NURS 233 (Med Surg III) EXAM 2 STUDY
GUIDE REVIEW RATED A HERZING
UNIVERSITY.
, NSG 233 MED-SURG III Review for Exam 2 Covers Modules 4, 5 and 6
Module 4- Nursing care of patients with Traumatic Neurological Disorders
Traumatic Brain injury (TBI)
• Result of external force on brain that interferes with daily life
• The gold standard diagnostic test is a head CT without contrast for any head injury
• Never perform a lumbar puncture if increased ICP is suspected, can cause
herniation.
• May be temporary or permanent
• Varying degrees of injury
• Prevention is key!
• Primary vs secondary injury
• PRIMARY: consequence of direct contact with head/brain during the instant of
initial injury
▪ ex: Contusions, lacerations, external hematomas, skull fractures, subdural
hematomas, concussion, diffuse axonal
• Secondary injury: damage evolves over ensuing days and hours after the initial
injury
▪ Caused by cerebral edema, ischemia, or chemical changes associated with
the trauma
• Interventions:
• Ensure Adequate Nutrition
• Monitor for Decreased Sodium Levels
• Administer Anticonvulsants
Types of Brain Injury:
• Closed brain injury (blunt trauma): acceleration/deceleration injury occurs when the
head accelerates and then rapidly decelerates, damaging brain tissue
• Open brain injury: object penetrates the brain, or trauma is so severe that the scalp and
skull are opened
• Concussion: a temporary loss of consciousness with no apparent structural damage
• Patient should be aroused and assessed frequently; however, they can be sent
home for family/friends to watch.
• Contusion: more severe injury with possible surface hemorrhage
• Symptoms and recovery depend on the amount of damage and associated
cerebral edema
• Longer periods of unconsciousness are associated with more symptoms of
neurologic deficits and changes in vital signs
• Monitor for worsening Neurological symptoms (educate loved ones to watch for the
follow too)
• Vomiting, confusion, seizures, worsening headache, irritability, slurred speech,
and weakness
• Diffuse Axonal Injury: Results from global shearing and rotational force
• Diffuse brain damage occurs in the axons
• Can result in prolonged traumatic coma= Poor prognosis
1
, NSG 233 MED-SURG III Review for Exam 2 Covers Modules 4, 5 and 6
Types of brain bleeds:
• Epidural Hematoma: Blood collection in
the space between the skull and the
dura
o Medical emergency- often
arterial bleed and require
prompt surgical intervention
(burr hole, craniotomy, EVD
placement)
o Patient presentation: Patient
may have a brief loss of
consciousness with return of
lucid/confused state; then as
hematoma expands, increased
ICP will oken suddenly reduce
LOC.
• Subdural Hematoma: Collection of
blood between the dura and the brain,
normally venous can be acute or
chronic.
o Acute: develops in 24-48h
(subacute 48h-2 weeks) with changes in LOC, pupillary response and possible
respiratory cardiac depression depending on location.
o Treatment: surgical craniotomy and medical management of ICP
o Chronic: most common in older populations due to atrophy of brain size hiding
formation of hematoma formation. Initial symptoms can be vague or mistaken as
aging or signs of dementia.
o Treatment: depending on size and symptoms. If neurological deficits are present,
then surgical evacuation will be done.
• Intracerebral hemorrhage: Hemorrhage occurs into the substance of the brain
o It can be caused by direct trauma or atraumatic origins such as HTN, vascular
anomalies, bleeding disorders or medications such as anticoagulants.
o S/S can be abrupt or slow onset, persistent severe headache, neurological and vison
deficits.
o Treatment: Administration of fluids, electrolytes, and antihypertensive medications
▪ Craniotomy or craniectomy to remove clot and control hemorrhage; this may
not be possible because of the location or lack of circumscribed area of
hemorrhage
Nursing management/assessment of TBI
• LOC with GCS
• Vital signs
• Ability to maintain airway
2
GUIDE REVIEW RATED A HERZING
UNIVERSITY.
, NSG 233 MED-SURG III Review for Exam 2 Covers Modules 4, 5 and 6
Module 4- Nursing care of patients with Traumatic Neurological Disorders
Traumatic Brain injury (TBI)
• Result of external force on brain that interferes with daily life
• The gold standard diagnostic test is a head CT without contrast for any head injury
• Never perform a lumbar puncture if increased ICP is suspected, can cause
herniation.
• May be temporary or permanent
• Varying degrees of injury
• Prevention is key!
• Primary vs secondary injury
• PRIMARY: consequence of direct contact with head/brain during the instant of
initial injury
▪ ex: Contusions, lacerations, external hematomas, skull fractures, subdural
hematomas, concussion, diffuse axonal
• Secondary injury: damage evolves over ensuing days and hours after the initial
injury
▪ Caused by cerebral edema, ischemia, or chemical changes associated with
the trauma
• Interventions:
• Ensure Adequate Nutrition
• Monitor for Decreased Sodium Levels
• Administer Anticonvulsants
Types of Brain Injury:
• Closed brain injury (blunt trauma): acceleration/deceleration injury occurs when the
head accelerates and then rapidly decelerates, damaging brain tissue
• Open brain injury: object penetrates the brain, or trauma is so severe that the scalp and
skull are opened
• Concussion: a temporary loss of consciousness with no apparent structural damage
• Patient should be aroused and assessed frequently; however, they can be sent
home for family/friends to watch.
• Contusion: more severe injury with possible surface hemorrhage
• Symptoms and recovery depend on the amount of damage and associated
cerebral edema
• Longer periods of unconsciousness are associated with more symptoms of
neurologic deficits and changes in vital signs
• Monitor for worsening Neurological symptoms (educate loved ones to watch for the
follow too)
• Vomiting, confusion, seizures, worsening headache, irritability, slurred speech,
and weakness
• Diffuse Axonal Injury: Results from global shearing and rotational force
• Diffuse brain damage occurs in the axons
• Can result in prolonged traumatic coma= Poor prognosis
1
, NSG 233 MED-SURG III Review for Exam 2 Covers Modules 4, 5 and 6
Types of brain bleeds:
• Epidural Hematoma: Blood collection in
the space between the skull and the
dura
o Medical emergency- often
arterial bleed and require
prompt surgical intervention
(burr hole, craniotomy, EVD
placement)
o Patient presentation: Patient
may have a brief loss of
consciousness with return of
lucid/confused state; then as
hematoma expands, increased
ICP will oken suddenly reduce
LOC.
• Subdural Hematoma: Collection of
blood between the dura and the brain,
normally venous can be acute or
chronic.
o Acute: develops in 24-48h
(subacute 48h-2 weeks) with changes in LOC, pupillary response and possible
respiratory cardiac depression depending on location.
o Treatment: surgical craniotomy and medical management of ICP
o Chronic: most common in older populations due to atrophy of brain size hiding
formation of hematoma formation. Initial symptoms can be vague or mistaken as
aging or signs of dementia.
o Treatment: depending on size and symptoms. If neurological deficits are present,
then surgical evacuation will be done.
• Intracerebral hemorrhage: Hemorrhage occurs into the substance of the brain
o It can be caused by direct trauma or atraumatic origins such as HTN, vascular
anomalies, bleeding disorders or medications such as anticoagulants.
o S/S can be abrupt or slow onset, persistent severe headache, neurological and vison
deficits.
o Treatment: Administration of fluids, electrolytes, and antihypertensive medications
▪ Craniotomy or craniectomy to remove clot and control hemorrhage; this may
not be possible because of the location or lack of circumscribed area of
hemorrhage
Nursing management/assessment of TBI
• LOC with GCS
• Vital signs
• Ability to maintain airway
2
