NSB 236 WEEK 2 case study (Questions & Answers) Rated 100% Correct!!

A 42 year old patient with a severe acute traumatic brain injury has developed a fever. The nurse is aware that the fever should be reverse quickly for which reason? - It increases the brain's metabolic needs. A brief loss of consciousness followed by a periods of being alert and orientated and then a loss of consciousness again is a typical presentation for which condition? - Epidural haematoma A patient is admitted to the hospital with a cerebral contusion. During the night, he develops a headache, vomits and seems more lethargic. What are the appropriate actions for the nurse to take? - Notify the medical officer of these symptoms, perform a neurological and pupillary assessment. Shouldn't give pain and nausea medication to the patient. A patient with a recent traumatic brain injury is to receive mannitol 20% (IV) bolus doses of 0.5g/kg every 4-6 hours. This drug reduces ICP through what action? - - Pulls fluid out of the brain cell and into the blood. Accumulation of cerebrospinal fluid (CSF) results in what condition? Which problems can lead to secondary injury? - - Hydrocephalus - Inflammation of the cerebral tissue, hypoxia and ischemia, cerebral swelling. Autoregulation - Through a process known as autoregulation, the brain has the ability to regulate its own blood flow in response to its metabolic needs. Briefly discuss why constipation should be avoid in neuosurgical patients? - Valsalva manoeuvre can increase ICP. Increased intrathoracic pressure contributes to increased ICP by impeding the venous returnCerebral perfusion pressure Fomula - CPP=MAP-ICP Compliance - Compliance is the expandability of the brain. With low compliance, small changes in volume result in greater increases in pressure. Complications of increased ICP? - Main complication of increased ICP? - inadequate cerebral perfusion and cerebral herniation. - Changes in LOC, changes in vital signs, dilation of pupils, decline in motor function, headache and vomitting. Describe the modes of action of antibiotics that are used to treat bacterial infections? - Inhibition of cell wall peptidoglycan synthesis (e.g. penicillins) - Inhibition of nucleic acid synthesis (e.g. quinolones) - Inhibition of protein synthesis (e.g. aminoglycosides or tetracyclines) - Inhibition of metabolic activity (e.g. sulfamethoxazole) How the injuries can impact on neurological condition? - Brain injury will have an obvious impact on patient's neurological condition due directly to cerebral bleeding, raised intracranial pressure and infarct. Increased Intracranial Pressure? - ICP is a life-threatening situation that results from an increase in any or all the three components within the skull. Is the following statement true or false: The spinal cord has no direct blood supply and receives its nutrition from the cerebrospinal fluid (CSF)? - False. The spinal cord has no direct blood supply but derives its blood supply from the branches of the vertebral arteries and from various regions of the aorta.List one primary limitation of the Glasgow Coma Scale (GCS)? - - The scoring is based on best response. Monro-kellie hypothesis - If the volume of any one of the three components increases within the cranial vault and the volume form another component is displaced, the total intracranial volume -and, therefore, pressure will not change. Mr Lee is subject to a number of potential complications; outline what these may be? - Mr Lee is at high risk for complications related to systemic inflammatory response syndrome (SIRS) including bleeding, sepsis, and acute respiratory distress syndrome (ARDS) caused by the multiple trauma and shock state he has experienced, the extensive surgical procedures he has undergone, and the extensive number of invasive lines that have been inserted. Normal ICP range - 5 - 15 mmHg. Maintain below 20 mmHg** On admission to the Emergency Department, a patient who has altered level of consciousness after being struck on the head with a cricket bat has a variety of diagnostic tests ordered. Which test should be done first? - CT scan patient with a severe head injury has been maintained on IV fluids of 5% dextrose in water for 3 days. The nurse consults with the doctor about starting enteral feedings for the patient, based on the knowledge that? - Mal-nutrition promotes continued cerebral oedema. The patient with increased ICP is in a hypermetabolic and hypercatabolic state that increases the need for glucose as fuel for metabolism of the injured brain. If the patient cannot maintain an adequate oral intake, other means of meeting the nutritional requirements, such as enteral feedings or total parenteral nutrition, should be initiated. Early feeding after brain injury may improve outcomes.10 Nutritional replacement should begin within 3 days after injury to reach full nutritional replacement within 7 days after injury.Presence of dizziness, headache and confusion for long periods of time after a concussion is? - - Known as post-concussion syndrome The administration of narcotics (such as morphine) to a patient with a traumatic brain injury may have which effect? - - It may mask neurological changes in the patient. The goal of multidisciplinary care for ICP? - Maintenance of a patent airway. Drug therapy: Osmotic diuretics, corticosteroids, barbiturates Metabolic demands (fever pain), which contributes to increased ICP must be controlled.