NRNP 6560 FINAL EXAM QUESTIONS AND 100% CORRECT ANSWERS
WALDEN UNIVERSITY
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.
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
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
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
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)
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
- Prevent Hypotension (Syst 90) And Hypoxemia (Pao2 60). May Give Blood To Improve Tissue
Perfusion.
- Treat Cerebral Edema: Elevate Bed, Sedate, Paralyse, Mannitol, Hyperventilation (Paco2 25-
30), During First 24hrs.
- Sedation And Analgesia: Opioids To Reduce Icp (Fentanyl) With Propofol. Could Give Nimbex
Or Vec. To Help Oxygenate/ Ventilate
- Steroids: Avoid
- Give 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
- For: 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 Initiating Treatment If Icp > 20 Mmhg. Can
Calculate Cpp (Cpp = Map - Icp). Should Be 60
Brain Death Criteria
- Must Have All:
No Spontaneous Movement
Absence Brain Stem Reflexes (Fixed/ Dilated Pupils, No Corneal Reflexes, Absent Doll's Eyes,
Absent Gag, Absent Vestibular Response)
Absence Breathing Drive/ Apnea
Can’t Be Declared Brain Dead When: Hypothermia, Drug Intoxication, Severe Electrolyte/ Acid-
Base Imbalance
Eeg, Cta Of Brain, Cerebral Angiography, Transcranial Doppler
Spinal Cord Trauma: Cause And Who
- Mva, Falls, Acts Of Violence, Sports, Wounds
- Rapid Acceleration/ Deceleration Causes Hyperextension (Fall, Rear-End Collision)(Central Cord
Syndrome), Hyperflexion (Bilateral Facet Dislocation), Vertical Column Loading (Compression
And Then Shattering From Falls/ Dive Lands On Butt, At C1 From Diving), Whiplash
- Distraction Injury: From Hanging
- Penetrating Trauma: From Wound
- Pathologic Fractures (Osteoporosis/ Cancer)
Mainly Cervical Spine. High Mortality.
More Common In Men
More Common In Young Than Old
Fractures And Vertebrae
- Cervical: C1-C7. Flexible And Small Diameter So Many
Fractures Thoracic (T1-T12): Connected To Ribs. Not Common In
Fractures Lumbar: L1-L5: Very Mobile, Requires Great Force To
Fracture
WALDEN UNIVERSITY
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.
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
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
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
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)
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
- Prevent Hypotension (Syst 90) And Hypoxemia (Pao2 60). May Give Blood To Improve Tissue
Perfusion.
- Treat Cerebral Edema: Elevate Bed, Sedate, Paralyse, Mannitol, Hyperventilation (Paco2 25-
30), During First 24hrs.
- Sedation And Analgesia: Opioids To Reduce Icp (Fentanyl) With Propofol. Could Give Nimbex
Or Vec. To Help Oxygenate/ Ventilate
- Steroids: Avoid
- Give 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
- For: 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 Initiating Treatment If Icp > 20 Mmhg. Can
Calculate Cpp (Cpp = Map - Icp). Should Be 60
Brain Death Criteria
- Must Have All:
No Spontaneous Movement
Absence Brain Stem Reflexes (Fixed/ Dilated Pupils, No Corneal Reflexes, Absent Doll's Eyes,
Absent Gag, Absent Vestibular Response)
Absence Breathing Drive/ Apnea
Can’t Be Declared Brain Dead When: Hypothermia, Drug Intoxication, Severe Electrolyte/ Acid-
Base Imbalance
Eeg, Cta Of Brain, Cerebral Angiography, Transcranial Doppler
Spinal Cord Trauma: Cause And Who
- Mva, Falls, Acts Of Violence, Sports, Wounds
- Rapid Acceleration/ Deceleration Causes Hyperextension (Fall, Rear-End Collision)(Central Cord
Syndrome), Hyperflexion (Bilateral Facet Dislocation), Vertical Column Loading (Compression
And Then Shattering From Falls/ Dive Lands On Butt, At C1 From Diving), Whiplash
- Distraction Injury: From Hanging
- Penetrating Trauma: From Wound
- Pathologic Fractures (Osteoporosis/ Cancer)
Mainly Cervical Spine. High Mortality.
More Common In Men
More Common In Young Than Old
Fractures And Vertebrae
- Cervical: C1-C7. Flexible And Small Diameter So Many
Fractures Thoracic (T1-T12): Connected To Ribs. Not Common In
Fractures Lumbar: L1-L5: Very Mobile, Requires Great Force To
Fracture
