TBI

Question 1

What is the Monroe Kellie hypothesis?

Answer 1

the sum of volumes of brain, CSF and intracranial blood is constant, therefore if one increases the other two could compress

Question 2

What are the S/Sx of IICP?

Answer 2

• change of LOC
• agitation/confusion
• delayed responses
• pupil changes
• N/V
• HA
• loss of reflexes
• coma
• CUSHINGS TRIAD

Question 3

What is cushings triad?

Answer 3

LATE sign of IICP:
1. rising BP with widened pulse pressure
2. bradycardia
3. bradypnea

Question 4

What is decorticate posturing?

Answer 4

flex posturing (arms in), indicates damage between brain and spinal cord

Question 5

What is decerebrate posturing?

Answer 5

extensor posturing (arms out), indicated damage to upper brain stem and is WORSE than decorticate

Question 6

6 Types of TBI’s?

Answer 6

• concussion
• severe TBI
• open brain injury
• basilar fracture
• hematoma
• hemorrhage

Question 7

S/Sx of concussion?

Answer 7

• altered level of consciousness
• changes in orientation
• pupil abnormalities
• change in vital signs
• headache, vomiting
  visual changes

Question 8

What assessment is required for concussion?

Answer 8

CT is done to rule out bleed

Question 9

Treatment for concussion?

Answer 9

Rest, treat symptoms, pt should be roused and assessed frequently

Question 10

How is severe TBI determined?

Answer 10

Glasgow Coma Scale (3-15)

Question 11

How can outcomes of severe TBI vary?

Answer 11

Can cause emotional changes, problems with cognition, changes in sleep patterns

Question 12

What is an open brain injury?

Answer 12

Injury caused by objects penetrating scalp, blunt trauma

Question 13

What is a basilar fracture?

Answer 13

Fracture at base of skull

Question 14

S/Sx of basilar fracture?

Answer 14

• raccoon eyes and/or battle’s sign
• bleeding from nose/ear/pharynx

Question 15

What is raccoon eyes/Battle’s sign?

Answer 15

Raccoon eyes is bruising around eyes, battle’s sign is bruising behind ear

Question 16

What is there a high risk for with regards to basilar fracture?

Answer 16

CSF leak from ears or nose

Question 17

How is CSF leak tested?

Answer 17

• look for halo sign
• glucose dipstick
• beta 2 transferrin test
• note: CSF leak will present with HA

Question 18

Describe epidural hematoma?

Answer 18

Blood collection in the space between skull and dura

Question 19

Symptoms of epidural hematoma?

Answer 19

• brief LOC on initial impact
• then return to lucid state
• ICP increase/expansion of hematoma occurs
• pt has second change in LOC

Question 20

Is epidural hematoma an emergency?

Answer 20

YES - surgical procedure needed to control ICP

Question 21

Describe Subdural hematoma?

Answer 21

Collection of blood between dura and brain

Question 22

Symptoms of subdural hematoma?

Answer 22

• change in LOC
• pupil changes
• coma
• increasing BP

Question 23

Is subdural hematoma an emergency?

Answer 23

YES - surgical procedure needed to control ICP via Burr holes/craniotomy

Question 24

Describe subarachnoid hemorrhage?

Answer 24

hemorrhagic stroke - bleeding into brain caused by either trauma or non traumatic case

Question 25

Symptom of subarachnoid hemorrhage?

Answer 25

'Worst headache of my life', sudden and very severe pain

Question 26

Treatment for subarachnoid hemorrhage?

Answer 26

control of ICP, craniotomy

Question 27

Respiratory interventions for TBI?

Answer 27

-maintain airway and oxygenation - balance suctioning since it increases ICP

Question 28

Neuro assessment/vitals interventions for TBI?

Answer 28

- initially qh - may give meds to manage ICP - prevent vasospasm - decrease cerebral edema - manage temp but avoid shivering - avoid hypotension with fluid bolus

Question 29

What medication is given to prevent vasospasm?

Answer 29

Nimodipine

Question 30

What meds are given to manage ICP?

Answer 30

anti-epileptics, sedation e.g. benzos, morphine

Question 31

What medication is given to decrease cerebral edema?

Answer 31

Mannitol as a diuretic

Question 32

What type of meds are given to avoid hypotension?

Answer 32

vasopressors

Question 33

Describe positioning interventions for TBI?

Answer 33

- semi fowlers (HOB 30 degrees) - neck neutral - avoid knee/hip flexion - exhale during repositioning

Question 34

Fluid/electrolyte balance interventions for TBI?

Answer 34

- careful I/O's - daily weight - monitor for sodium imbalance, hyperglycemia due to stress response

Question 35

Nutrition interventions for TBI?

Answer 35

- tube feedings (watch aspiration risk) - adequate protein intake for healing

Question 36

Bowel/bladder interventions for TBI?

Answer 36

- reduce risk of constipation/IICP (stool softeners) - avoid enemas

Question 37

What meds are commonly given to reduce risk of constipation/IICP?

Answer 37

Colace, Senna

Question 38

Interventions for immobility complications TBI?

Answer 38

- prevent infection - prevent pressure ulcers - prevent DVT - PT/OT consult