NRNP 6560 Final Exam Questions And 100%
Correct Answers
coup-contrecoup injury
The brain strikes twice in the skull, once at the point of injury; a second impact, or
contrecoup injury, occurs as the brain rebounds on the opposite side of the skull.
Scalp laceration: what, effect, management
Open head injury
excessive bleeding - hypovolemia signs and symptoms
Apply direct pressure to wound
Suture/staple laceration
Lidocaine 1% with epi to control bleeding
Skull fracture: types, effect, management
Open 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
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 > 2min
Contusion: bruising to surface of brain w/ edema
Frontal and temporal region
Brainstem contusion: posturing, variable temp, variable vital signs
N/V, dizzy, visual changes
seizure precautions
Hematoma - neuro: types, effect, management
Epidural hematoma: most commonly temporal/ parietal region w/ skull fracture, bleeding
into epidural space
Loss of consciousness
Rapid deterioration: obtunded, contralateral hemiparesis, ipsilateral pupil dilation
,CT scan (non contrast)
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
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)
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
Electrolyte imbalances in brain injury
Hyponatremia: SIADH and cerebral salt wasting
Hypernatremia: DI (give mannitol)
Management of traumatic brain injury
- Consult neurosurgery
- Limit secondary injury
- Avoid hypotension (syst 90) and hypoxemia (PaO2 60). Consider blood administration
to maintain tissue perfusion.
- Cerebral oedema: elevation of the bed, sedation, paralysis, mannitol, hyperventilation
(PaCO2 25-30), first 24 hrs
- Sedation and Analgesia: Opioids to prevent increase in ICP-Fentanyl, may be given
with Propofol. May give Nimbex or Vec. to aid oxygenation/ventilation
- Steroids: Avoid
- Mannitol or hypertonic saline for herniation: bolus then gtt. Monitor serum osmolality,
sodium and BP.
-Seizure precautions- give phenytoin or keppra
-DVT prophylaxis- stockings, LMWH
-head injury means spine injury until proven otherwise
-hypothermia: can control ICP (89 - 91F)
-decompressive crani: ICP refractory to tx
-brain O2 monitoring (jugular vein O2 sats)
ICP monitoring
Indications: GCS 3-8 with abnormal CT and comatose pt's with normal CT and older than
40, posturing, hypotension.
Normal value: 5-10 mmHg
Recommend starting treatment if ICP > 20 mmHG.
Correct Answers
coup-contrecoup injury
The brain strikes twice in the skull, once at the point of injury; a second impact, or
contrecoup injury, occurs as the brain rebounds on the opposite side of the skull.
Scalp laceration: what, effect, management
Open head injury
excessive bleeding - hypovolemia signs and symptoms
Apply direct pressure to wound
Suture/staple laceration
Lidocaine 1% with epi to control bleeding
Skull fracture: types, effect, management
Open 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
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 > 2min
Contusion: bruising to surface of brain w/ edema
Frontal and temporal region
Brainstem contusion: posturing, variable temp, variable vital signs
N/V, dizzy, visual changes
seizure precautions
Hematoma - neuro: types, effect, management
Epidural hematoma: most commonly temporal/ parietal region w/ skull fracture, bleeding
into epidural space
Loss of consciousness
Rapid deterioration: obtunded, contralateral hemiparesis, ipsilateral pupil dilation
,CT scan (non contrast)
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
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)
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
Electrolyte imbalances in brain injury
Hyponatremia: SIADH and cerebral salt wasting
Hypernatremia: DI (give mannitol)
Management of traumatic brain injury
- Consult neurosurgery
- Limit secondary injury
- Avoid hypotension (syst 90) and hypoxemia (PaO2 60). Consider blood administration
to maintain tissue perfusion.
- Cerebral oedema: elevation of the bed, sedation, paralysis, mannitol, hyperventilation
(PaCO2 25-30), first 24 hrs
- Sedation and Analgesia: Opioids to prevent increase in ICP-Fentanyl, may be given
with Propofol. May give Nimbex or Vec. to aid oxygenation/ventilation
- Steroids: Avoid
- Mannitol or hypertonic saline for herniation: bolus then gtt. Monitor serum osmolality,
sodium and BP.
-Seizure precautions- give phenytoin or keppra
-DVT prophylaxis- stockings, LMWH
-head injury means spine injury until proven otherwise
-hypothermia: can control ICP (89 - 91F)
-decompressive crani: ICP refractory to tx
-brain O2 monitoring (jugular vein O2 sats)
ICP monitoring
Indications: GCS 3-8 with abnormal CT and comatose pt's with normal CT and older than
40, posturing, hypotension.
Normal value: 5-10 mmHg
Recommend starting treatment if ICP > 20 mmHG.
