Med Surg Nursing Neuro

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Ch. 56-61 (cont)

Head Injury
-trauma to head, including chg in LOC
-traumatic brain injury= incr potential for poor outcome
-immediately after, 2h after, 3 wk after, death common

-*abnormal motor reflex, alt eye mvmt, hypotension= hypoxia= decr O2 in brain, incr ICP greater than 20

GCS measures speech, eye, motor
-if greater than 8= 90% chance recov
-if less than 8= 30-70% chance recov

Scalp lac- most common type, profuse bld, complication is infx -skull fx- linear, depressed, simple, comminuted, compound, closed, open -velocity, what did head hit?

-*LOC of fracture alters manifestation
-basilar @ base of skull= Battles sign
*conjug deviation of gaze
*assess for bruising behind ear (Battles)
*rhinorrhea/otorrhea- CSF leak

Minor head trauma- concussion= brief LOC, amnesia, headache
-short duration

Post Concussive Syndrome- lasts 2w-2m
-persistent headache, lethargic, short attention span, long-term mental probs, change in intellect ability, behavioral changes

Diffuse Axonal Injury (DAI)
-widespread axonal damage following any traumatic brain injury -*decr LOC
-*incr ICP
-*decortic/decerebr
-*global cerebral edema

Major head trauma
-contusion- bruising of brain tissue w/in focal area of pia/arachnoid layers

Coup- Brain accelerates forward to skull- primary impact
Countrecoup- brain back to skull- second impact (decel)

Lacerations
-tearing of brain tissue
-depressed & open fx, penetr injuries

Intracerebral hemorrhage
**ABX ASAP!
**O2!

Epidural hematoma- blood b/w dura & inner surface of skull
-**neurologic emergency
Sx: period of LOC, lucid interval followed by decr in LOC, headache, N/V, focal findings

**if incr ICP, do NOT DO LP bc brain goes down (herniation) into SC

Subdural hematoma-blood b/w dura & arachnoid space
-acute 24-48 hr of injury
-sx similar to brain tissue compress in incr ICP
-drowsy/confused
-ipsilateral pupils dilate & fixed

Intracerebral hematoma- blood in brain tissue, front & temporal lobes
-size/location affect outcome

Chronic subdural hematoma- more common in older pt from normal brain atrophy

Best dx to determine cerebral trauma is CT
-MRI, PET, Doppler, C-spine x-ray

GCS categories!

Treatment
-get care ASAP
-prevent secondary injury
-timely dx
-surg if necessary

Assessment
-GCS
-Neuro status
-presence of CSF
-**maintain adequate cerebral profusion with O2!!**
-**elevated HOB, no straining, no incr metabolic rate, keep O2 on, keep pt calm

Tell pt of incr risk of seizures after head injury

Stroke
-give O2 ASAP
-CVA
-block in cerebral vessel= ischemia
-ischemic stroke or hemorrhagic stroke
-brain gets 20% of blood flow from cardiac
-ischemic/occlusive strokes= supply blocked by clot

Thrombotic stroke-stays in place
Embolitic stroke= comes from elsewhere to brain

-ischemic stroke caused by atheroscl -> plaque build-up
-hemorrh stroke-vessels in brain wk & bld, trauma
-can cause aneurysm-> abnormal ballooning of vessel

AV malformation- b/w arterial & venous system-> during embryonic developmt- wkns can cause hemorrh stroke.

-Cause by AV mal, aneurysm, incr BP

Modifiable risks- incr BP, smoking, obesity, heavy alcohol use, sedentary lifestyle, substance abuse (cocaine)

Nonmodifiable risks- being older, males, Afr Amer, family hx, sickle-cell anemia

What makes pt more prone to stroke?
-A-fib, previous MI, TIAs, previous heart surgery, diabetes, incr LDL (atheroscler), migraines (using vasoconstrictors), sudden stop of BP med, Afr Amer

-Assess LOC
-assess drug/alcohol use
-dominant hemisphere-> left
-alteration in ability to do math, analytical skills, aphasia, agraphia, alexia (these mean L side stroke)

Sx of R hemisp stroke- visual/spatial awareness, disoriented to time/place, poor impulse control, poor judgment, do not think they have a problem

Spasticity in strokes starts w/ hand contrax, elbow, foot drop -Do PT!
-OT- makes accom to...
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