ANEURYSM  CT angiogram (CTA): can show the size,

location, and shape of an unruptured or ruptured

Brain Aneurysm - A brain (cerebral) aneurysm is a aneurysm.
bulge in a weak area of a blood vessel in or around your  MRI (magnetic resonance imaging) scan: to see
brain. images of the brain’s arteries and can show the
Cause of Brain Aneurysm size, location, and shape of an aneurysm.
 Cerebral angiography: This is a procedure in
 abnormality (birth defect) in an artery wall. (thin which a neurosurgeon or an interventional
wall of the blood vessel) neuroradiologist inserts a catheter into a blood
 Smoking. vessel in the groin or wrist and threads it to the
 High blood pressure. brain to take more accurate images of the
 Substance use, particularly cocaine. arteries in the neck and brain. This imaging test
 Excessive alcohol use. can find blockages in arteries in your brain or
neck.
Brain Aneurysm - Most aneurysms are small and don’t  Cerebrospinal fluid (CSF) analysis: This test
cause issues. But a ruptured brain aneurysm is life- measures the substances in the fluid that
threatening. surrounds and protects the brain and spinal cord
- The first sign of a ruptured brain aneurysm is (cerebrospinal fluid). CSF sample is collected by
usually a severe headache — the worst headache. Seek performing a spinal tap (lumbar puncture). The
medical care immediately if you have symptoms of a analysis can detect bleeding around your brain.
brain aneurysm rupture.
Symptoms of an unruptured brain aneurysm NURSING MANAGEMENT
 Most unruptured (intact) brain aneurysms don’t 1. Assess for signs of aneurysm
cause symptoms. 2. Immediate referral
 If they become large enough, the bulge in the 3. Follow up diagnostic tests
artery can put pressure on nearby nerves or 4. Implement aneurysm precautions:
brain tissue, causing symptoms a. (immediate and absolute bed rest in a
 Headaches. quiet,
 Vision changes. b. no stressful setting;
 Enlarged (dilated) pupil. c. restrict visitors, except for family).
 Numbness or tingling on your head or face. d. Elevate the head of the bed 15 to 30
 Pain above and behind your eye. degrees or as ordered
 Seizures. 5. pre-op care for possible surgeries: coiling or
 Thunderclap headache (sudden onset and clipping to repair the ruptured brain aneurysm.
severe, often described as “the worst headache
of my life”). Health Education for the high risk:
 Nausea and vomiting.
 Stiff neck.  Don't smoke cigarettes. ...
 Blurred or double vision.  Control the blood pressure
 Sensitivity to light (photophobia).  Eat a healthy diet and exercise
 Drooping eyelid and a dilated pupil.  Don't use drugs (such as cocaine,
 Pain above and behind your eye. methamphetamine, or others)
 Confusion.
 Weakness and/or numbness.
 Loss of consciousness. HEAD INJURY

cause of brain aneurysm rupture  Head Injury is a broad classification that include
injury to the:
 Ongoing stress or a sudden burst of anger or a. scalp
other strong emotion. b. skull
 Working hard (straining) to lift, carry or push c. brain
something heavy like weights or furniture.  Is the common cause of death from
 Known high blood pressure that isn’t properly trauma
treated with medications.  Trauma involving the CNS is life-
threatening or may result in major
Factors that determine whether an aneurysm is likely to physical and psychological dysfunction,
burst and can alter the life completely
 Size and shape: Smaller aneurysms may be - A head injury is any trauma to the scalp, skull, or
less likely to bleed than larger, irregularlyshaped brain.
ones. - The injury may be a minor bump on the skull or
 Growth: If an aneurysm has grown over time, it a serious brain injury
may be more likely to rupture. Assessment
 Location: Aneurysms on the posterior
communicating arteries (a pair of arteries in the 1. Signs and symptoms of increased ICP
back of your brain) and the anterior
communicating artery (an artery in the front of a. Headache
your brain) have a higher risk of rupturing than b. Blurred vision
brain aneurysms in other locations. c. Confusion
 Race: People of Japanese or Finish heritage d. High blood pressure
have higher risk of aneurysm rupture. e. Shallow breathing
 Older age: People older than 70 are at higher f. Vomiting
risk of aneurysm rupture. g. Changes in your behavior
h. Trouble speaking and moving
DIAGNOSTIC TESTS i. Drowsiness

 CT (computed tomography) scan or CT 2. CSF leakage from ears and nose

Angiogram: to determine the leaked blood leak 3. Battle’s sign (hematoma at the mastoid process) in
into the brain. basilar head trauma (break in the bone at the base of the
skull)
Causes of Head Injury
 Motor vehicle accidents
 Falls
 Assaults
 Sports-related injuries
 Firearm-related injuries
 Act of violence
Types of Head Injury
1. Concussion - Jarring of the brain and its sudden,
forceful contact with the rigid skull
- There is a transient period of consciousness
(lasting only for a short time)
 Typical signs of Concussion Clinical Manifestations
 Brief disruption of LOC
 altered level of consciousness
 Can last from a few over 3 minutes or
 confusion
less than 5 minutes
 pupillary abnormalities (change in shape, size,
 headache
and response to light)
 retrograde amnesia
 sudden onset of neurologic deficits
- Retrograde amnesia is when you
 changes in vital signs
can’t recall memories from your past.
- altered respiratory pattern
- Anterograde amnesia is when you
- hypertension
can’t form new memories but can
- bradycardia or tachycardia
still remember things from before you
- hypothermia or hyperthermia
developed this amnesia or
* refers to an impaired capacity for Complications
new learning.
2. Contusion (bruising) - A structural alteration 1. Extra – axial hemorrhage
characterized by extravasation of blood cells *Epidural
(The leakage of blood, lymph, or other fluid, from *Subdural
a blood vessel or tube into the tissue) - acute
- usually associated with a closed head injury - sub-acute
- occur both at the site of the direct impact of the - chronic
brain on the skull (coup) and at a secondary 2. Intra axial hemorrhage
area damage on opposite side away from injury * Intra – karenchymal
(contrecoup) leading to multiple contusion areas * Intra – ventricular
3. Laceration - Tearing of tissues caused by sharp
fragment or object or a shearing force
Complication – hemorrhage which may cause: 1. Intracranial Hemorrhage
a. Epidural hematoma (space between the  epidural hematoma (EDH) is a collection
outer layer of the dura mater and the of blood that forms between your skull
inner table of the skull) and the dura mater, the outermost
b. Subdural hematoma (bleeding fills the protective membrane covering your
brain area very rapidly, compressing brain.
brain tissue. This often results in brain  typically occur when a skull fracture
injury and may lead to death tears an underlying blood vessel.
c. Intracerebral or subarachnoid
hemorrhage complications
4. Compression of the brain - Results from
depressed fracture causing edema and  bleeding inside the head.
hemorrhage  It happens when blood collects under the dura
mater, one of the layers of tissue that protect
your brain.
Anatomy and Physiology of the Skull  It most often happens from a head injury and
can be fatal.
 Cranial Bones
frontal occipital
temporal sphenoid 2. Intra axial hemorrahge
parietal ethmoid  Intraparenchymal hemorrhage
 layers of Skull  ICH occurs as a result of the rupture of a blood
dura mater – outer layer vessel in the brain; usually small penetrating
arachnoid (mater) – contains blood blood vessels.
vessel  Intra – ventricular
subarachnoid space – filled with CSF  (IVH) is bleeding into the fluid-filled areas, or
pia mater – covers the brain ventricles, surrounded by the brain.
 The condition is most often seen in premature
babies, and the smaller and more premature the
infant, the higher the risk for IVH.
 common cause – lack of O2
complications
 Intra – karenchymal
 Intra - ventricular
Nursing Management; Collaborative
1. Care of the client with increased ICP
2. Monitor drainage from ears and nose (test the
fluid for glucose with Tes-tape, CSF is positive
for glucose)
 3. Monitor for S/Sx of  place a rigid collar around the neck and
a. meningitis (Neck stiffness, carefully place the person on a
Nausea or vomiting, Sensitivity to light: backboard to prevent further damage to
(photophobia), Confusion or altered the spinal cord.
mental state, Lack of energy (lethargy),  Sedatives are used to relax the person
extreme sleepiness, or trouble waking and prevent movement.
up, Lack of appetite, Small round spots
that look like a rash (petechiae). 2. physical modalities such as TENS, heat, and
b. Atelectasis cold.
 Trouble breathing/shortness of  TENS (Transcutaneous Electrical Nerve
breath (dyspnea). Stimulation) is a method of electrical
 Coughing. stimulation that primarily aims to provide
 Chest pain. a degree of symptomatic pain relief by
 Rapid breathing (tachypnea). exciting sensory nerves and thereby
 wheezing or crackling sounds. stimulating either the pain gate
 sputum (phlegm, or thick mechanism and/or the opioid system.
mucus) production.
 less chest expansion. 3. soft tissue techniques such as massage.
 Skin and lips turning blue. 4. specific strengthening and stretching exercises.
c. Pneumonia 5. graded exercise or activity programmes.
 Chest pain 6. hydrotherapy.
 Cough 7. education on activity pacing.
 Fever 8. education on posture.
 Fatigue
 Shortness of breath COMPLICATIONS
 Vomiting
 Loss of appetite 1. Pressure ulcer
 Persistent cough with phlegm  Damage to an area of the skin caused
 Chills by constant pressure on the area for a
long time.
SPINAL CORD INJURY  This pressure can lessen blood flow to
the affected area, which may lead to
- involves damage to any part of the spinal cord. tissue damage and tissue death
- It also can include damage to nerves at the end (necrosis)
of the spinal cord
COMMON CAUSES: 2. Autonomic dysreflexia
 a dangerous syndrome involving an
 Motor vehicle accidents. overreaction of your autonomic nervous
 Auto and motorcycle accidents system.
 Falls.  It causes a sudden and severe rise in
*A spinal cord injury after age 65 is most often blood pressure, in addition to other
caused by a fall. symptoms.
 Acts of violence. 3. Neurogenic bladder dysfunction
 Sports and recreation injuries  Is a bladder dysfunction (flaccid or
 Diseases. spastic) caused by neurologic damage.
 Symptoms can include overflow
CATEGORIES:
incontinence, frequency, urgency, urge
- The cervical vertebrae are numbered from C1 incontinence, and retention.
down to C7.  The risk of serious complications (eg,
- The thoracic vertebrae are numbered from T1 recurrent infection, vesicoureteral reflux,
down to T12. autonomic dysreflexia) is high.
- The lumbar vertebrae are numbered from L1
down to L5. 4. Depression
- The sacral vertebrae are numbered from S1 5. Pain
down to S5. 6. Breathing
7. Neurogenic Shock
Signs and Symptoms:  Is a condition in which the pt. has
- Extreme back pain or pressure in the neck, trouble keeping the heart rate, bp, &
head, or back. temperature stable because of damage
- Weakness, incoordination, or loss of control in to the nervous system after a spinal
any part of the body. cord injury.
- Numbness, tingling, or loss of feeling in the 8. Orthostatic hypotension
hands, fingers, feet, or toes.  also called postural hypotension —a
- Loss of bladder or bowel control. form of low blood pressure that happens
- Trouble with balance and walking. when standing after sitting or lying
- Trouble breathing after injury. down.
 Can cause dizziness or lightheadedness
nursing priorities for patients with spinal cord injuries: and possibly fainting
9. Osteoporosis
- Ensure airway, breathing, and circulation  a bone disease that develops when
stability. bone mineral density and bone mass
- Prevent complications such as pressure ulcers, decrease, or when the structure and
urinary tract infections, and respiratory strength of bone changes.
infections.  This can lead to a decrease in bone
- Provide pain management and optimize strength that can increase the risk of
fractures (broken bones).

Medical, collaborative interventions

1. In emergency site: