NSG 430 TOPIC 9
1. Spinal cord compression is...?: an emergency!
2. What is the treatment for spinal cord tumor?: - emergency surgery
- surgery
- chemo/radiation
3. What is Guillain-Barre syndrome?: very rare autoimmune disease in which the peripheral
nerves become inflammed a few days or weeks after a viral or bacterialinfection
4. Clinical manifestations of Guillain-Barre syndrome?: acute, ascending, rapid- ly progressing
symmetric weakness of the limbs
5. What are complications of Guillain-Barre syndrome?: - respiratory failure #1
- paralytic ileus
- muscle atrophy
- VTE
- PIs
- orthostatic hypotension
- nutrition deficiency
6. Nursing management for Guillain-Barre syndrome?: - ventilator support
- immunomodulating treatments within 2 weeks (plasma exchange or IV im-munoglobulin)
- evaluate motor and sensory function and report changes
- monitor ABGs
- monitor cardiac and respiratory function
- vasopressors or volume expanders may be given to raise BP
- assess for gag reflex
- EN or PN for proper caloric intake
7. Scalp lacerations often bleed very much due to the number of blood vesselsthere. What are
some complications of a scalp laceration?: - blood loss
- infection
8. What are signs of a basilar skull fracture?: CSF or brain otorrhea, bulging of tympanic
membrane caused by blood or CSF, Battle sign, tinnitus or hearing difficulty, rhinorrhea, facial
paralysis, conjugate deviation of gaze, vertigo
9. What are the sings of a orbital fracture?: Periorbital bruising (raccoon eyes),optic nerve
injury
, 10. Emergency management of a head injury?: • If unresponsive, assess circu-lation, airway,
and breathing.
• If responsive, monitor airway, breathing, and circulation.
• Assume neck injury with head injury.
• Stabilize cervical spine.
• Apply O2 via nonrebreather mask.
• Establish IV access with 2 large-bore catheters to infuse normal saline or lactatedRinger
solution.
• Intubate if GCS score <8.
• Control external bleeding with sterile pressure dressing.
• Remove patient's clothing.
11. Ongoing management of a head injury?: • Maintain normothermia usingblankets, warm
IV fluids, as needed.
• Monitor vital signs, LOC, O2 saturation, cardiac rhythm, GCS score, pupil size andreactivity.
• Expect intubation if gag reflex is impaired or absent.
• Assess for rhinorrhea, otorrhea, scalp wounds.
• Give fluids cautiously to prevent fluid overload and increasing ICP.
12. Health promotion for preventing head injuries?: • Always wear car seat beltsin motor
vehicles.
• Do not drive after using drugs or alcohol.
• Do not text and drive or drive distracted.
• Wear helmets while bicycling, skating, skateboarding, skiing, and playing contactsports.
• Athletes should follow safe playing techniques and the rules of the game.
• Assess home safety and implement any corrective measures needed.
• Older adults should continue to exercise regularly to improve strength and balance.
• Follow workplace safety precautions, including wearing helmets and protectivegear.
13. Patient and caregiver teaching for head injury?: 1. Notify your HCP imme-diately if you
have signs and symptoms that may indicate complications. These include:
• Increased drowsiness (e.g., difficulty arousing, confusion)
• Nausea or vomiting
• Worsening headache or stiff neck
1. Spinal cord compression is...?: an emergency!
2. What is the treatment for spinal cord tumor?: - emergency surgery
- surgery
- chemo/radiation
3. What is Guillain-Barre syndrome?: very rare autoimmune disease in which the peripheral
nerves become inflammed a few days or weeks after a viral or bacterialinfection
4. Clinical manifestations of Guillain-Barre syndrome?: acute, ascending, rapid- ly progressing
symmetric weakness of the limbs
5. What are complications of Guillain-Barre syndrome?: - respiratory failure #1
- paralytic ileus
- muscle atrophy
- VTE
- PIs
- orthostatic hypotension
- nutrition deficiency
6. Nursing management for Guillain-Barre syndrome?: - ventilator support
- immunomodulating treatments within 2 weeks (plasma exchange or IV im-munoglobulin)
- evaluate motor and sensory function and report changes
- monitor ABGs
- monitor cardiac and respiratory function
- vasopressors or volume expanders may be given to raise BP
- assess for gag reflex
- EN or PN for proper caloric intake
7. Scalp lacerations often bleed very much due to the number of blood vesselsthere. What are
some complications of a scalp laceration?: - blood loss
- infection
8. What are signs of a basilar skull fracture?: CSF or brain otorrhea, bulging of tympanic
membrane caused by blood or CSF, Battle sign, tinnitus or hearing difficulty, rhinorrhea, facial
paralysis, conjugate deviation of gaze, vertigo
9. What are the sings of a orbital fracture?: Periorbital bruising (raccoon eyes),optic nerve
injury
, 10. Emergency management of a head injury?: • If unresponsive, assess circu-lation, airway,
and breathing.
• If responsive, monitor airway, breathing, and circulation.
• Assume neck injury with head injury.
• Stabilize cervical spine.
• Apply O2 via nonrebreather mask.
• Establish IV access with 2 large-bore catheters to infuse normal saline or lactatedRinger
solution.
• Intubate if GCS score <8.
• Control external bleeding with sterile pressure dressing.
• Remove patient's clothing.
11. Ongoing management of a head injury?: • Maintain normothermia usingblankets, warm
IV fluids, as needed.
• Monitor vital signs, LOC, O2 saturation, cardiac rhythm, GCS score, pupil size andreactivity.
• Expect intubation if gag reflex is impaired or absent.
• Assess for rhinorrhea, otorrhea, scalp wounds.
• Give fluids cautiously to prevent fluid overload and increasing ICP.
12. Health promotion for preventing head injuries?: • Always wear car seat beltsin motor
vehicles.
• Do not drive after using drugs or alcohol.
• Do not text and drive or drive distracted.
• Wear helmets while bicycling, skating, skateboarding, skiing, and playing contactsports.
• Athletes should follow safe playing techniques and the rules of the game.
• Assess home safety and implement any corrective measures needed.
• Older adults should continue to exercise regularly to improve strength and balance.
• Follow workplace safety precautions, including wearing helmets and protectivegear.
13. Patient and caregiver teaching for head injury?: 1. Notify your HCP imme-diately if you
have signs and symptoms that may indicate complications. These include:
• Increased drowsiness (e.g., difficulty arousing, confusion)
• Nausea or vomiting
• Worsening headache or stiff neck
