Traumatic Brain Injury and Head Trauma, Exams of Nursing

Download Traumatic Brain Injury and Head Trauma and more Exams Nursing in PDF only on Docsity! Practice TNCC - 7th Ed. - Chapter 9 Test Exam 2023 The ___ provides a protective covering and absorbs some energy transferred during an injury event. Since it is highly vascular, lacerations or tears can result in profuse bleeding. - CORRECT ANSWER-Scalp What are the 6 cranial bones? - CORRECT ANSWER-Frontal Ethmoid Sphenoid Occipital Parietal Temporal The ___ is the thinnest skull bone. - CORRECT ANSWER-Temporal bone Lack of flexibility in the skull prevents ___ and the force is transmitted to the parenchyma and vascular structures of the brain, causing injury without skull fracture. - CORRECT ANSWER-absorption of energy List the 3 depressions formed at the base of the skull. - CORRECT ANSWER-Anterior Middle Posterior Fossae ___ is required to fracture the base of the skull. - CORRECT ANSWER-Significant Force List the meninges that PAD the brain and spinal cord. - CORRECT ANSWER-Pia Mater Arachnoid Membrane Dura Mater The ___ is the innermost meningeal layer. It firmly attaches to the brain and spinal cord. - CORRECT ANSWER-Pia Mater The ___ is thin and transparent. - CORRECT ANSWER-Arachnoid Membrane The ___ is the outermost layer, it is a tough, fibrous membrane that adheres to the internal surface of the skull. - CORRECT ANSWER-Dura Mater The ___ in the lateral and 3rd ventricles of the brain produces CSF that circulates around the brain beneath the arachnoid membrane and through the central canal of the spinal cord. - CORRECT ANSWER-Choroid Plexus What is the name for the space below the arachnoid membrane? - CORRECT ANSWER-Subarachnoid space ___, including the middle meningeal arteries, are located above the dura mater. - CORRECT ANSWER-Arteries ___ lie beneath the dura mater. - CORRECT ANSWER-Small bridging veins Subdural bleeding may be less evident in patients who have ___ or ___ associated with aging or diseases such as alcoholism. - CORRECT ANSWER-Atrophy Widening of the subdural space There are ___ Traumatic Brain Injuries annually. - CORRECT ANSWER-1.7 million Of the TBI's that occur annually, ___ of them came to the ER. - CORRECT ANSWER- 1.3 million ___% of TBI's are minor. - CORRECT ANSWER-75% ___% of TBIs are Moderate - CORRECT ANSWER-15% ___% of TBIs are major - CORRECT ANSWER-10% The ___ divides the cranial vault into two compartments. - CORRECT ANSWER- Tentorium The ___ contains the cerebral hemispheres in the anterior and middle fossae. - CORRECT ANSWER-Supratentorial compartment The ___ contains the lower parts of the brainstem (pons and medulla) and the cerebellum in the posterior fossa. - CORRECT ANSWER-Infratentorial The ___ and the ___ pass through a gap in the tentorium. - CORRECT ANSWER-upper part of the brainstem (midbrain) Cranial Nerve III (CN3) - Oculomotor nerve Which lobe is responsible for vision? - CORRECT ANSWER-Occipital Which lobe is responsible for speech, auditory and memory functions? - CORRECT ANSWER-Temporal Which lobe is responsible for sensory functions and spatial orientation? - CORRECT ANSWER-Parietal MVCs The most common MOI for blunt trauma is ___. - CORRECT ANSWER-Falls Brain injury is classified as ___. - CORRECT ANSWER-Primary or Secondary Injury ___ injuries result from a direct transfer of energy and include: skull and craniofacial fractures, intracranial lesions (contusions or mild TBI), lacerations, tearing, and shearing injuries and bleeding into the brain (epidural or subdural hemoatomas). - CORRECT ANSWER-Primary brain injuries ___ injuries are caused by complex physiological changes that include: - CORRECT ANSWER-Hypotension Hypoxemia Hypercarbia Cerebral Edema Increased ICP Decreased CPP Cerebral ischemia The goal of caring for a patient who has experienced head trauma is to ___. - CORRECT ANSWER-Prevent or limit secondary injury and the catastrophic cascade of events that result from those conditions, including death. ___ brain injury can't be prevented. - CORRECT ANSWER-Primary A single episode of ___ can be harmful to patient outcomes. - CORRECT ANSWER- Hypotension (SBP<90) CO2 causes ___ which can have a powerful but reversible effect on cerebral blood flow. - CORRECT ANSWER-Vasodilation ___ causes significant dilation of cerebral arterial vasculature and increased blood flow while ___ causes constriction and decreased blood flow. - CORRECT ANSWER- Hypercapnia Hypocapnia Hyperventilation reduces the PaCO2 causing cerebral vasoconstriction and hypoperfusion and may result in ___. - CORRECT ANSWER-Cerebral ischemia Hypercarbia promotes vasodilation and increases ___, so it is also to be avoided. - CORRECT ANSWER-ICP A brief period of hyperventilation may be indicated if the patient demonstrates signs of impending ___. - CORRECT ANSWER-Herniation Increased RR = ___. - CORRECT ANSWER-Decreased ICP Signs and symptoms of ___ may initially be obscured by the brain's ability to compensate by extracting more oxygen from the blood. - CORRECT ANSWER-Hypoxia Early changes in mental status may be ___. - CORRECT ANSWER-Vague As ICP rises, ___ decreases, resulting in cerebral ischemia, hypoxemia, and lethal secondary insult. - CORRECT ANSWER-CPP What are the early assessment findings of increased ICP? - CORRECT ANSWER- Headache Nausea/Vomiting Amnesia Behavior changes (impaired judgment, restlessness or drowsiness) ALOC What are the late assessment findings of increased ICP? - CORRECT ANSWER- Dilated, nonreactive pupils Unresponsive to verbal and painful stimuli Abnormal motor posturing Cushing's response Widening pulse pressure Reflex bradycardia Decreased respiratory effort Rigid C-collars may contribute to an increase in ___ as the collars can interfere with venous outflow and cause pain and discomfort to the patient. - CORRECT ANSWER- ICP If applying direct pressure to bleeding sites, avoid pressure in the area over a ___. - CORRECT ANSWER-Depressed skull fracture If possible, avoid ___. - CORRECT ANSWER-Hypotension ___ may be indicated to maintain CPP. - CORRECT ANSWER-Vasopressors The role of ___ in maintaining normovolemia and notmotension without infusing large volumes of fluid is controversial. - CORRECT ANSWER-Hypertonic saline (3%-5%) A ___ may indicate oculomotor nerve compression from increased ICP and herniation syndrome. - CORRECT ANSWER-Unilaterally fixed and dilated pupil Bilaterally fixed and pinpoint pupils may indicate in injury in the ___ or the effects of opioids. - CORRECT ANSWER-Pons A moderately dilated pupil with sluggish response may be an early sign of ___. - CORRECT ANSWER-Herniation Syndrome What is a FOUR score? - CORRECT ANSWER-Full Outline of UnResponsiveness The GCS measures: - CORRECT ANSWER-BEST eye opening BEST verbal response BEST motor response The ___component of GCS is the most sensitive subscore for identifying patients with severe brain injury. - CORRECT ANSWER-Motor The GCS becomes limited as a reliable tool when the patient is ___. - CORRECT ANSWER-Intubated The ___ provides greater neurologic detail than GCS. - CORRECT ANSWER-FOUR score What components make up the FOUR score? - CORRECT ANSWER-Eye response Motor response Brainstem reflexes Respiration Can a FOUR score be used to rate an intubated patient? - CORRECT ANSWER-Yes Describe the eye opening response in GCS. - CORRECT ANSWER-Spontaneous = 4 To Speech = 3 To Pain = 2 None = 1 Describe the Best Verbal Response in the GCS. - CORRECT ANSWER-Oriented = 5 Confused = 4 Inappropriate words = 3 Incomprehensible sounds = 2 None = 1 Describe the Best Motor Response in GCS. - CORRECT ANSWER-Obeys commands = 6 Localizes to pain = 5 Withdrawal (normal flexion) = 4 Abnormal flexion (decorticate) = 3 Extension (decerbrate) = 2 None = 1 Describe the EYE response in a FOUR score. - CORRECT ANSWER-Eyelids open or opened, tracking, or blinking to command = 4 Focal brain injuries include: - CORRECT ANSWER-Cerebral contusion, intracerebral hematoma, epidural hematoma, subdural hematoma and herniation syndromes A ___ is damaged brain tissue usually caused by blunt trauma. - CORRECT ANSWER- Cerebral contusion Most cerebral contusions are located in the ___ and ___ lobes, but they may also occur in tissue beneath a depressed skull fracture. - CORRECT ANSWER-Frontal Temporal The maximum effects of contusion and edema formation usually peak ___ after injury. - CORRECT ANSWER-18-36 hours Delayed hemorrhage or formation of intracranial hematomas may occur HOW LONG after injury? - CORRECT ANSWER-18-36 hours ___ occur deep within the brain tissue, and may be single or multiple and may be associated with brain contusions. - CORRECT ANSWER-Intracerebral hematomas What are the assessment findings associated with intracerebral hematomas? - CORRECT ANSWER-Progressive and often rapid decline in LOC Headache Signs of increased ICP Pupil abnormalities Contralateral hemiparesis, hemiplegia or abnormal motor posturing A ___ results from a collection of blood that forms between the dura mater and the skull. - CORRECT ANSWER-Epidural hematoma The epidural hematoma is 90% associated with fractures of the ___ or ___ skull that lacerate the meningeal artery. - CORRECT ANSWER-Temporal Parietal Since the source of epidural hematoma is ___, blood can accumulate rapidly, and the expanding hematoma may cause compression of underlying brain tissue, rapid rise in ICP, decreased CBF, and secondary brain injury. - CORRECT ANSWER-Arterial Significant epidural hematomas require ___. - CORRECT ANSWER-Immediate surgical intervention The most common causes of epidural hematoma are ___ & ___ but they can also be the result of sports-related injuries. - CORRECT ANSWER-Falls MVCs What are the assessment findings of epidural hematoma? - CORRECT ANSWER- Transient LOC followed by a lucid period lasting minutes to hours Headache and dizziness Nausea and vomiting Contralateral hemiparesis, hemiplegia, or abnormal motor posturing (flexion or extension) Ipsilateral unilateral fixed and dilated pupil Rapid deterioration in neuro status What is the most important symptom of the epidural hematoma? - CORRECT ANSWER-Ipsilateral unilateral fixed and dilated pupil!! ___ abnormal posturing is associated with brainstem herniation and poor outcomes. - CORRECT ANSWER-Extension A ___ results from a collection of blood formed immediately beneath the dura mater usually following acceleration, deceleration, or combination forces. - CORRECT ANSWER-Subdural hematoma A subdural hematoma consists of ___ blood. - CORRECT ANSWER-Venous Subdural hematomas may be ___ or ___. - CORRECT ANSWER-Acute Chronic Patients with acute subdural hematoma usually manifest signs and symptoms within ___ hours. - CORRECT ANSWER-72 hours The ___ is commonly the type of head injury sustained by athletes who suffer head trauma. - CORRECT ANSWER-Subdural hematoma What are the assessment findings for patients with subdural hematomas? - CORRECT ANSWER-Severe headache Changes in LOC Ipsilateral dilated or nonreactive pupil Contralateral hemiparesis ___ subdural hematomas are frequently associated with minor injury in older adults, patients taking anticoagulants and patients with chronic alcohol use. - CORRECT ANSWER-Chronic The assessment findings of a chronic subdural hematoma may not be found until ___. - CORRECT ANSWER-2 weeks What are the assessment findings of a chronic subdural hematoma? - CORRECT ANSWER-Altered or steady decline in LOC Headache Loss of memory or altered reasoning Motor deficit: contralateral hemiparesis, hemiplegia, or abnormal motor posturing or ataxia Aphasia Ipsilateral unilateral fixed and dilated pupil Incontinence Seizures ___ subdural hematomas occur between 72 hours and 2 weeks. - CORRECT ANSWER-Subacute Alcohol = ___ Older = ___. - CORRECT ANSWER-Brain atrophy ___ is a shifting of the brain tissue with displacement into another compartment as the result of bleeding or edema. - CORRECT ANSWER-Herniation ___ herniation is most common in trauma. - CORRECT ANSWER-Supratentorial What are the assessment findings of herniation syndrome? - CORRECT ANSWER- Asymmetric pupillary reactivity Unilateral or bilateral pupillary dilation Abnormal motor posturing Other evidence of neuro deterioration (loss of normal reflexes, paralysis or change in LOC) The 2 major types of surpatentorial herniation are named by the sites of herniation. - CORRECT ANSWER-Uncal and Central ___ is a transtentorial herniation where the cerebral hemispheres are pushed downward through the tentorial notch directly compressing the brainstem. - CORRECT ANSWER- Central of Transtentrorial Herniation ___ occurs when the uncus of the temporal lobe is displaced unilaterally over the tentorium into the posterior causing a shift of the mid-brain to the opposite side. - CORRECT ANSWER-Uncal Herniation ___ TBIs occur over a widespread area. They may not always be identifiable on a radiograph or CT because the damage involves contusions or shearing and stretching of the microvasculature, not a localized hematoma. - CORRECT ANSWER-Diffuse TBI ___ often follow a direct blow to the head and are often sports-related. They may also occur after a blow to the body. - CORRECT ANSWER-Diffuse TBI What are the symptoms of a diffuse TBI? - CORRECT ANSWER-Transient LOC Headache and dizziness Nausea and vomiting The presence of a large contusion, hemorrhage or hematoma, especially when both hemispheres are involved is associated with ___. - CORRECT ANSWER-Increased mortality The significance of a skull fracture is ___. - CORRECT ANSWER-The considerable force it takes to cause the injury A ___ is a non-displaced fracture of the cranium - CORRECT ANSWER-Linear Skull Fracture What are the assessment findings for a linear skull fracture? - CORRECT ANSWER- Headache Surrounding soft tissue injury Possible decreased LOC What are the interventions for a linear skull fracture? - CORRECT ANSWER-This is a mild injury, there are usually no interventions A ___ extends below the surface of the skull and may cause sura mater laceration and brain tissue injury. - CORRECT ANSWER-Depressed skull fracture What are the assessment findings of a depressed skull fracture? - CORRECT ANSWER-Headache Surrounding soft tissue injury Palpable depression of skull over fracture site Possible open fracture Possible decreased LOC What are the two major concerns with an open skull fracture? - CORRECT ANSWER- Bleeding Infection A depressed skull fracture includes a ___. - CORRECT ANSWER-Dura injury A ___ includes fracture of any of the five bones in the base of the skull. - CORRECT ANSWER-Basilar skull fracture A basilar skull fracture can result in ___ to the brain tissue or cranial nerves and CSF leakage. - CORRECT ANSWER-Puncture or laceration A basilar skull fracture may result in ___, placing the patient at risk for infections such as meningitis, encephalitis, or brain abscess. - CORRECT ANSWER-Laceration of the dura mater and open passage of CSF A basilar skull fracture usually occurs concurrently with ___. - CORRECT ANSWER- Facial fractures What are the assessment findings for a basilar skull fracture? - CORRECT ANSWER- Headache ALOC CSF rhinorrhea or otorrhea Periorbital ecchymoses (raccoon eyes) Mastoid ecchymoses (battle sign) Bleeding behind the tympanic membrane (hemotympanum) Facial nerve palsy (CN VII injury) A ___ is a transverse maxillary bone fracture that occurs above the level of the teeth and results in a separation of the teeth from the maxilla. - CORRECT ANSWER-Le Fort I What are the assessment findings of a Le Fort I fracture? - CORRECT ANSWER- Independent movement of the maxilla from the rest of the face Slight swelling of the maxillary area Lip laceration or fractured teeth Malocclusion A ___ is a pyramidal maxillary fracture involving the mid-face area. The apex of the fracture transverses the bridge of the nose. - CORRECT ANSWER-Le Fort II fracture What are the assessment findings of a Le Fort II fracture? - CORRECT ANSWER- Massive facial edema Nasal swelling with obvious fracture of the nasal bones Malocclusion CSF rhinorrhea A ___ is a complete craniofacial separation involving the maxilla, zygoma, orbits and bones of the cranial base. - CORRECT ANSWER-Le Fort III What are the two most important symptoms of a Le Fort II? - CORRECT ANSWER- Malocclusion CSF rhinorrhea What are the assessment findings of a Le Fort III fracture? - CORRECT ANSWER- Massive facial edema Mobility and depression of zygomatic bones Ecchymoses Diplopia Open bite or malocclusion What fracture is known as a "floating face" - CORRECT ANSWER-Le Fort III In the assessment of a Le Fort III fracture, the symptom of diplopia signifies ___. - CORRECT ANSWER-Optic nerve compression ___ occur to the horseshoe-shaped lower jawbone that attaches to the cranium at the TMJ. These can be open or closed, have multiple breaks in the same bone, or be impacted (one fragment pushed into another). - CORRECT ANSWER-Mandibular fractures What are the assessment findings for a mandibular fracture? - CORRECT ANSWER- Malocclusion Inability to open mouth Pain, especially on movement Facial asymmetry and a palpable step-off deformity Edema or hematoma formation of the fracture site Blood behind, or ruptured tympanic membrane Anesthesia of the lower lip What medications should be given to a patient with a Le Fort fracture? - CORRECT ANSWER-Manitol (introduces salt) Tetanus Anti-convulsants (prevent seizure) Nausea med (decrease risk of vomiting) What is the term for the inability to open the mouth? - CORRECT ANSWER-Trismus For a patient with brain, cranial or maxillofacial trauma, elevate the head of bed to ___ to decrease ICP. - CORRECT ANSWER-30 degrees The spine board may be tilted in reverse trendelenberg at ___. - CORRECT ANSWER- 30 degrees For a patient with brain, cranial or maxillofacial trauma, position the head ___ to facilitate venous drainage. - CORRECT ANSWER-Midline For a patient with brain, cranial or maxillofacial trauma, rotation of the head can compress the neck veins and result in ___. - CORRECT ANSWER-Venous engorgement and decreased venous drainage For a patient with brain, cranial or maxillofacial trauma, prepare for insertion of an ___. A brain tissue oxygenation monitoring device can be inserted at the same time. - CORRECT ANSWER-ICP monitoring device What are the indications for ICP monitoring? - CORRECT ANSWER-Severe TBI (GCS 3-8 with abnormal CT scan on admission ) Severe TBI (GCS 3-8 with NORMAL CT scan) and w or more of the following: Age older than 40