Assessment & Neuro
Trauma part I
Nurs 285
Carol Greulich
University of Saint Francis
Review Anatomy of the brain
Function of the following
– Cerebrum
Frontal Lobe
– Controls voluntary muscle movement, Broca’s motor speech area, Intellectual functions
(judgment, memory, problem solving, autonomic functions, cardiac and emotional responses
Parietal lobe
– Coordinates and interprets sensory information from the opposite side of body
Temporal lobe
– Center for taste, hearing, smell, and interpretation of spoken word
Occipital lobe
– Interprets visual stimuli
Pathophys. Continued
– Cerebellum
Coordinates voluntary muscle movement, controls posture, and maintain equilibrium
– Brainstem (provides 2 way connection between brain and spinal cord)
Midbrain: reflex center for CN 3 & 4
Pons: regulates respiration and CN 5-8
Medulla oblongata: influences cardiac, respiratory, and vasomotor functions. Center for vomiting, coughing, and hiccups
– Spinal cord: 2 way conduction between brain stem and peripheral nervous system
– Meninges
Dura mater
Arachnoid mater
Pia mater
Neurologic System:
History
Biographical and Demographic Data
Current Health
Past Health History
Family Health History
Psychosocial History
Physical exam
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Vital signs
Level of consciousness
Cranial nerves
Motor function
Sensory Function
Reflexes, Babinski’s
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Gerontology
Considerations
Loss of neurons causing enlargement of ventricles
Cerebral blood flow decreases
CSF production declines
Degenerative changes in myelin cause decrease in nerve conduction
Changes in neuromuscular activity resulting in increase chance of orthostatic hypotension
Decrease in memory, vision, hearing, smell, vibration and position sense
Diagnostic Test
Skull and Spinal X-Ray Studies
Computed Tomography
MRI & MRA
Positron Emission Tomography
Lumbar Puncture
Myelography
Cerebral Angiograph
Electroencephalogram (EEG)
Caloric Testing
Carotid Doppler
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Fig. 56-20
Fig. 56-22
Head Injury
Causes
– Motor vehicle accidents
– Falls
– Firearm-related injuries
– Assaults
– Sports-related injuries
– Recreational accidents
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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Types of Head Injuries
Minor head trauma
– Concussion
A sudden transient mechanical head injury with disruption of neural activity and a change in LOC
Brief disruption in LOC
Amnesia
Headache
Short duration
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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Types of Head Injuries
Minor head trauma (cont’d)
– Postconcussion syndrome
2 weeks to 2 months
Persistent headache
Lethargy
Personality and behavior changes
Shortened attention span, decreased shortterm memory
Changes in intellectual ability
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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Patient and Family teaching for head injury
Use the following guidelines for the first 3 days following head injury
– Notify health care provider of
Increased drowsiness
Nausea and vomiting
Worsening headache or stiff neck
Seizures
Vision difficulty
Behavior change
Motor problems
Sensory disturbances
Decreased heart rate
Head Injury
Types of Head Injuries
– Contusion
– Lacerations
– Diffuse axonal injury (DAI)
Focal Injuries
– Epidural Hematoma-blood between skull and dura mater
– Subdural Hematoma-blood between dura mater and pia-arachnoid mater in subdural
– Intracerebral Hematoma-blood in brain tissue Head Injury
Fig. 57-14. Coup-contrecoup injury. After the head strikes the wall, a coup injury occurs as the brain strikes the skull (primary impact). The contrecoup injury (the secondary impact) occurs when the brain strikes the skull surface opposite of the site from the original impact.
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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Skull Fractures
Linear
Depressed Skull