NU 170
FINAL EXAM STUDY GUIDE
Maternal-Child Nursing
Galen College of Nursing
,MANAGEMENT OF CLIENTS WITH COMPLEX NEUROLOGICAL PROBLEMS
Central Nervous System
- Brain and spinal cord
- Meninges (protective covering for brain and spinal cord)
o Dura matter (outside layer), arachnoid matter (middle layer), pia matter (inner
layer), epidural space (between skull and duramatter)
Brain
- 3 main areas
- Brainstem (basics, life sustaining)
- Cerebellum (coordination)
- Forebrain (includes relay station, memory, intelligence, creativity, emotions)
Cerebral Cortex
- Frontal lobe (front of head, controls voluntary movement, broca’s area for expressive,
voluntary eye movement, judgment, reasoning, concentration)
- Parietal lobe (understanding sensation, spatial relationships, perception of body parts,
taste)
- Temporal lobe (wernicke’s area for receptive, auditory center for sound interpretation,
complicated memory patterns)
- Occipital lobe (primary visual center)
Cerebellum
- Receives continuous information regarding the condition of muscles, joints, and tendons
- Control is ipsilateral (controls same side)
Head injuries
- Injury to the scalp, skull, or brain. Most common cause of death from trauma. Blunt or
penetrating.
- Highest at risk are male’s age 15-24 r/t playing sports, being more active/impulsive and
elderly r/t falls.
Pathophysiology of TBI
- Brain suffers traumatic injury brain swelling or bleeding increases intracranial volume
rigid cranium allows no room for expansion of contents so intracranial pressure
increases pressure on blood vessels within the brain causes blood flow to the brain to
slow cerebral hypoxia and ischemia occur intracranial pressure continues to rise,
brain may herniate cerebral blood flow ceases
o If ICP goes up pt is at risk for brain herniation and pt will die
, Anatomy of Head Injuries
- Scalp
o Significant bleeding; portal of infections (direct route to brain)
- Skull
o Protective, rigid, fixed space.
o Fractures at the base of the skull
Leaking CSF from nose, pharynx, or ears
• CSF if it tests + for glucose, will cause yellow halo on sheets
Battle signs: ecchymosis behind the ear
- Dura (protective covering)
- Brain (direct, primary; indirect, secondary)
Direct (Primary) Brain Injuries
- Primary injury: due to initial damage (contusions, lacerations, damage to blood vessels,
or foreign object penetration
- Direct damage done to brain (being stabbed in the head), irreversible
Indirect (Secondary) Brain Injury (Prevent, stop, slow down, or reverse)
- Secondary injury is damage that evolves after the initial injury (Expanding mass, lesions,
swelling, hydrocephalus (abnormal increase of CSF fluid) or bleeding.
- Increased ICP and/or herniation
- Diagnosis and treatments target minimizing the effects of the indirect injuries
Brain Injury
- Closed brain injury (blunt trauma): Acceleration/deceleration injury occurs when the
head accelerates then rapidly decelerates, damaging brain tissue. (Car accident)
- Open brain injury: Object penetrates brain or scalp and skull are opened from a
traumatic injury.
- Concussion (brain shakes): A temp loss of consciousness with no apparent structure
damage.
Manifestations of Brain Injury
- Altered LOC (Earliest indicator)
- Pupil abnormalities (Check pupils of TBI pts for size and reaction to light. Report any
changes to provider immediately because they could indicate an increased ICP)
- Sudden onset of neurological deficits and neurological changes; change in sense,
movement, and reflexes
o Flaccid limbs, drooping of face, cushing’s triad (severe HTN with widening pulse
pressure, the difference between diastolic and systolic 40 or greater is
widening pulse pressure. Look at trends can be moving towards cushing’s triad)
FINAL EXAM STUDY GUIDE
Maternal-Child Nursing
Galen College of Nursing
,MANAGEMENT OF CLIENTS WITH COMPLEX NEUROLOGICAL PROBLEMS
Central Nervous System
- Brain and spinal cord
- Meninges (protective covering for brain and spinal cord)
o Dura matter (outside layer), arachnoid matter (middle layer), pia matter (inner
layer), epidural space (between skull and duramatter)
Brain
- 3 main areas
- Brainstem (basics, life sustaining)
- Cerebellum (coordination)
- Forebrain (includes relay station, memory, intelligence, creativity, emotions)
Cerebral Cortex
- Frontal lobe (front of head, controls voluntary movement, broca’s area for expressive,
voluntary eye movement, judgment, reasoning, concentration)
- Parietal lobe (understanding sensation, spatial relationships, perception of body parts,
taste)
- Temporal lobe (wernicke’s area for receptive, auditory center for sound interpretation,
complicated memory patterns)
- Occipital lobe (primary visual center)
Cerebellum
- Receives continuous information regarding the condition of muscles, joints, and tendons
- Control is ipsilateral (controls same side)
Head injuries
- Injury to the scalp, skull, or brain. Most common cause of death from trauma. Blunt or
penetrating.
- Highest at risk are male’s age 15-24 r/t playing sports, being more active/impulsive and
elderly r/t falls.
Pathophysiology of TBI
- Brain suffers traumatic injury brain swelling or bleeding increases intracranial volume
rigid cranium allows no room for expansion of contents so intracranial pressure
increases pressure on blood vessels within the brain causes blood flow to the brain to
slow cerebral hypoxia and ischemia occur intracranial pressure continues to rise,
brain may herniate cerebral blood flow ceases
o If ICP goes up pt is at risk for brain herniation and pt will die
, Anatomy of Head Injuries
- Scalp
o Significant bleeding; portal of infections (direct route to brain)
- Skull
o Protective, rigid, fixed space.
o Fractures at the base of the skull
Leaking CSF from nose, pharynx, or ears
• CSF if it tests + for glucose, will cause yellow halo on sheets
Battle signs: ecchymosis behind the ear
- Dura (protective covering)
- Brain (direct, primary; indirect, secondary)
Direct (Primary) Brain Injuries
- Primary injury: due to initial damage (contusions, lacerations, damage to blood vessels,
or foreign object penetration
- Direct damage done to brain (being stabbed in the head), irreversible
Indirect (Secondary) Brain Injury (Prevent, stop, slow down, or reverse)
- Secondary injury is damage that evolves after the initial injury (Expanding mass, lesions,
swelling, hydrocephalus (abnormal increase of CSF fluid) or bleeding.
- Increased ICP and/or herniation
- Diagnosis and treatments target minimizing the effects of the indirect injuries
Brain Injury
- Closed brain injury (blunt trauma): Acceleration/deceleration injury occurs when the
head accelerates then rapidly decelerates, damaging brain tissue. (Car accident)
- Open brain injury: Object penetrates brain or scalp and skull are opened from a
traumatic injury.
- Concussion (brain shakes): A temp loss of consciousness with no apparent structure
damage.
Manifestations of Brain Injury
- Altered LOC (Earliest indicator)
- Pupil abnormalities (Check pupils of TBI pts for size and reaction to light. Report any
changes to provider immediately because they could indicate an increased ICP)
- Sudden onset of neurological deficits and neurological changes; change in sense,
movement, and reflexes
o Flaccid limbs, drooping of face, cushing’s triad (severe HTN with widening pulse
pressure, the difference between diastolic and systolic 40 or greater is
widening pulse pressure. Look at trends can be moving towards cushing’s triad)
