TBI
Distinguish between coup vs contrecoup injury
What is coup is injury at site of impact and contrecoup is injury on opposite side of impact.
What three components fill the skull under the Monro-Kellie doctrine?
What is brain tissue, blood, CSF. (Approx: 78%, 12%, 10%)
What increases mortality most in clients with SAH?
What is rebleeding
What is the FIRST priority test for a patient with a suspected brain bleed after a fall?
What is a STAT non-contrast CT scan.
Which medication is used specifically to decrease ICP?
What is mannitol
What force in TBI damages blood vessels and cellular function leading to ischemia and edema?
What is mechanical force disrupting blood vessels and cells.
MAP determines what vital brain function?
What is cerebral blood flow.
Which conditions are risk factors for SAH?
What is Marfan's Syndrome and Ehlers-Danlos
What physical finding is associated with a basilar skull fracture?
What is a Battle’s sign (bruising behind the ear).
A patient on mechanical ventilation receiving propofol should be monitored for what adverse effect?
What is hypotension
What activity is a common cause of TBI esp. in the older adult?
What is falls.
What are the three manifestations of Cushing’s Triad?
What is widening pulse pressure, bradycardia, irregular respirations.
What BP target is recommended for clients with SAH?
What is SBP <160 mm Hg.
What does a ventriculostomy do?
What is monitors ICP and drains CSF.
Elevating the head of the bed to 30–45° helps with what?
What is reducing ICP and improving venous drainage.
Name two secondary disabilities a client may develop after a TBI.
What is a loss of sensation, depression, fatigue, chronic pain and cognition difficulties.
Cushing’s Triad is an attempt to prevent what life-threatening condition?
What is brainstem ischemia.
Nimodipine is used in SAH to prevent what complication?
What is vasospasm
Which noninvasive test may help estimate ICP but cannot replace invasive monitoring?
What is optic nerve sheath ultrasound or transcranial Doppler.
Which action should the nurse NOT encourage in a patient with increased ICP: turning, coughing, deep breathing?
What is coughing
Name 3 mild (Concussion) clinical manifestations
What are headache, confusion and dizziness
Also: nausea, sensitivity to light, fatigue, mood changes
Name four findings that indicate Cushing’s Triad and require immediate follow-up.
What is widening pulse pressure, bradycardia, shallow breathing, episodes of apnea.
A lumbar puncture is contraindicated if...?
What is ICP is elevated. Can cause a brain herniation
What three assessment changes indicate worsening neurologic condition?
What is ↓ GCS, pupil size/shape changes, optic nerve swelling.
Name three essential nursing interventions when caring for a client with a TBI or high ICP.
What is: elevate HOB 30–45°, keep neck midline, maintain ventriculostomy at correct level, administer pain/sedation and provide enteral feedings (any three are correct)