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NSG 3280
Alterations in Neurological Function
Unit 5
● Primary injury
○ Immediately at onset of brain injury
○ Irreversible damage
● Secondary injury
○ Development of further neuro damage subsequent to primary injury; may take days
to weeks to occur
○ Progressive with delayed cell death
● Mild TBI cannot b seen on MRI/CT
○ Need to use assessment skills and patient hx to diagnose
● Ischemia
○ Oxygenated blood is less than needed to meet metabolic needs of brain tissue
● Hypoxia
○ Deficiency of O2
● ICP
○ Increased cranial pressure
○ 0-15 is NORMAL
○ Montro kellie hypothesis
■ Relationship describing compensatory response to change in volume of any
of 3 compartments
○ Pathophysiology
■ Increase in cranium compartments
○ Etiology
■ Trauma, edema, hemorrhage, tumor, obstruction
○ Complications
■ Brain compression/herniation
● Herniation-protrusion of brain tissue through an opening in dura of
brain
○ Cushing’s triad
■ Bradycardia, and respirations changes(cheyne stokes irregular pattern), late
sign of injury to compensate; systolic hypertension
● Compartments
○ Volume 1700 cc in adults
○ Brain tissue
○ Cerebrospinal fluid
○ Blood
● LOC
○ Confused
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■
Unable to think clearly or engage effective problem solving; oriented x4,
aroused by verbal stimuli
○ Delirious
■ Restless and disoriented, may have hallucinations
○ Lethargic
○ Obtunded
○ Stuporous
■ In a deep state of sleep; vigorous stimulation is required to arouse, and a
wakeful state is not maintained
○ Comatose
● Cranial nerve reflexes
○ Pupil reflex
■ Indicator of increased ICP
■ CN II and III
■ Changes in pupil size, shape, and reactivity
■ Eye Movement controlled by CN III, IV, and VI
● Nystagmus, disconjugate movement, ocular palsy
■ Oculovestibular reflex
● Impaired implies brainstem dysfunction
○ Doll’s eyes test (MUST HAVE C SPINE XRAY BEFORE MOVING
NECK)
○ Cold calorics test (cold water poured into ear to open eyes)
●
● TBI
○ Injuries to brain tissue sustained due to trauma
○ Causes
■ Falls, sports, firearms, violence, car accidents
○ Characterized by
■ Severity
■ Location of injury
■ Mechanism of injury
○ GSC
○ Primary
■ Focal injuries localized at site of impact to skull
■ Polar injuries
● Coup contrecoup-also known as whiplash;consequence of brain
shifting within skull/meninges during acceleration/deceleration
movement
■ Diffused injuries
● When movement of brain within cranial cavity causes widespread
neuronal damage
■ Hematomas
● Blood formation of brain tissue/swelling
This study source was downloaded by 884789 from cliffsnotes.com on 04-04-2025 16:31:41 GMT -05:00
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https://www.cliffsnotes.com//study-notes/16877666 https://www.stuvia.com/user/allatopnotch https://www.stuvia.com/user/allatopnotch
NSG 3280
Alterations in Neurological Function
Unit 5
● Primary injury
○ Immediately at onset of brain injury
○ Irreversible damage
● Secondary injury
○ Development of further neuro damage subsequent to primary injury; may take days
to weeks to occur
○ Progressive with delayed cell death
● Mild TBI cannot b seen on MRI/CT
○ Need to use assessment skills and patient hx to diagnose
● Ischemia
○ Oxygenated blood is less than needed to meet metabolic needs of brain tissue
● Hypoxia
○ Deficiency of O2
● ICP
○ Increased cranial pressure
○ 0-15 is NORMAL
○ Montro kellie hypothesis
■ Relationship describing compensatory response to change in volume of any
of 3 compartments
○ Pathophysiology
■ Increase in cranium compartments
○ Etiology
■ Trauma, edema, hemorrhage, tumor, obstruction
○ Complications
■ Brain compression/herniation
● Herniation-protrusion of brain tissue through an opening in dura of
brain
○ Cushing’s triad
■ Bradycardia, and respirations changes(cheyne stokes irregular pattern), late
sign of injury to compensate; systolic hypertension
● Compartments
○ Volume 1700 cc in adults
○ Brain tissue
○ Cerebrospinal fluid
○ Blood
● LOC
○ Confused
This study source was downloaded by 884789 from cliffsnotes.com on 04-04-2025 16:31:41 GMT -05:00
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, https://www.stuvia.com/user/allatopnotch https://www.stuvia.com/user/allatopnotch https://www.stuvia.com/user/allatopnotch
■
Unable to think clearly or engage effective problem solving; oriented x4,
aroused by verbal stimuli
○ Delirious
■ Restless and disoriented, may have hallucinations
○ Lethargic
○ Obtunded
○ Stuporous
■ In a deep state of sleep; vigorous stimulation is required to arouse, and a
wakeful state is not maintained
○ Comatose
● Cranial nerve reflexes
○ Pupil reflex
■ Indicator of increased ICP
■ CN II and III
■ Changes in pupil size, shape, and reactivity
■ Eye Movement controlled by CN III, IV, and VI
● Nystagmus, disconjugate movement, ocular palsy
■ Oculovestibular reflex
● Impaired implies brainstem dysfunction
○ Doll’s eyes test (MUST HAVE C SPINE XRAY BEFORE MOVING
NECK)
○ Cold calorics test (cold water poured into ear to open eyes)
●
● TBI
○ Injuries to brain tissue sustained due to trauma
○ Causes
■ Falls, sports, firearms, violence, car accidents
○ Characterized by
■ Severity
■ Location of injury
■ Mechanism of injury
○ GSC
○ Primary
■ Focal injuries localized at site of impact to skull
■ Polar injuries
● Coup contrecoup-also known as whiplash;consequence of brain
shifting within skull/meninges during acceleration/deceleration
movement
■ Diffused injuries
● When movement of brain within cranial cavity causes widespread
neuronal damage
■ Hematomas
● Blood formation of brain tissue/swelling
This study source was downloaded by 884789 from cliffsnotes.com on 04-04-2025 16:31:41 GMT -05:00
https://www.stuvia.com/user/allatopnotch
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