Spinal Cord Injury
A Spinal Injury in this section of the spinal cord, results in ABSOLUTE need for a ventilator
C1-C4
DX Criteria-
Closed Head Injury:
Closed Skull Fracture:
Open Skull Fx/open head injury:
1: Open Scalp, no open skull
2:Closed scalp, Open Skull
3: Open scalp, open skull
Glasgow coma scale-
What are the 3 categories
Scoring- a ___ score means BAD
Eye opening, verbal response, motor response
LOW
Range of ICP
Cushings triad
0 to 10mmHg (15 upper limit of normal)
HTN, Bradycardia, Bradypnea
What does a DAI injury usually lead to?
Coma... then death
Autonomic Dysreflexia: what is it?
When does it occur?
Who does it happen to?
S&S
When: up to years after initial injury
Who: Above T6 SC lesions
S&S: Sweating above the injury, severe headache, dramatic increase in BP, Nausea,Congestions and Bradycardia
Concussion Vs. Contusion
Contusion- Focal (1 area of brain), MORE SERIOUS, S&S have delayed onset 18-36 hours (stupor, confusion, altered LOC)... INTERVENE EARLY
Complications of Intracranial Hemorrhage
Increased ICP, Dural tears, seizures, Diabetes Insipidus/SIADH, Meningitis, Herniation syndrome (blood pushes one hemi into the other, leading to herniation through spinal cord= death)
Medical Treatments for ICP
Mannitol, Hypertonic Saline, Corticosteroids(antiacid/histamines- H2 blockers),
Lower body temp to NORMAL body temp
Inotropes & Vasopressors- for Cardiac support
Sedation- reduces metabolic demand
Barbituates- reduces metabolic demand and provides cerebral protections
FOLEY & I&O's
Mannitol-- what is it? how quick does it work? where can it be given?
Osmotic Diuretic, Only given in ICU, ICP can be relieved in 15min
Autonomic Dysreflexia Interventions:
Do we label the patient chart Y/N?
SIT THEM UP and determine cause of problem:
Needle cap, kinked catheter, abdominal distention? Y
Yes: Label the chart to alert future caretakers on risk of this problem being possible in the future.
S&S of a Basal Skull Fracture:
Biggest risk of getting ______ from this type of type of fracture.
CSF Otorrhea; CSF Rhinorrhea; Hemorrhage, Circumoral Bruising (around the eyes) and back of ears (battle signs)
Intracranial Hemorrhage-
Causes:
S&S:
1- Brain Injury, bullets, stabbings, uncontrolled HTN, aneurysms rupturing, vascular anomalies, tumors
2- headache, possible neuro deficits
ICP monitoring management-
Where does it go?
How clean does it have to be?
cockstop must be in what posistion?
Directly into skull, layer of brain, or brain
STERILE...
Off position-- outward
SIADH- Increased ADH= FVO
Causes
TX for SIADH
Interventions
Causes: Pituitary Tumor, TBI, Meds; Vincristine (chemo), phenothiazines (psych), Nicotine
TX: Remove cause, 3% NS, Fluid Restriction (800mL-mild; 500mL-severe), Diuretics (lasix)
Conivaptin- inhibits ADH Tolvaptan- vasopressing agonist
Declomycin- diminishes responsivness to ADH
Interventions: VS, Lung sounds, I&O's, daily weights, hyponatremia s&s, neuro status
Medications/Tx (5 things) (3 types of Meds)
Permanent Pacemaker, Maintain BP with fluids/pressors, Decompress stomach with NG, Straight Cath
methylprednisone (inflammation)
Atropine(brady)
Antispasmodics- Baclofin, Dantrium
Epidural Hematoma-
Patient presentation:
Treatments:
Brief LOC with return of lucid state; then as hematoma expands, increased ICP will suddenly reduce level of consciousness.
TX: Reduce ICP, remove the clot, stop bleeding (burr hole/craniotomy), Mannitol, Diuretics, ET Vent
ICU monitoring and ICP monitoring
Nursing Interventions for ICP (8 things)-
Positioning- 30* or higher; Manage CSF leak, NO NG TUBE (infection, ICP); initiate enteral feedings after 24hrs, maintain temp of 98.6, Seizure precautions, ensure VTE prophylaxis
Teaching to patient and family- Injury, Orientation to room & equipment
Early Signs:
Headaches-come or go? intensity? what makes it worse?
VS
Early: Changes in LOC, restlessness, confusion, drowsiness (increasing), increased respiratory effort, purposeless movements, weakness, pupillary changes, delayed eye movement, extremity weakness (unilateral or bilateral)
Headaches: constant, increasing in intensity, aggravated by movement or straining.
Vital Signs: HTN, bradycardia, decreased RR
Diabetes Insipidus- peeing sooo soo much. "High and Dry"
Causes
Tx
Interventions
Central (infection, sx, brain tumor, head trauma) , Renal (kidney injury, lithium) or Dipsogenic (hypothalamus defect)
TX: Desmopressin -- caution in CAD patients
Chloropropamide(Diabinese)-- r/o hypoglycemia --- Thiazide diuretics
Prostaglandin Inhib if nephrogenic cause
Inter: early detection Replace ADH,maintain hydration, medical alert bracelet, low sodium diet <3g/day, low protein,
Explain autonomic dysreflexia and how it occurs
Exaggerated neuron response to minima stimuli, produced initial spinal injury/shock
Acute Subdural Hematoma-
Possible Causes:
Patient Presentation:
Treatments:
1- Anticoags, trauma, aneurysms
2- s&s develop over 24 hrs, altered LOC, Increased BP, decreased HR/RR--> coma
3- IMMEDIATE craniotomy and control of ICP
Chronic Subdural Hematomas:
How long do they develop?
S&S
TX
2- s&s may fluctuate- headache, personality changes, mental deterioration and seizures.
3- Evacuation of the clot, may be left alone if tx will do more harm than good, d/c of blood thinners if suggest
Late Signs:
VS:
Respiratory:
Neuro Status:
LS: Projectile vomiting, resp and vasomotor changes, hemiplegia, decortication, deceberation, flaccidity
VS: Increase in systolic pressure, widening pulse pressure, slowing heart rate (Called Cushings reflex), fluctuating pulse (high to low), CUSHINGS TRIAD (HTN,<HR&RR)
Respiratory: Cheyne-Strokes, breathing and arrest
Neuro Status: loss of brainstem flexes- pupil, gag, corneal, and swallow reflex
SIADH S&S labs VS. DI S&S labs
SIADH- Decrease UO, Increased ICP/Serum osmolality, urine osmolality, stupor/coma, tachy, limp muscles,headache and seizures.
DI- increased Urine output (>250ml/hr), decreased- serum and urine osmolality, hypotension,tachy, weight loss