
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What is the primary goal of prevention strategies for stroke?
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What is the primary aim of in-hospital care in trauma management?
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What is a major risk of using anti-coagulation for atrial fibrillation in stroke prevention?
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What is a key factor in the management of shock states in trauma care?
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What is a significant risk associated with the use of birth control pills in relation to stroke?
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What is the primary imaging modality for early recognition in stroke management?
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What is a key consideration in the prevention of stroke related to atrial fibrillation?
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Which of the following is NOT a reversible cause of changes in the context of brain injury assessment?
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Which medication is NOT typically administered for status epilepticus in the context of brain injury management?
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Which of the following is NOT a sign of head trauma mentioned in the text?
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Which part of the brain is responsible for functions such as reasoning, planning, and problem-solving?
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What is the primary type of cerebral edema mentioned in the text?
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Which of the following is NOT a clinical manifestation of increased intracranial pressure mentioned in the text?
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What is the equation for calculating cerebral perfusion pressure (CPP)?
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Which of the following responses to changes in metabolic rate affects autoregulation of cerebral blood flow?
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What is the primary goal of managing cerebral edema in brain injury cases?
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What is the primary focus of managing brain injury in relation to perfusion and oxygenation?
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What is the Monro-Kellie Hypothesis primarily concerned with?
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Which of the following is NOT a component of the brain anatomy mentioned in the text?
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What is the recommended dose range for Mannitol bolus infusion in brain injury patients?
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What is the primary purpose of hypertonic saline solutions in managing intracranial pressure?
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What is the recommended range for pCO2 (partial pressure of carbon dioxide) in respiratory support for managing intracranial pressure?
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What is the primary aim of using CNS depressants in brain injury patients?
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What is the controversial aspect of using steroids (Decadron) in brain injury treatment?
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What is the primary purpose of administering anticonvulsants in brain injury patients?
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What is the primary aim of maintaining cerebral perfusion pressure (CPP) in brain injury management?
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What is the recommended position for the patient's head in terms of degrees to maintain intracranial pressure (ICP) below 20-25 mmHg?
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What is the primary goal of blood pressure management in brain injury patients?
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What are the primary methods for monitoring intracranial pressure in brain injury patients?
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What is the equation for calculating cerebral perfusion pressure (CPP)?
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What is the primary nursing implication to prevent hypoxemia and hypotension in brain injury patients?
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What is the recommended dose range for mannitol bolus infusion in brain injury patients?
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What is the recommended range for maintaining intracranial pressure (ICP) in brain injury patients?
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What is the primary purpose of using hypertonic saline solutions in managing intracranial pressure?
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Which of the following is a key nursing implication for managing intracranial pressure in brain injury patients?
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What is the recommended range for cerebral perfusion pressure (CPP) in brain injury patients?
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What is the primary aim of using barbiturate coma in brain injury patients?
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What is a key consideration for blood pressure management in brain injury patients?
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What is the primary function of respiratory support in managing intracranial pressure?
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What is the primary purpose of CNS depressants in brain injury patients?
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What is the primary function of steroids (Decadron) in brain injury treatment?
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What is a key implication for nursing care in brain injury patients to prevent hypoxemia and hypotension?
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What is the primary aim of anticonvulsants in brain injury patients?
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Study Notes
Traumatic Brain Injury and Nursing Care Summary
- Brain abnormalities can be categorized into primary head injuries, including scalp lacerations, skull fractures, and basilar fractures.
- Scalp lacerations, the most common head injury, may result in profuse bleeding and require direct pressure to control bleeding.
- Skull fractures can be simple (no bone displacement) or depressed (bone fragment depresses the skull thickness), with surgery required for depressed fractures.
- Concussion is a transient, reversible alteration in brain functioning, and diffuse axonal injury usually results in coma and death.
- Contusion results in bruising to the brain's surface, with varying degrees of edema and visual disturbances, and brain stem contusion may lead to posturing and variable vital signs.
- Infections such as meningitis and brain abscess require specific diagnostic and treatment approaches.
- Brain swelling or edema can occur as a secondary effect of various brain injuries.
- Hematomas, including epidural and subdural hematomas, present specific symptoms and require immediate surgical intervention in some cases.
- Arteriovenous malformations may result in a hemorrhagic stroke, and their detection and treatment methods are outlined.
- Cerebral aneurysms may present with specific symptoms, and their diagnosis and treatment, including surgical clipping and endovascular techniques, are detailed.
- Nursing care for patients with traumatic brain injuries involves monitoring for neuro changes, hemorrhage prevention, symptom management, and lifestyle modifications.
- Complications such as vasospasm, hyponatremia, and neurogenic pulmonary edema should be monitored and managed in patients with traumatic brain injuries.
Intracranial Pressure Management in Brain Injury
- Avoid overhydration during treatment to restore adequate blood pressure and monitor urine output
- Goal: Increase serum osmolarity to 300-320 or serum sodium to 145-150mmol/L
- Mannitol: Bolus infusion over 10-30 minutes, dose 0.25 to 2 g/kg body weight, reduces ICP by pulling water from cerebral cells
- Hypertonic agents induce hypernatremia to increase cerebral perfusion pressures and decrease ICP
- Respiratory support: PEEP increases mean airway pressure, normocapnia is essential, avoid hyperventilation in the first 24 hours
- CNS depressants like opioids and sedatives help lower ICP and relieve anxiety and pain
- Steroids like Decadron remain controversial and not recommended by Brain Trauma Foundation guidelines
- Anticonvulsants and metabolic needs for paralyzed and non-paralyzed patients are essential considerations
- Barbiturate coma is used as a last resort for severe refractory elevated ICP
- Blood pressure management: Hypertension defined as SBP>185 mmHg or DBP 110 mmHg, avoid hypotension and arrhythmias
- Monitoring intracranial pressure: Continuous monitoring of ICP, CSF drainage, and CPP management
- Summary of nursing implications: Frequent neuro exams, maintain ICP<20-25, prevent hypoxemia and hypotension, pre-sedate before procedures, attention to fluid & electrolyte balance, treat fever
Trauma Care and Management Summary
- Ischemic stroke has a 35% mortality rate, with 40% occurring in people under 60 years
- Risk factors for stroke include HTN, smoking, obesity, cardiac disease, hypercholesterolemia, DM, cancer, and use of BC pills
- Prevention of stroke includes anti-coagulation for atrial fibrillation and ASA
- Management of stroke involves early recognition (FAST), CT scan, MRI, cerebral angiography, and IV thrombolytic (tPA) administration
- Intracranial hemorrhage is a major risk of tPA administration
- Hemorrhagic stroke has a 30-day mortality rate of 40-80%
- Trauma care aims to avoid oxygen supply-demand mismatch, optimize organ perfusion, and manage shock states
- The "golden hour" is crucial for interventions in trauma care
- Pre-hospital resuscitation includes immediate stabilization and transportation, with a primary survey including ABC's
- In-hospital care involves a primary survey (ABC's), secondary survey (detailed head-to-toe assessment), and tertiary survey on admission to the ICU
- Trauma complications include acute respiratory distress syndrome, sepsis, shock states, and multiple organ dysfunction syndrome (MODS)
- Resuscitation phase of trauma care involves fluid resuscitation with crystalloids, colloids, and blood products; definitive care/operative phase includes damage control resuscitation and surgical management by organ system
Motor Responses to Pain: Assessment and Management of Brain Injury
- Assessment of reversible causes of changes: Dextrose 50% for hypoglycemia, Oxygen 100% for hypoxemia, Naloxone for narcotic-induced pinpoint pupils, and Thiamine with fluids for alcohol withdrawal
- Consider seizure prophylaxis and administer IV Keppra, lorazepam, and Valium for status epilepticus; intubation and propofol drip for further treatment
- Focused physical assessment includes signs of head trauma like Battle’s sign, raccoon eyes, facial bone fractures, and scalp lacerations
- Evaluation of cranial nerves and reflexes to monitor the patient's neurological status and response to stimuli
- Anatomy of the brain includes the functions of the frontal lobe, parietal lobe, temporal lobe, occipital lobe, cerebellum, brainstem, and amygdala
- Monro-Kellie Hypothesis explains the relationship between intracranial components and compensatory mechanisms for increased intracranial pressure
- Clinical manifestations of increased intracranial pressure include Cushing’s triad and brainstem herniation
- Cerebral perfusion pressure (CPP) calculation and its importance in head injury management
- Autoregulation of cerebral blood flow and its response to changes in metabolic rate, acidosis, and alkalosis
- Types of cerebral edema including vasogenic and cytotoxic edema with their respective causes and implications
- Management of brain injury focuses on preventing hypotension and hypoxemia, maintaining adequate mean arterial pressure (MAP), and managing cerebral edema
- Importance of maintaining adequate perfusion and oxygenation to prevent cerebral ischemia and optimize outcomes in brain injury cases
Intracranial Pressure Management in Brain Injury Patients
- Avoid overhydration when restoring blood pressure
- Mannitol bolus infusion over 10-30 minutes, dose 0.25 to 2 g/kg body weight
- Hypertonic saline solutions 3%-23.4% to increase serum sodium
- Respiratory support: PEEP, normocapnia (pCO2 35-45) essential
- CNS depressants: opioid sedatives, short-acting opioids, sedatives, neuromuscular blocking agents
- Steroids (Decadron) remain controversial in brain injury treatment
- Anticonvulsants for frequent and routine neurologic assessment
- Barbiturate coma for severe refractory elevated ICP
- Blood pressure management: hypertension defined, avoid hypotension and arrhythmias
- Monitoring intracranial pressure: ventriculostomy catheter, fiber-optic monitors, ICP waveforms
- Cerebral perfusion pressure (CPP) calculation and maintenance
- Nursing implications: hourly neuro exam, HOB > 30 degrees, maintain ICP < 20-25, prevent hypoxemia and hypotension, attention to fluid and electrolyte balance, treat fever
Intracranial Pressure Management in Brain Injury Patients
- Avoid overhydration when restoring blood pressure
- Mannitol bolus infusion over 10-30 minutes, dose 0.25 to 2 g/kg body weight
- Hypertonic saline solutions 3%-23.4% to increase serum sodium
- Respiratory support: PEEP, normocapnia (pCO2 35-45) essential
- CNS depressants: opioid sedatives, short-acting opioids, sedatives, neuromuscular blocking agents
- Steroids (Decadron) remain controversial in brain injury treatment
- Anticonvulsants for frequent and routine neurologic assessment
- Barbiturate coma for severe refractory elevated ICP
- Blood pressure management: hypertension defined, avoid hypotension and arrhythmias
- Monitoring intracranial pressure: ventriculostomy catheter, fiber-optic monitors, ICP waveforms
- Cerebral perfusion pressure (CPP) calculation and maintenance
- Nursing implications: hourly neuro exam, HOB > 30 degrees, maintain ICP < 20-25, prevent hypoxemia and hypotension, attention to fluid and electrolyte balance, treat fever
