INSTRUCTIONS Managing patients with severe traumatic brain injury
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Managing patients with severe traumatic brain injury
GENERAL PURPOSE: To provide an overview of TBI and its implications for patient care. LEARNING OBJECTIVES: After reading this article and taking the test, you should be able to: 1. Identify the causes of TBI. 2. Choose appropriate nursing interventions for patients with severe TBI.
- Which is an example of a diffuse brain injury?
- Which group has the highest rate of TBI hospitalization and death?
- children age 4 years and younger
- adults age ≥ 75
- women ages 30 to 40
- adults ages 20 to 24
- Which GCS score indicates moderate TBI?
- 3 to 5
- 6 to 8
- 9 to 12
- 13 to 15
- The mechanism of injury associated with coup-contracoup injuries is
- angular acceleration.
- Which statement about DAI is true?
- It's readily demonstrated on noncontrast CT scan.
- Severe DAI often occurs in the brain stem.
- DAI is a common secondary injury.
- DAI results from penetrating head injuries.
- What's the primary tenet of the Monro-Kellie hypothesis?
- The brain accounts for 60% of the skull's contents.
- Decreased ICP leads to neurologic deterioration.
- Cerebral edema causes brain herniation.
- A rigid container (the skull) can't expand.
- Which of the following is correct about secondary brain injury?
- It's associated with lower mortality than primary injury.
- It's often related to hypoxia and hypoperfusion.
- It can be prevented by keeping BP at hypotensive levels.
- It's more easily treated than primary injury.
- In the ED, care for a patient with severe TBI begins with
- transporting the patient to a trauma center.
- protecting the patient's airway and maintaining oxygenation.
- establishing peripheral venous access.
- initiating cardiac monitoring.
- Which statement about ICP monitoring in adults with TBI is accurate?
- The ICP target is often 30 mm Hg.
- Monitoring should be initiated in any patient with a GCS score < 12.
- The ICP target is < 20 mm Hg.
- Lab specimens should be collected after ICP catheter placement.
- Which statement is correct about CPP?
- It's an estimate of the adequacy of cerebral circulation.
- It's measured directly using a ventricular catheter.
- It's normally 50 mm Hg or less.
- It represents the volume of CSF.
- Which of the following raises ICP?
- avoiding extreme hip flexion
- maintaining the cervical spine in neutral position
- elevating the head of the bed
- lateral neck flexion
- Mannitol helps manage TBI by
- increasing brain volume.
- drawing water from the intravascular space to the brain parenchyma.
- decreasing cerebral edema.
- increasing ICP.
- Which of the following is correct about propofol?
- It prevents hypotension.
- It's a slow-acting analgesic.
- It permits intermittent neurologic assessment.
- It has a long half-life.
- Which medication is contraindicated in patients with an egg allergy?
- Which drug is a relatively selective alpha2-adrenergic agonist?
- The goal of decompressive craniectomy is to
- prevent brain herniation.
- reverse brain damage.
- prevent the brain from expanding.
- increase ICP.
- Which statement is true about postdecompressive craniectomy care?
- Cerebral blood flow isn't likely to change postoperatively.
- Advanced neuromonitoring devices are always placed intraoperatively.
- PaCO2 is maintained between 35 and 45 mm Hg.
- Therapeutic hypothermia is a standard of care.
- Which factor is associated with fewer infections and lower overall complications?
- decreased metabolic demands
- sympathetic storming
- early enteral feeding
- abnormal posturing