TBI > complications, subdural/epidural hematomas, intracerebral/subarachnoid hemorrhages

with a focal injury will the sequelae stay focal as well

no

• brief disruption of LOC

• amnesia regarding the event/retrograde amensia

• HA

these are all S/S of a

typical concussion

if a patient comes in with a concussion and reports either no LOC or a LOC < ______ they will be sent home with instructions to report if anything changes or worsens

5 mins

with a diffuse axonal injury where the damage really occurring

the axons, white matter, brainstem, corpus callosum

with an epidural hematoma the bleeding occurs where

in between the skull and dura mater

an epidural hematoma is a

neurologic emergency

an epidural hematoma is usually associated with what kind of skull fx that crosses what; what does this cause

linear fx crossing major artery > tear

what artery is usually involved in the epidural hematoma

middle meningeal artery

epidural hematomas develop _______ because it involves an ______

rapidly;artery

• increased ICP

• initial period of unconscioousness > brief lucid interval > decreased LOC

• low GCS

• HA

• N/V

• cushing’s triad

• focal findings

these are all S/S of a patient with an

epidural hematoma

with an epidural hematoma how does the patient’s LOC change

initial period of unconscioousness > brief lucid interval > decreased LOC

what is immediate treatment is needed for an epidural hematoma so that the brain from herniating

surgery to evacuate hematoma

what develops quicker an epidural hematoma or a subdural hematoma

epidural

where does a subdural hematoma occur

between the dura mater and the arachnoid layer

subdural hematomas usually involve _____ which make it develop slower (on average)

veins

what are the three general patterns of subdural hematomas

acute, subacute, chronic

how soon does an acute subdural hematoma develop

24-48 hours after injury

• HA

• confusion/drowsy

• changes in level of consciousness

• weakness

• slurred speech

• seizures

• increasing ICP

these are all S/S of what

increased ICP/acute subdural hematoma

what is a common cause of acute subdural hematomas in the elderly

falls

since a subdural hematoma can occur so slowly it can have what kind of onset that can have S/S _____ to ______ later

insidious; days to weeks

because the subdural space is larger the main complaint is

focal symptoms

chronic alcoholics are prone to

cerebral atrophy

injury > subdural hematoma starts > S/S increase and worsen days to weeks later

subacute subdural hematoma

how long does a chronic subdural hematoma take to develop

weeks to months

chronic subdural hematomas are what kinds of bleeds

slow, gradual bleeds

when age range do chronic subdural bleeds start to peak

60s-70s

an intracerebral hemorrhage usually occurs in what lobes

frontal and temporal

what are 2 major factors of intracerebral hemorrhages that determine patient outcome

size and location

intracerebral hemorrhage occurs when there is bleeding in the

actual brain

with intracerebral hemorrhage the onset can be insidious, beginning with the development of

neurological deficits

what are 3 common causes of intracerebral hemorrhage

cerebral aneurysm, HTN, bullets

• supportive care

• control pain

• controlled ICP

• careful admin of fluids and electrolytes

• careful admin of anti-HTN meds

• surgical intervention > craniotomy/craniectomy

these are all part of the treatment plan for someone with a

intracerebral hemorrhage

with a subarachnoid hemorrhage the bleeding occurs where

between the arachnoid layer and the pia mater

what is the leading cause of a subarachnoid hemorrhage

AVMs

• subarachnoid trauma

• HTN

• congenital AVMs

• *leaking aneurysms in the Circle of Willis*

these are all causes of (bold means top 2)

subarachnoid hemorrhage

what is a major complication of subarachnoid hemorrhages

cerebral vasospasms

what is the leading cause of morbidity and mortality for those who survive the initial subarachnoid hemorrhage

cerebral vasospasm

when do cerebral vasospasms typically occur

3-14 days after hemorrhage

what is one of the most important nursing goals when caring for someone with a head injury is to

establish and maintain an airway

why is maintaining an airway for someone with a head injury so important (besides O2 and avoiding hypoxia)

CO2 can cause acidosis and increase ICP

CO2 can cause vaso______

dilation

why is positioning so important for someone with increased ICP

can increase/decrease ICP

what position helps decrease ICP

semi fowlers/at least 15-30 degrees

what does suctioning do to ICP

increase

abd pressure such as _______ and _______ increase ICP

coughing, straining

closely monitoring ABGs is important because they can

show increased ICP and detect adequate ventilation

what is the #1 indicator for LOC changes/complications

GCS

hyperthermia increases the metabolic demands of the

brain

a rapid increase in body temp is may indicate a

poor prognosis

if a persons temp goes above what temp we should be concerned about hyperthermia developing

100.4

what two things can indicate bleeding occuring somewhere else in the body

tachycardia and arterial hypotension

what is a hallmark sign of a CSF leak

halo sign

CSF leaking from the ear is called

otorrhea

if someone has otorrhea it can indicate what

a basilar skull fx

with a head injury we NEVER want to do what

pack/plug ear canal

packing or plugging the ear canal is contraindicated because it can directly cause what

infections/meningitis

if the patient is leaking CSF fluid from the ears or nose how do we want to collec this fluid

passively > put loose sterile pad beneath

what will prophylactically be given to make sure the ICP doesn’t increase

stool softeners

what will suspected CSF be tested for to confirm it is CSF

glucose

what should the nurse educate the patient to avoid if they have a head injury

blowing nose, coughing, ear drops

what is heavily contrainidcated in people who have basilar skull fx or head injuries

NG tube