Chapter 68 Management of Patients With Neurologic Trauma

The nurse is planning the care of a patient with a TBI in the neurosurgical ICU. In developing the plan of care, what interventions should be a priority? (Select all that apply.)

-Making nursing assessments -Setting priorities for nursing interventions -Anticipating needs and complications -Initiating rehabilitation

The five vertebrae most commonly involved in spinal cord injuries (SCIs) are the ________, ________, ________, ________, and ________.

5th cervical, 6th cervical, 7th cervical, 12th thoracic, 1st lumbar

For a patient with a SCI, why is it beneficial to give oxygen to maintain a high partial pressure of oxygen (PaO2)?

Because hypoxemia can create or worsen a neurologic deficit of the spinal cord

The nurse is caring for a patient in the emergency department with a diagnosed epidural hematoma. What procedure will the nurse prepare the patient for?

Burr holes

While riding a bicycle in a race, a patient fell into a ditch and sustained a head injury. Another cyclist found the patient lying unconscious in the ditch and called 911. What type of concussion does the patient most likely have?

Grade 3 concussion

When a patient sustains a head injury and is admitted to the hospital for observation, what will be monitored?

Monitoring includes observing the patient for a decrease in LOC, worsening headache, dizziness, seizures, abnormal pupil response, vomiting, irritability, slurred speech, and numbness or weakness in the arms or legs.

According to the ________, the cranial vault is a closed system, and if one of the three components increases in volume, at least one of the other two must decrease in volume, or the pressure will increase.

Monro-Kellie doctrine

A patient with a C7 spinal cord fracture informs the nurse, "My head is killing me!" The nurse assesses a blood pressure of 210/140 mm Hg, heart rate of 48, and observes diaphoresis on the face. What is the first action by the nurse?

Place the patient in a sitting position

What is the difference between primary and secondary brain injury?

Primary injury is the initial damage to the brain that results from the traumatic event. Secondary injury evolves over the ensuing hours and days after the initial injury and results from inadequate delivery of nutrients and oxygen to the cells.

The cranial vault contains three main components: ________,________, and ________.

brain, blood, cerebrospinal fluid

The three cardinal signs of brain death are ________, ________, and ________.

coma, absence of brain stem reflexes, apnea

The four signs of a rapidly expanding, acute subdural hematoma that would require immediate surgical intervention are ________, ________, ________, and ________.

coma, hypertension, bradycardia, bradypnea

A ________ after head injury is a temporary loss of neurologic function with no apparent structural damage.

concussion

The three criteria used to assess level of consciousness (LOC) using the Glasgow Coma Scale (GCS) are ________, ________, and ________.

eye opening, verbal responses, motor responses to verbal commands or painful stimuli

Name the four most common causes of traumatic brain injury (TBI).

falls (35.2%), motor vehicle crashes (17.3%), being struck by objects (16.5%), and assaults (10%).

The most serious brain injury that can develop within the cranial vault is a ________.

hematoma (either epidural, subdural, or intracerebral)

A patient sustains a grade 1 head injury. Describe the clinical manifestations that would be seen with this type of injury:

A grade 1 concussion has symptoms of transient confusion, no loss of consciousness, and duration of mental status abnormalities on examination that resolve in less than 15 minutes.

A patient sustained a head trauma in a diving accident and has a cerebral hemorrhage located within the brain. What type of hematoma is this classified as?

An intracerebral hematoma

The nurse in the emergency department is caring for a patient brought in by the rescue squad after falling from a second-storey window. The nurse assesses ecchymosis over the mastoid and clear fluid from the ears. What type of skull fracture is this indicative of?

Basilar skull fracture

A ________ is used to diagnose a skull fracture.

CT scan

A patient brought to the hospital after a skiing accident was unconscious for a brief period of time at the scene, then woke up disoriented and refused to go to the hospital for treatment. The patient became very agitated and restless, then quickly lost consciousness again. What type of TBI is suspected in this situation?

Epidural hematoma

A patient has developed autonomic dysreflexia and all measures to identify a trigger have been unsuccessful. What medication can the nurse provide as prescribed by the healthcare provider to decrease the blood pressure?

Hydralazine hydrochloride IV given slowly

Skull fractures are classified by type and location. Types include ________, ________, and ________ skull fractures, while location fractures include ________, ________, and ________ skull fractures.

linear, comminuted, depressed; frontal, temporal, basilar.

The nurse is planning to provide education about prevention in the community YMCA due to the increase in numbers of SCIs. What predominant risk factors does the nurse determine should be addressed? (Select all that apply.)

-Young age -Male gender -Substance abuse

While stopped at a stop sign, a patient's car was struck from behind by another vehicle. The patient sustained a cerebral contusion and was admitted to the hospital. During what time period after the injury will the effects of injury peak?

18 to 36 hours

A patient was body surfing in the ocean and sustained a cervical spinal cord fracture. A halo traction device was applied. How does the patient benefit from the application of the halo device?

It allows for stabilization of the cervical spine along with early ambulation

A patient comes to the emergency department with a large scalp laceration after being struck in the head with a glass bottle. After assessment of the patient, what does the nurse do before the healthcare provider sutures the wound?

Irrigates the wound to remove debris

A patient sustained a head injury and has been admitted to the neurosurgical intensive care unit (ICU). The patient began having seizures and was given a sedative-hypnotic medication that is ultra- short acting and can be titrated to patient response. What medication will the nurse be monitoring during this time?

Propofol

A patient has an S5 spinal fracture from a fall. What type of assistive device will this patient require?

The patient will be able to ambulate independently

Complications after traumatic head injuries can be classified according to ________, ________, and ________.

systemic infections, neurosurgical infections, heterotrophic ossification