Week 10 Traumatic Brain Injury
Terms in this set (69)
When is the value when ICP is considered increased?
What is the range on the Galsgow Coma Scale?
What is the normal MAP?
What is the normal CPP?
What is a traumatic brain injury?
Trauma to the brain caused by an external force impinging upon the head and brain. Injury can result in damage to the scalp, skull, meninges, and the brain including neuronal pathways, cranial nerves and intracranial vessels
What is the most common causes of TBI?
Motor vehicle accidents
Injury plus alcohol
True or False: Most accidents are related to alcohol, drug use or horse play.
What is an open injury?
The scalp is torn or a fracture extends into the sinus or middle ear
What is a closed injury?
There is not break in the scalp
What is the acceleration-deceleration etiology of a TBI?
The head is moving (acceleration) and hits a stationary object (deceleration) but the brain continues to move inside the skull
Example of Acceleration-Deceleration:
In a motor vehicle accident, the head is moving at the same rate and the vehicle, but the brain continues to move inside of skull when the vehicle stops suddenly. Acceleration: object strikes the head while it is stationary. Deceleration: Object strikes an object and stops
What is the coup-contre-coup mechanisms of TBI?
Coup is the area damaged at site of impact. Contre-coup is the brain rebounds on side opposite of injury, striking the skull and is frequently worse than the point of impact
What is a scalp laceration?
A break in the skin of the scalp
True or False: Scalp laceration are common in traumatic injury and are often associated with skull fracture
Nursing Care for a scalp laceration:
Wound is cleansed, debrided, and inspected for a depressed skull fracture, then sutured closed
What is a open, penetrating head injury?
Tearing of scalp, penetratio of meninges, and extension of fracture into sinuses, middle ear, or brain. There is a deep laceration of the brain tissue and possible damage to the ventricular system
What are some examples of low velocity causes of a open, penetrating head injury?
What are some examples of high velocity causes of a open, penetrating head injury?
Bullets, missiles may be involved
What are the 3 different types of skull fractures?
Linear, Depressed, and comminuted
True or False: Linear skull fractures are the most common.
What is a depressed skull fracute?
When the outer table of the skull is depressed below the inner table of the surrounding skull
What are the three types of depressed skull fracture?
Closed with scalp intact
Compound; scalp open but dura intact
Complex; dura lacerated by bone fragments
How is a depressed skull fracture treated?
If compound or complex, surgery!
What are comminuted skull fractures?
When there are multiple linear fractures with a depressed area at the site of inpact. The facture radiated away from the impact.
What is another name for a comminuted skull fracture?
What are basilar fractures?
Linear skull fractures at the skull base into either the anterior, middle, or posterior fossa
What is Battle Sign in a linear skull fracture?
Bruising behind the ear
What does it mean if you have "racoon eyes" with a linear skull fracture?
Bilateral periorbital edema and bruising
When would you see a Battle Sign or "Raccoon Eyes"?
With a basilar skull fracture
What is Rhinorrhea?
Drainage of CSF from the nose
What is Otorrhea?
Drainage of CSF from the ears
What is the halo sign?
Blood encircles by a yellowish stain on a dressing or bed linin and indicated CSF
What are dural tears?
Leakage of of CSF
What is a patient at risk for when CSF leaks?
What are some symptoms of a linear skull fracture?
Swollen, ecchymotic areas over scalp
What is the care for CSF otorrhea or rhinorrhea?
Observe for signs of intracranial bleeding and epidural hematoma
If CSF leaking from the nose or ear, allow to flow freely (can use small bandages to collect drainage.
Instruct pr to avoid blowing nose
If a tube is needed, go in the mouth
What is primary injury in a TBI?
A direct injury that occurs to the brain from an impact
What is a coup injury?
The area under the direct impact is injured
What is a contrecoup injury?
Injury distal to the site of impact can occur as the brain moves inside the skull
True or False: Stretching, shearing, rotational, and tearing forces that result from impact interrupt normal neuronal pathways.
What are some examples of a primary injury?
Concussion, contusion, penetrating injuries, hematomas, intracerebral hemorrhage and diffuse axonal injury
What is a concussion?
The temporary interruption of impulses
True or False: The neurologic deficits in a concussion are reversible and are generally mild.
True or False: Patients may lose consciousness for a few seconds at the time of injury but lasting effects are not common.
What is a contusion?
The bruising and/or bleeding of the brain in result of a coup-contrecoup
What is a diffuse axonal injury?
Widespread whit matter damage from shearing, tearing forces and shifting and rotation of the brain inside of the skull that results in the disruption of axons
True or False: There is a minimal to no recovery from a diffuse axonal brain injury.
S&S of Diffuse Axonal injury:
Vary from mild LOC to profound coma and permanent disability
What is a penetrating injury?
Deep laceration of brain tissue and disruption of ventricles
What problems are associated with penetrating injury?
Risk for bleeding and infection, possibility of bone fragments in the brain, and shock waves
What is a epidural hematoma?
Blood between the dura and the skull
True or False: A epidural hematoma is typically associated with a linear fracture of the temporal bone and results from tearing of the middle meningeal artery.
How quickly does a epidural hematoma develop?
Within the first 24-48 hours
Is a epidural hematoma a emergency?
What is ipsilateral?
The pupil on the side of the lesion becomes fixed and dilated
What is a subdural hematoma?
Collection of blood in the subdural space and may be bilateral
What is acute subdural hematoma?
Occurs within the first 48 hours
What is a chronic subdural hematoms?
Occurs as a result of a low-velocity impact and symptoms occur from 2 weeks to several months after an injury
True or False: A higher incidence of chronic subdural hematomas is seen in the elderly, chronic alcohol abusers, and those taking anticoagulants such as warfarin, antiplatelet aggregates, or aspirin.
What is a intracerebral hematoma?
A hemorrahage into brain tissue that creates a mass lesion
How do you treat a small intracerebral hematoma?
May resolve on its own
How do you treat a large intracerebral hematoma?
May require surgical excision
Common causes of a intracerebral hematoma:
Ruptured vessels from hypertension
What is Second Brain Injury?
A consequence of the initial trauma and is characterized by an inflammatory response and release of cytokines from macrophages that cause increased vascular permeability of the blood vessel wall, leading to vasogenic cerebral edema
What is the most common secondary brain injury?
What are some other secondary brain injuries?
Intracranial Hypertension (IICP)
Abnormalities of Cerebral blood flow
Nursing Interventions for TBI:
Maintain patent airway
May need intubation
Maintain ventilation and oxygenation
Monitor for shock
Monitor neurologic status: obtain good baseline
Provide support to patient and family
Continue care plan for increased ICP; monitor and control ICP
Control pain and agitation with extreme caution
Monitor fluid and electrolyte status
Maintain normal temperature
Prevent and/or treat seizure activity
Provide cognitive retraining
What are the goals for a patient with a TBI?
Maintain MAP > 90mmHg.
Maintain CPP > 70mmHg.
Treat ICP > 20mmHg.
Avoid hyperventilation in severe TBI unless cerebral oxygenation monitoring.
Keep pCO2 30-35 or titrate. (your book states 35-45)
How should a patient with a TBI be positioned?
Head position in neutral midline position to facilitate venous drainage.
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