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Traumatic Brain Injury, Spinal Cord Injury, ICP, Meningitis
Terms in this set (54)
Causes of Viral meningitis?
•enterovirus, arbovirus, HIV, and HSV
Mechanism of spearding viral menigitis?
Direct contact w/ resp secretions
Common s/sx of viral meningitis?
headache, fever, photophobia, and stiff neck
Dx test for viral meningitis?
-Xpert EV test (enterovirus test)
-PCR test (viral DNA)
Does viral meningitis kill people?
disease is self limiting
full recovery expected
Transmission precautions of Bacterial vs. Viral Meningitis?
Treatment for family members of a viral meningitis?
No treatment needed, contact precaution
Pathology of meningitis?
•Acute inflammation of meningeal tissue surrounding brain and spinal cord
Causes of bacterial meningitis?
S/sx of bacterial meningitis?
•Nuchal rigidity aka Stiff Neck
Signs of ↑ ICP
•Seizures occur in 1/3 of all cases
•Vomiting and irritability may occur
Complications of bacterial meningitis?
•Residual neuro dysfnx
•Blindness (CN II-Optic Nerve)
-Ptosis (drooping of upper eyelid)
-Diplopia (double vision)
•Corneal reflex lost (CN V)
•Tinnitus, vertigo, deafness (poss. permanent, CN VII))
•Hemiparesis, dysphagia, hemianopsia (CN VIII)
Dx of Bacterial Meningitis?
•CT scan, MRI
•Analysis of CSF
•Specimens of secretions are cultured to identify causative organism
•Gram-stain to detect bacteria
•Neutrophils are main WBC in CSF
•X-rays of skull
3 Vaccinations to help with bacterial meningitis?
2 others which also help?
Early treatment of what 2 illness help prevent meningitis?
-Influenzas & Pneumonia
-Respiratory tract & Ear infections
If someone is exposed to bacterial meningitis, what should be done?
Clinical Manifestations of ICP?
Vomiting w/o emesis (projectile)
-widened pulse pressure
•Unilateral pupil dilation
•Sluggish or no response to light
•Inability to move eye upward
-Blurred vision, Diplopia
Decerebrate posturing (Extensor)
Decorticate posturing (Flexor)
Complications of ICP?
vCerebral perfusion (ischemia)
Dx for ICP?
•CT scan / MRI / PET
•ICP and brain tissue oxygenation measurement (LICOX catheter)
•Doppler and evoked potential studies
•NO lumbar puncture
"Glasgow coma scale less than 8, plan to _________"
What can a Ventirculostomy help with?
Placing cranial catheter inserted into lateral ventricle, coupled with external transducer
ICP slides 34-42
Glasgow Coma Scale (GCS) is made of 3 main categories?
Best verbal response
Best motor response
ICP drug therapies?
•Antiseizure (seizures b/c ICP)
•Benzodiazepines (Lorazepam, diazepam)
•Neuromuscular blocking agents
Precautioned actions with patient with ICP?
•HOB elevated appropriately
•Prevent extreme neck flexion
•Avoid coughing, straining, Valsalva
•Avoid hip flexion
Review all Spinal Cord injury slides....
Long term issues with Spinal Cord injury (SCI)?
Growth & Development
§ Altered family dynamics
§ Economic loss
¡ Round-the-clock care
Describe Secondary pathophysiology of SCI?
-Free radical formation
-Release of glutamate
-Uncontrolled calcium influx
-Apoptosis (programmed cell death) for weeks after injury
---Lead to scar tissue formation, irreversible nerve damage, and permanent neurologic deficit
Clinical manifestations for SCI depending on System?
-musculoskeletal pain: dull, aching, viseral
-At or below injury site
-Hot, burning, tingling, pins&needles, cold, shooting
-Above C4, total loss of resp. muscle fnx
-Below C4, diaphragmatic breathing, resp. insuffiieny
-Above T6, dysfnx of Sympatheti nervous system
-vBP (vaso dilation)
VTE/DVT/PE hard to detect
Hyperactive reflex (spastic)
^Release of HCl-> ulcers
vAbility to sweat/shiver below injury (more common
Alkalosis (NG suctioning, Na & K)
^nutritional need (calories & nitrogen)
Traumatic Brain Injury
Death common occurs during what three points after injury?
- ~2 hours
- 3 weeks
Scalp lacerations are prone to....?
Bleeding a LOT, highly vascular
Classic sign of Skull Fracture?
Raccoon Eyes & Battle's sign
GCS scores for Minor, Moderate, Severe?
•Minor (GCS 13-15)
•Moderate (GCS 9-12)
•Severe (GCS 3-8)
•Brief disruption in LOC
•May result in postconcussion syndrome
Post-concussion Syndrome s/sx?
•Shortened attention span
Diffuse Axonal Injury (DAI) s/sx?
•Widespread axonal damage
•Global cerebral EDEMA
Explain a Coup-Contrecoup Injury
Primary & secondary impact (high energy impacts)
Complications of Traumatic Brain Injury
-Weeks-months (older adults)
Dx of head injuries?
MRI, PET, evoked potential studies
Cervical spine Xray
Glasgow Coma Scale
General Care for patient with emergent head injury?
•Intubate if GCS <8
•STOP external bleeding
•Assume neck injury
•Administer fluids cautiously
Treatment of care for...?
Concussion & contusion?
•Observation and management of ICP
•Surgery if depressed
•Craniectomy if extreme swelling
Subjective data needed for Traumatic Brain Injuries?
Objective data needed for Traumatic Brain Injuries?
Laceractions, Contusions, abrasions
Imparied gag reflex
Cushing's Triad (vHR, iRR, wideBP)
•Rigidity or flaccidity
Diagnostics/labs for Traumatic Brain injury?
•Positive toxicology screen or alcohol level
•↑ or ↓Blood glucose level
Nursing care for Traumatic Brain Injury?
Eye drops, compression, patches
HOB elevated (max 30 degrees)
Loose collection pad for CSF
No sneezing or blowing nose
No NG tube
No nasotracheal suctioning
NORMAL ICP range?
Elevated if >____?
What are the 3 compensatory adaptations for change in ICP?
Intracranial Blood Volume
Brain Tissue Volume
Amount of blood passing through 100g of brain tissue in 1 minute?
50 mL/min per 100 g of Brain tissue
Cerebral blood flow can be autoregulated by blood vessels only if MAP is between ________?
70-150 mm Hg
Formula for CPP?
Normal pressure range for CPP?
When does ischemia start?
60-100 mm Hg
Decorticate vs. Decerebrate posturing?
-Internal rotation, adduction, and flexion of the arms in an unconscious patient is documented as decorticate
-Extension of the arms and legs is decerebrate posturing
Primary drug therapy given for ICP?
What is the primary parameter to watch?
-monitor ICP, BP may initially go up & vHct
Glasgow Coma Scale (GCS)
If Cerebral spinal fluid is suspected to be leaking from nose/ears/etc what will it test POSITIVE for?
Frontal lobe controls?
Parietal lobe controls?
Occipital lobe controls?
Parietal - speech
Occipital- visual reception
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