NRNP 6560 FINAL EXAM SOLVED QUESTIONS AND ANSWERS 2023.

NRNP 6560 FINAL EXAM SOLVED QUESTIONS AND ANSWERS 2023. NRNP Finals 6560 2023 1. coup-contrecoup injury: Dual impacting of the brain into the skull; coup injury occurs at the point of impact; contrecoup injury occurs on the opposite side of impact, as the brain rebounds. 2. Scalp laceration: what, effect, management: Primary head injury profuse bleeding - signs of hypovolemia Apply direct pressure Suture/ staple laceration Lidocaine 1% with epi to control bleeding, not close to nose/ ears 3. Skull fracture: types, effect, management: Primary head injury Simple: no displacement of bone. Observe and protect spine Depressed: bone fragment depressing thickness of scull Surgery for debridement. Give tetanus and seizure precautions Basilar: fracture at floor of skull Raccoon eye - periorbital bruising battle's sign: mastoid bruising otorrhea/ rhinorrhea - halo sign: do not obstruct flow Give Ab's Oral intubation and oral gastric instead of nasal 4. Brain injury: types, effect, management: Primary head injury Concussion: reversible change in brain functioning loss of consciousness, amnesia Do not give opioids, admit for unconsciousness greater than 2min Contusion: bruising to surface of brain with edema Frontal and temporal region Brainstem contusion: posturing, variable temp, variable vital signs N/V, dizziness, visual changes seizure precautions 5. Hematoma - neuro: types, effect, management: Epidural hematoma: commonly temporal/ parietal region with skull fracture, causing bleeding into epidural space Loss of consciousness Rapid deterioration: obtunded, contralateral hemiparesis, ipsilateral pupil dilation CT scan (non contrast) 1 / 57 NRNP Finals 6560 2023 Treatment based on Brain trauma foundation. Surgical if greater than 30cm Subdural hematoma most common type of intracranial bleed Acute (hours): drowsy, agitated, confused, headache, pupil dilation, CT scan (noncontrast) surgery for 10mm thickness or 5mm midline shift or for worsening GCS Chronic (days): headache, memory loss, incontinence CT scan (noncontrast) Surgery: burr holes/ crani 6. Cerebral edema/ ICP elevated/ herniation: symptoms, management: decreased level of consciousness Blown pupil Cushing triad: HTN (widening pulse pressure), decreased resp rate, bradycardia (means increased intracranial pressure) 7. Neuro exam components: AVPU: awake, response to verbal stimuli, painful stimuli, unresponsive GCS: 8 or below is comatose Posturing: decorticate = arms, legs in decerebrate = arms, legs out 8. Electrolyte imbalances in brain injury: Hyponatremia: SIADH and cerebral salt wasting Hypernatremia: DI (give mannitol) 9. Management of traumatic brain injury: - Consult neurosurgery - Limit secondary injury - Prevent hypotension (