Professional Documents
Culture Documents
2.. Identify the subjective data collected from significant others while
gathering information for the nursing history.
4.. State the normal values and interpret findings with significant
deviation of laboratory and diagnostic results.
8.. Appreciate the role of the nurse in caring for patient with
Traumatic Brain Injury
THE HUMAN BRAIN
Brain
In humans, the brain consists of cerebrum (center for thought and memory
association); hypothalamus-thalamus (center for processing information),
cerebellum and brain stem (center for locomotion and coordination) and
the spinal cord, an extension of the brain consists of motor and sensory
nerves in the cervical, thoracic and lumber regions of the spine.
A. Embryological Development
• During the development stages, the brain starts out as a tube in most
mammals. The tube has three bulges or balloon-like structures at one end
of the third week of conception.
• The first part is prosencephalon (forebrain); mesencephalon (midbrain)
and rhobemencephalon (hindbrain).
• After 5wks, telencephalon and diencephalons form develop from the
forebrain (prosencephalon); the hind brain forms metencephalon
(afterbrain) and myelin-cephalon (form spinal cord).
• These structures form the brain and the other end forms the spinal cord.
• The cerebrum develop from telencephalon; diencephalons forms the
hypothalamus, thalamus and epithalamus.
• Mesencephalon, metencephalon and myelencephalon develop into
cerebellum and midbrain or brain stem (pons and medulla oblongata).
B. Characteristics of the CNS
The entire CNS is protected by a bony capsule – the cranium and the vertebral column
protects the spinal cord.
The cranium is covered with membrane called meninges of which there are three: dura
mater (out layer), arachnoid (middle) and pia mater (interior layer).
The surface of brain contains ridges called gyri (gyrus, singular) and are separated by
valleys called sulci and deeper valleys or grooves are called fissure.
There are five lobes: frontal, parietal, occipital, temporal and the insula lobe.
Two cerebral hemispheres exist which are mirrow images and are connected in the
middle by a bundle of nerves called corpus collasum.
1. Cerebrum
Cerebrum is the center for control, thought and associations.
Command center: It serves as the command center of the brain. All information from the
periphery nervous system (PNS), motor functions and sensory activities are received,
processed, analyzed and relayed or commands are issued for their respective
responses.
Other functions include development, vision, speech, memory, thought, and association.
The cerebrum is divided into left and right hemispheres and these hemispheres contain
fibers or tracts, which cross over each half of the hemispheres
The association of the tract with each half of the cerebral hemispheres is very important.
During an accident or removal of tumor, the tracts can be cut accidentally. When the
cut is not repairable, it may leave permanent damage that could lead to loss of
function or paralysis of the functions related to that area.
2. Thalamus and hypothalamus
The peripheral nervous system uses special senses to connect the body to the
outside environment.
Spinal cord relays sensory and motor signals to the brain.
The spinal cord is the center for many reflex actions. It also functions as a
center providing communication between the brain and the spinal nerves that
leave the spinal cord.
It contains unmyelinated cell bodies and short fibers that give the gray
appearance inside.
The outside of the spinal cord contains bundles of myelinated long fibers of
interneurons. These tracts give the bundles a white color outside.
FRONTAL LOBE
Located in front of the central sulcus.
Concerned with reasoning, planning, parts of speech and movement (motor
cortex), emotions, and problem-solving.
PARIETAL LOBE
Located behind the central sulcus.
Concerned with perception of stimuli related to touch, pressure, temperature
and pain.
TEMPORAL LOBE
Located below the lateral fissure.
Concerned with perception and recognition of auditory stimuli (hearing) and
memory (hippocampus).
OCCIPITAL LOBE
Located at the back of the brain, behind the parietal lobe and temporal lobe.
Concerned with many aspects of vision.
By direction
There are three types of directions of the neurons:
Sensory system by sensory neurons, which carry impulses from a receptor to the CNS
Efferent system by motor neurons, which carry impulses from the CNS to an effector
Relay system by relay neurons, which transmit impulses between the sensory and motor
neurons. However, there are relay neurons in the CNS as well.
The junction between two neurons is called a synapse. There is a very narrow gap
between the neurons - the synaptic cleft.
By function
By function, the peripheral nervous system is divided into the somatic nervous system and
the autonomic nervous system.
The somatic nervous system is responsible for coordinating the body's movements, and
also for receiving external stimuli. It is the system that regulates activities that are under
conscious control.
The autonomic nervous system is then split into the sympathetic division,
parasympathetic division, and enteric division. The sympathetic nervous system responds
to impending danger or stress, and is responsible for the increase of one's heartbeat and
blood pressure, among other physiological changes, along with the sense of excitement
one feels due to the increase of adrenaline in the system. The parasympathetic nervous
system, on the other hand, is evident when a person is resting and feels relaxed, and is
responsible for such things as the constriction of the pupil, the slowing of the heart, the
dilation of the blood vessels, and the stimulation of the digestive and genitourinary
systems. The role of the enteric nervous system is to manage every aspect of digestion,
from the esophagus to the stomach, small intestine and colon.
Name: Captain Hook
Age: 6 years old
Address: Canetown Subdivision Victorias, City Negros Occidental
Religion: Roman Catholic
Citizen: Filipino citizen
Birthday: August 27,2001
Fathers name: Peterpan
Mothers name: Tinkerbell
Chief Complaint: Vehicular Accident
Diagnosis:
1. Multi-system trauma with Brain Injury Acute Subdural
Hematoma right fronto temporo- parietal and multiple
hemorrhagic concussions severe diffuse cerebral edema;
diffuse subarachnoid hemorrhage.
2. Fracture midshaft right femur.
3. Multiple contusion/ abrasion in faces and extremities
4. Post craniotomy evacuation of subdural hematoma right
temporal.
>Post decompression craniotomy,
dural entry, evacuation of acute
subdural hematoma.
>Post application of long leg posterior
mold.
>Post IV cutdown at right arm.
>Post application of skeletal traction.
>Post suturing of 7cm lacerated
wound at right temporal area.
At 6 am, 2 hours prior to admission, patient was riding in a
vehicle (Toyota revo) driven by his father from Victorias going
to Bacolod to fetch his sister. He was sleeping at the back
passenger seat, with no seatbelt on, when another 4 wheeled
vehicle (land cruiser) hit them head on at EB Magalona.
Luckily, one of there neighbor was passing by on the time of
the accident and with the help of the bystander patient and his
father was rushed to the nearest Hospital (Teresita Lopez
Jalandoni Provincial Hospital).Patient was unconscious and
suffered bleeding and multiple abrasion, he was immediately
given first aid, was intubated and transferred to Dr. Pablo O.
Torre Memorial Hospital for further evaluation and
management together with his father.
Patient’s mother verbalized that patient was delivered
via caesarian section secondary to transverse.Mother
had gestational diabetes during pregnancy.Patient had
complete immunizations, no history of hospitalizations
and no known allergy.
X √
Diabetes mellitus
√ √
Hypertension
X √
Cancer
X X
Asthma
Captain Hook is a grade 1 student in Jack
and Jill Victorias He is the only boy and the
youngest among the 2 siblings. His father
and mother are businessmen. On the time of
the accident, his mother was in the USA for
some business matter. Tinkerbell verbalized
that her son is a normal active school grader
before the accident happen.
As a child , captain hooks usual activity is playing on their
school and at there house together with his neighbors. He and
his dad love to drive everywhere. They usually practice safety
measures such as wearing of seatbelts. But during the time of
the accident, his dad was the only one who was able to wear a
seatbelt because he was sleeping at the backseat of there car.
Eating/drinking √
Bathing √
Dressing/groo √
ming
toileting √
Bed Mobility √
StairClimbing √
Ambulating √
Normal appetite
No swallowing difficulty
Ate a well balance diet
Loves to eat chicken
Hypotonicity (flaccidity)
a.Pupillary reflexes – pupils round, unequal L- 2mm R-
4mm, reactive to light, don’t accommodate
pH 7.01 ( 7.35-7.45 )
PCO2 49.6 ( 35-45 mmHg )
PO2 362.1 ( 80- 100 mmHg )
HCO3 12.5 ( 22- 26 meq/L )
BE 18.5 ( ± 2 meq/L )
O2 sat 99.5 ( 97 % )
Multiple axial tomographic sections of the head were obtained without
intravenous contrast material due to craniocerebral trauma secondary to
vehicular accident.
CHEST BUCKY-negative for fracture or subluxation in the ribs and thoracic spine
No evidence of pneumothorax or pulmonary contusions.
Right thigh APL shows complete fracture with tiny comminuted in the
midshaft femur with overriding as the distal fragment slipped posterior.
Cervical spine APL shows no abnormal curvatures. Normal weight and contour
of the vertebral bodies and disc spaces
Pedicles and spinous processes are intact
Prevertal soft tissue thickness is with in normal