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Head Injury

Head Injury
Any trauma to the scalp, skull, or brain

Head trauma includes an alteration in
consciousness no matter how brief
Head Injury
Causes
Motor vehicle accidents
Firearm-related injuries
Falls
Assaults
Sports-related injuries
Recreational accidents
Head Injury
High potential for poor outcome
Deaths occur at three points in time after
injury:
Immediately after the injury
Within 2 hours after injury
3 weeks after injury
Head Injury
Types of Head Injuries
Scalp lacerations
The most minor type of head trauma
Scalp is highly vascular profuse
bleeding
Major complication is infection
Head Injury
Types of Head Injuries
Skull fractures
Linear or depressed
Simple, comminuted, or compound
Closed or open
Direct & Indirect
Coup & Contrecoup
Head Injury
Types of Head Injuries
Skull fractures
Location of fracture alters the
presentation of the manifestations
Facial paralysis
Conjugate deviation of gaze
Battles sign

Head Injury
Types of Head Injuries
Basal Skull fractures
CSF leak (extravasation) into ear (Otorrhea)
or nose (Rhinorrhea)
High risk infection or meningitis
HALO Sign (Battle Sign) on clothes of
linen
Possible injury to Internal carotid artery
Permanent CSF leaks possible

Battles Sign
Fig. 55-13
Nursing Care of Skull
Fractures
Minimize CSF leak
Bed flat
Never suction orally; never insert NG tube; never use Q-Tips
in nose/ears; caution patient not to blow nose

Place sterile gauze/cotton ball around area

Verify CSK leak:
DEXTROSTIX: positive for glucose

Monitor closely: Respiratory status+++

Head Injury
Types of Head Injuries
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

Head Injury
Types of Head Injuries
Minor head trauma
Postconcussion syndrome
2 weeks to 2 months
Persistent headache
Lethargy
Personality and behavior changes
Head Injury
Types of Head Injuries
Major head trauma
Includes cerebral contusions and
lacerations
Both injuries represent severe trauma
to the brain
Head Injury
Types of Head Injuries
Major head trauma
Contusion
The bruising of brain tissue within a focal
area that maintains the integrity of the pia
mater and arachnoid layers
Lacerations
Involve actual tearing of the brain tissue
Intracerebral hemorrhage is generally
associated with cerebral laceration


Head Injury
Pathophysiology
Diffuse axonal injury (DAI)
Widespread axonal damage occurring
after a mild, moderate, or severe TBI
Process takes approximately 12-24
hours

Head Injury
Pathophysiology
Diffuse axonal injury (DAI)
Clinical signs:
LOC
ICP
Decerebration or decortication
Global cerebral edema


Head Injury
Complications
Epidural hematoma
Results from bleeding between the
dura and the inner surface of the skull
A neurologic emergency
Venous or arterial origin

Head Injury
Complications
Subdural hematoma
Occurs from bleeding between the
dura mater and arachnoid layer of the
meningeal covering of the brain

Epidural and Subdural Hematomas
Fig. 55-15
Epidural Hematoma
Subdural Hematoma
Head Injury
Complications
Subdural hematoma
Usually venous in origin
Much slower to develop into a mass
large enough to produce symptoms
May be caused by an arterial
hemorrhage
Head Injury
Complications
Subdural hematoma
Acute subdural hematoma
High mortality
Signs within 48 hours of the injury
Associated with major trauma (Shearing
Forces)
Patient appears drowsy and confused
Pupils dilate and become fixed
Head Injury
Complications
Subdural hematoma
Subacute subdural hematoma
Occurs within 2-14 days of the
injury
Failure to regain consciousness may
be an indicator
Head Injury
Complications
Subdural hematoma
Chronic subdural hematoma
Develops over weeks or months after
a seemingly minor head injury

Head Injury
Diagnostic Studies and
Collaborative Care
CT scan considered the best diagnostic test to
determine craniocerebral trauma
MRI
Cervical spine x-ray
Glasgow Coma Scale (GCS)
Craniotomy
Craniectomy
Cranioplasty
Burr-hole


Head Injury
Nursing Management
Nursing Assessment

GCS score
Neurologic status
Presence of CSF leak
Head Injury
Nursing Management
Nursing Diagnoses

Ineffective tissue perfusion
Hyperthermia
Acute pain
Anxiety
Impaired physical mobility
Head Injury
Nursing Management
Planning

Overall goals:
Maintain adequate cerebral perfusion
Remain normothermic
Be free from pain, discomfort, and
infection
Attain maximal cognitive, motor, and
sensory function

Head Injury
Nursing Management
Nursing implementation

Health Promotion
Prevent car and motorcycle accidents
Wear safety helmets
Head Injury
Nursing Management
Nursing implementation

Acute Intervention
Maintain cerebral perfusion and
prevent secondary cerebral ischemia
Monitor for changes in neurologic
status
Head Injury
Nursing Management
Nursing implementation
Ambulatory and Home Care
Nutrition
Bowel and bladder management
Spasticity
Dysphagia
Seizure disorders
Family participation and education

Head Injury
Nursing Management
Evaluation

Expected Outcomes
Maintain normal cerebral perfusion
pressure
Achieve maximal cognitive, motor, and
sensory function
Experience no infection, hyperthermia,
or pain