UNIT # 11 Neurological
Assessment & Neuro
Trauma part I
Nurs 285
Carol Greulich
University of Saint Francis

Review Anatomy of the brain 

Function of the following
– Cerebrum
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Frontal Lobe

– Controls voluntary muscle movement, Broca’s motor speech area, Intellectual functions
(judgment, memory, problem solving, autonomic functions, cardiac and emotional responses

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Parietal lobe

– Coordinates and interprets sensory information from the opposite side of body

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Temporal lobe

– Center for taste, hearing, smell, and interpretation of spoken word

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Occipital lobe

– Interprets visual stimuli

Pathophys. Continued
– Cerebellum
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Coordinates voluntary muscle movement, controls posture, and maintain equilibrium

– Brainstem (provides 2 way connection between brain and spinal cord)
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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
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Dura mater
Arachnoid mater
Pia mater

Neurologic System:
History
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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
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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
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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
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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
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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
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Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

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Types of Head Injuries
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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
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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
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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)
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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
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Linear
Depressed Skull