Traumatic Brain Injury

Flashcards about Traumatic Brain Injury

What is a Traumatic Brain Injury (TBI)?

Injury to the skull or brain due to external force that interferes with normal functioning, prompting the client to seek treatment.

What are the most common causes of Traumatic Brain Injuries (TBIs)?

Falls (35%), Motor vehicle crashes (17%), Being struck by objects (16.5%), Assaults (10%).

Who is at the highest risk for brain trauma?

Males in all age groups, Adolescents ages 15 to 19 years, Children younger than 4 years, Adults 65 years and older, Military service.

What are some methods of primary prevention for Head and Spinal Cord Injuries?

Obey traffic laws; Avoid speeding; Do not text and drive; Avoid alcohol, drugs, and driving under the influence; Wear seat belts and helmets when appropriate; Secure firearms; Prevent falls.

What are the Mechanisms of TBI injury?

Coup, Contrecoup, Rotational forces, Shearing, Twisting, Blood vessel dissection.

What are the three types of intracranial contents and their approximate percentages?

Brain (80%), Arterial and Venous blood supply (10%), Cerebrospinal fluid (CSF) (10%).

What does the Monro-Kellie doctrine state?

The sum of the volumes of the brain, cerebrospinal fluid (CSF) and intracerebral blood is constant.

What are the two types of Primary Injuries for TBI?

Extracranial (contusions, lacerations, external hematomas, skull fractures), Intracranial (subdural hematomas, concussions, diffuse axonal injuries).

What are the Secondary Injuries for TBI?

Intracranial hemorrhage, Cerebral edema, Vasospasm, Seizure, Hyperemia, Intracranial hypertension.

What are some common manifestations of TBI?

Scalp wounds bleed heavily; Skull fractures have localized pain; Basilar skull fractures may present with CSF from nose/ears and Battle’s sign.

What are the three types of skull fractures?

Linear, Comminuted, Depressed.

What are the Mechanisms of injury for concussion?

Rapid acceleration-deceleration, Direct blow to head, Blast injury.

What are the presentation and imaging findings of chronic traumatic encephalopathy (CTE)?

Personality changes, memory impairment, and speech and gait disturbances and gross cerebral atrophy.

What may Post-Concussion Syndrome be related to?

Emotional distress, motivational issues, and cognitive factors.

What are some physical symptoms of Post Concussion Syndrome?

Headache, Nausea or vomiting, Balance problems, Dizziness, Fuzzy or blurry vision, Feeling tired, Sensitivity to noise or light.

What are some emotional/mood symptoms of Post Concussion Syndrome?

Irritability, Sadness, More emotional, Nervousness, or anxiety.

What is a contusion?

Bruising of brain tissue with associated hemorrhage & edema due to acceleration-deceleration or blunt trauma.

What are the three types of cerebral hematomas?

Epidural, Subdural, Intracerebral.

What is an epidural hematoma?

Blood accumulates between the skull and Dura Mater.

What is a subdural hematoma?

Damage to vein or network of veins called bridging veins (tiny veins between the surface of the brain and outer covering, the dura).

What are some symptoms of an Intracerebral Hematoma?

Headache, Confused Speech, Lethargy, Confusion, Difficulty with balance or walking, Nausea and vomiting, Numbness, Weakness, Seizures, Visual disturbances.

What is the treatment for Intracerebral Hemorrhage?

Supportive care, Control of ICP, Administration of fluids, electrolytes, and antihypertensive medications, Craniotomy or craniectomy.

What is an Intraventricular hemorrhage?

Bleeding into brain’s ventricular system, where CSF is produced.

What are the types of Diffuse Brain Injury?

Concussions and diffuse axonal injuries.

What are Diffuse Axonal Injuries caused by?

Tearing, shearing, strains and compression.

What are some signs and symptoms to be alert for when assessing a patient with a TBI?

Altered level of consciousness, Confusion, Pupillary abnormalities, Altered or absent gag reflex, Sudden onset of neurological deficits, Changes in vital signs, Vision or hearing impairment, Sensory dysfunction, Motor response, Headache, Seizures.

What are parts of the assessment for patients with TBI?

Health history, LOC (Glasgow Coma Scale), Frequent and ongoing neurologic assessment (GCS), Multisystem assessment.

What are the diagnostic tests for TBI?

X-rays of head and neck, CT without contrast, Magnetic resonance imaging (MRI), Angiography (CTA; MRA), PET Scan.

What are the three categories assessed in the Glasgow Coma Scale?

Best eye opening, Best verbal response, Best motor response.

What are the general management strategies for a patient with TBI?

Preserve brain homeostasis, Treat cerebral edema, maintain cerebral perfusion, Monitor and manage ICP, Maintain oxygenation, Manage fluid and electrolyte balance.

What Major TBI goals for patient outcomes

Maintenance of patent airway and adequate CPP, Fluid and electrolyte balance, Adequate nutritional status, Prevention of secondary injury, Maintenance of skin integrity, Prevention of sleep deprivation, Maintenance of normal temperature, Improvement of cognitive function, Effective family coping, Increased knowledge about rehabilitation process, Absence of complications.

What are the Nursing Interventions for TBI patients?

Control intracranial pressure, Support of cognitive function, Support of family, Provide and reinforce information, Measures to promote effective coping, Setting of realistic, well-defined short-term goals (SMART goals), Referral for counseling, Support groups, Patient and family teaching.

What symptoms constitutes Cushing's Triad?

Increased BP, Decreased Pulse, Decreased Respirations.

What medications are Osmotic Diuretics medication?

Mannitol, Isosorbide, and Glycerin.

When administering Mannitol for TBI, watch for what potential side effects?

Increased renal flow, fluid & electrolyte imbalance, headaches, edema, pulmonary & intracranial pressure.

What are the contraindications for Osmitrol (Mannitol)?

Severe renal disease, Dehydration, Intracranial bleeding, and Severe pulmonary edema.

What is the indication to give Mannitol?

Decreases cerebral edema resulting in increased ICP.

When administering Mannitol, what should the nurse assess for?

Begins 30-60 minutes after administration. Assess LOC every hour

What symptoms will the patient exhibit with Cushing’s triad?

Bradycardia, hypertension, and bradypnea

What are the nursing cares to control ICP?

Elevate head of bed 30 degrees, Maintain patient’s head in neutral alignment, Initiate measures to prevent Valsalva maneuver, Maintain O2 to keep SaO2 above 90%, Administer sedation.

What are the common cognitive impairments post-TBI?

Memory deficits, Decreased ability to focus and sustain attention to a task (distractibility), Impulsivity, Egocentricity, Slowness in thinking, perceiving, communicating, reading, and writing.

What are the side effects of performing the Valsalva Maneuver?

Increased thoracic pressure decreases output of heart and Increased pressure in head

What are main approaches with cognitive rehabilitation?

Remediation and Compensation

What are the long term effects on Cognition After TBI?

Attention and concentration, Processing and understanding information, Language and communication, Learning and remembering new information, Planning and organization problems, Reasoning, problem solving, judgment, Inappropriate, embarrassing or impulsive behavior.