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Chronic subdural hematoma

A common complexity

doi: 10.1097/01.NURSE.0000533605.15088.e6
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INSTRUCTIONS Chronic subdural hematoma: A common complexity

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PROVIDER ACCREDITATION

Lippincott Professional Development will award 1.0 contact hour for this continuing nursing education activity.

Lippincott Professional Development is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Lippincott Professional Development is also an approved provider of continuing nursing education by the District of Columbia, Georgia, and Florida CE Broker #50-1223. This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 1.0 contact hour.

Chronic subdural hematoma: A common complexity

GENERAL PURPOSE: To provide information about cSDH in adults. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing-education activity, you should be able to: 1. Outline the risk factors for cSDH. 2. Identify nursing interventions for patients with cSDH.

  1. Which statement about cSDH in adults is true?
    1. It usually has a very good prognosis.
    2. It can occur spontaneously.
    3. It typically develops within 24 hours of the inciting event.
  2. The incidence of SDH
    1. is highest in young adults.
    2. declines in people over age 80.
    3. almost doubles from ages 65 to 75.
  3. By 2030, cSDH in the United States is projected to
    1. affect 15% of the population over age 65.
    2. affect more older women than men.
    3. become the most common neurosurgical condition.
  4. Which statement about cSDH is correct?
    1. About 83% of patients have a history of minor head trauma.
    2. It's frequently caused by a fall.
    3. It's unrelated to brain pathology.
  5. Most patients with cSDH
    1. may have an intrinsic susceptibility to developing SDH.
    2. experienced head trauma with loss of consciousness.
    3. can identify a specific recent head trauma.
  6. Which statement about nontraumatic cSDH is correct?
    1. Compared with traumatic cSDH, it's less likely to result in death.
    2. Seventy-five percent of patients are taking anticoagulant or antiplatelet therapy.
    3. Patients on oral anticoagulant therapy have a twofold increased risk for cSDH.
  7. Which of the following is a risk factor for additional intracerebral hemorrhage?
    1. undiagnosed atrial fibrillation
    2. anticoagulation
    3. loss of consciousness
  8. The initial diagnostic imaging study for cSDH is
    1. MRI.
    2. contrast CT.
    3. noncontrast CT.
  9. The vascular membrane encapsulating a cSDH
    1. contains friable vessels that may bleed.
    2. prevents the cSDH from expanding further.
    3. causes rapid arterial bleeding.
  10. Which initial intervention is crucial to preventing SDH expansion?
    1. collaboration between neurologists and neurosurgeons
    2. monitoring ICP
    3. normalizing coagulation status
  11. For patients taking NOACs,
    1. reversal isn't necessary before emergency surgery.
    2. nonemergency surgery should be delayed until 24 hours after the last dose.
    3. anticoagulant reversal therapy includes dabigatran.
  12. What preoperative intervention is recommended for symptomatic patients taking clopidogrel?
    1. idarucizumab administration
    2. platelet transfusion
    3. delaying surgery for 48 hours
  13. Which statement is accurate regarding surgical treatment for patients with cSDH?
    1. Only radiologic imaging can determine the need for evacuation.
    2. Most cSDHs are naturally reabsorbed without surgical intervention.
    3. All symptomatic patients should be considered potential surgical candidates.
  14. Which surgical technique is preferred for an older adult with multiple comorbidities?
    1. twist drill craniostomy
    2. burr hole craniostomy
    3. open craniotomy
  15. Which statement about SDH recurrence is correct?
    1. It usually occurs within the first year after the primary event.
    2. Risk decreases with exposure to statins.
    3. Recurrence rates are greater than 50%.
  16. Medical management of cSDH
    1. is driven by evidence-based guidelines.
    2. may be complicated by cerebral edema.
    3. usually results in worsening cSDH within 90 days.
  17. Compared with traumatic cSDH, the risk of poor outcomes such as readmission for nontraumatic cSDH is
    1. lower.
    2. equal.
    3. higher.
  18. Which I.V. fluids are administered to support cerebral perfusion in patients with cSDH?
    1. hypertonic
    2. isotonic
    3. hypotonic
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