Nr 325 Final Study Guide Neurology(Graded A)

NR 325 FINAL STUDY GUIDE Neurology Skull Fractures- Linear- break in continuity of bone without alteration of relation of part. Caused by- low velocity injury Depressed- Inward indention of skull Caused by- powerful blow Simple- Linear or depressed skull fracture without fragmentation or communicating lacerations. Caused by- low to moderate impact Comminuted- Multiple linear fractures with fragmentation of bone into many pieces Caused by- direct, high momentum impact Compound- Depressed skull fracture and scalp laceration with communication pathway to intracranial cavity Caused by- Severe head injury Basilar Skull fracture- type of linear fracture. S/S: Can occur over several hours CSF, brain otorrhea, bulging or tympanic membrane caused by blood or CSF, Battle’s Sign (postauricular ecchymosis→ tear in dura and leakage of CSF), tinnitus or hearing difficulty, rhinorrhea, facial paralysis, conjugate deviation of gaze, vertigo. (Orogastric instead of NG tube should be used) Dx: CSF leak first, CT Scan. Tests to Determine CSF Leak: Destrosix, Test Tape Strip→ CSF will test positive for glucose. Complications: Epidural Hematoma- bleeding between dura and inner surface of skull Associated with: linear fracture crossing major artery in dura→ tear Venous: tear of the dural venous sinus and develop slowly. Arterial: middle meningeal artery under temporal bone is often torn S/S: Initial unconsciousness with brief lucidness followed by decrease in LOC, headache, nausea and vomiting. Tx: Rapid surgical intervention to evacuate hematoma and prevent herniation, manage ICP. Subdural Hematoma- bleeding between dura mater and arachnoid layer of meninges. Usually venous in origin. Slower to develop. Acute Subdural Hematoma- Manifests in 24-48 hours. S/S: Similar to those associated with tissue compression in increased ICP, decreased LOC, headache. Appearance: May range from drowsy, confused and unconscious. Ipsilateral pupil dilates and becomes fixed if ICP is significantly elevated. Progression: Immediate deterioration Complications: Blunt force injuries may cause underlying brain injury→ cerebral edema. Tx: Craniotomy, evacuation and decompression Subacute Subdural Hematoma- 48 hours- 2 weeks after severe trauma