Crani's & Burr Holes
What is the purpose of burr holes in a patient with suspected epidural hematoma?
Rapid decompression, remove clot, reduce ICP
What skin finding is most consistent with heat stroke?
Hot, dry skin (anhidrosis), altered mental status
Difference between hemorrhage and hematoma?
Hemorrhage = active bleeding into tissue; hematoma = collection of clotted blood post-bleed
What type of consent applies when treating an unconscious patient in a life-threatening emergency?
Implied consent
A patient is disoriented but answers simple questions. How should the nurse document the LOC?
Patient is confused but arousable — indicates altered LOC, not fully alert
Why is this complication most concerning after craniotomy: clear nasal drainage with salty taste?
CSF leak (risk of meningitis, delayed healing
DAILY DOUBLE!!!
A patient with hemorrhagic shock is ordered 3,000 mL NS over 24 hours. The IV tubing has a drop factor of 20 gtts/mL.
How many gtts/min should the nurse deliver?
3000 ÷ 24 = 125 mL/hr
Per minute: 125 ÷ 60 = 2.08 mL/min
Drops/min: 2.08 × 20 = 42 gtts/min
Which hematoma presents with a lucid interval then rapid deterioration?
Epidural hematoma
Which type of consent requires voluntary agreement after explanation of risks/benefits?
Informed consent
What abnormal posture shows flexion of upper extremities and internal rotation of legs?
Decorticate posturing
Name major complications post-craniotomy.
Increased ICP, bleeding/hypovolemic shock, electrolyte imbalances, infection, seizures, CSF leaks
What is the target temperature in heat stroke management?
Reduce core temp to ≤39.2°C (102.5°F) rapidly
Which hematoma may occur with minor forgotten trauma and fluctuating symptoms?
Chronic subdural hematoma
DAILY DOUBLE!!!!!
Phenytoin 15 mg/kg IV loading dose. Patient weighs 132 lbs. Vial concentration: 250 mg/5 mL.
How many mL should be administered for the loading dose?
Convert weight: 132 ÷ 2.2 = 60 kg
Dose: 15 × 60 = 900 mg
Concentration: 250 mg/5 mL = 50 mg/mL
Volume: 900 ÷ 50 = 18 mL
A patient has a brief loss of consciousness, then a lucid interval before rapid deterioration. Which injury does this suggest?
Epidural hematoma
Why is maintaining cerebral perfusion the highest priority after cranial surgery?
Hypoxia and hypercapnia worsen ICP, reduce cerebral blood flow, cause ischemia
Why must rubbing frostbitten tissue be avoided?
Ice crystals cause further tissue damage, necrosis
Which intracerebral bleed is often due to hypertension or aneurysm rupture?
Intracerebral hematoma/hemorrhage
What federal law requires EDs to screen and stabilize before transfer?
EMTALA
A patient with severe TBI is at risk for which secondary injuries if ICP is not controlled?
Cerebral edema, ischemia, herniation, infection, seizures
Which ICP management strategy peaks 24–36 hours post-op?
Cerebral edema
What complication may occur during hypothermia rewarming when cold blood returns to the core?
Cardiac dysrhythmias, metabolic acidosis, electrolyte shifts
Untreated hematomas/hemorrhage increase ICP and may cause what?
Brain herniation (life-threatening)
Why should forensic clothing evidence be bagged in paper, not plastic?
Paper prevents moisture buildup and mold, preserving integrity
Which nursing interventions are most important when monitoring a patient with altered LOC?
Frequent neuro checks, airway/oxygenation, skin and eye care, bladder/bowel monitoring, prevent injury, maintain fluid/electrolyte balance