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Book Notes
A. Brain Trauma
b.
c. Complication: intracranial infection (meningitis), hematoma,
meningeal and brain tissue damage.
d. S&S:
i. Mild injury
1. Loss of consciousness for a few seconds to a few
minutes, no loss of consciousness (but is dazed and
confused), memory/ concentration problems,
headache, dizzy/ loss of balance, N/V, ringing in
ears, sensitive to light, mood change, depressed,
fatigue, difficulty sleeping, sleep more than usual
ii. Moderate injury
1. Loss of conscious for several hours, profound
confused, agitation/ combative, unable to awaken
from sleep, slurred speech, weak or numb
fingers/toes, persistent headache, repeated
vomiting, dilation of one or both pupils in eyes,
clear fluid draining from nose or ears
iii. Children
1. Change in eating/ nursing habit, persistent crying,
unusual irritability, change in ability to pay
attention, change in sleeping habits, sad/depressed
mood, loss of interest
e. Diagnostic:
i. GCS, CAT scan, MRI, SPECT scan, PET scan, Ranchos Los
Amigos scale, evaluation from physicians
f. Testing: determine whether the fluid leaking from nose or
ear.
ii.
iii.
iv.
v.
vi. Post
1.
2.
3.
4.
5.
surgical:
Flat or slight elevate (10-15o) for post op phase. 30o after
Avoid phenogran as anti-seizure medication
Monitor F&E, DI, and hypovolemic shock
Dressing will be wrapped around head
If craniectomy do not place pt on the side of operation
B. Encephalopathy
a. Definition:
i. Related more to an infection in which patient experiences alteration
in mental status
b. Cause:
i. It is multifactorial and includes infection, alcoholism, liver/kidney
problems, change in ICP, poor nutrition, anoxic injury, neurotoxic
effects of ammonia, metabolic diseases, brain tumors, abnormal
neurotransmission, certain medications
c. Grading scale (Table 44-11 pg. 1021)
d. Risks
i. Placement of transjugular intrahepatic portosystemic shunt (TIPS), GI
hemorrhage, constipation, hypokalemia, hypovolemia, infection,
cerebral depressant, metabolic alkalosis, paracentesis, dehydration,
increase metabolism, uremia
e. Manifestations
i. Could be sudden or slow changes
ii. Asterixis (flapping tremors), apraxia(inability to construct simple
figures w/ pen), fetor hepaticus (musty/sweet odor of patients
breath), Change in neuro and mental responsiveness, impaired
consciousness, inappropriate behavior, lethargy/ sleep disturbance,
nervousness, forgetful, disturbed sleep pattern.
iii. if caused by infection they will have fever, headache, Nausea,
seizures, abnormal cerebrospinal fluid
f. Diagnostic study
i. Mental status test, memory tests, coordination tests
g. Treatment
i. Treat precipitating causes.
C. Postpartum Psychosis
a. Definition:
i. Is very rare but is a psychiatric emergency. Is considered an overt
presentation of bipolar disorder after delivery
b. Etiology
i. Once a mother has had an episode of postpartum psychosis, she has
a 30-50% change of recurrence after the next birth.
c. S&S
i. Typically shows w/I 2 wks postpartum.
ii. Patient may have auditory or visual hallucinations, paranoid or
grandiose delusions, elements of delirium or disorientation, and
extreme deficit in judgment accompanied by high levels of
impulsivity that may increase risk of suicide of infanticide
iii. Typically begins with fatigue, insomnia, and restlessness. May have
episodes of tearfulness and emotional lability
iv. Complaints of inability to move, stand, or work
v. Later on may feel confused, incoherence, irrational statements, OCD
about baby
d. Treatment
i. Medications
1. Lithium, Antipsychotics, Mood stabilizers,
Benzodiazepines
2. Antidepressants
a. Should be used with caution due to risk of precipitating
rapid cycling
ii. ECT and Psychotherapy are other options
e. Interventions
i. Inform about the risks of breastfeeding and taking medications
ii. Safety risk for infant and mother!
iii. Outpatient follow-up care is critical and timely remission of symptoms
is important so mother can bond with infant
iv. Arrange for family, friend, and professional support os mother can
get sleep and recover