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Head Injury
• Causes
– Penyebab
– Kecelakaan kendaraan bermotor
– Cedera yang berhubungan dengan senjata api
– Air terjun
– Assaults
– Cedera terkait olahraga
– Kecelakaan rekreasi
Head Injury
• 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
– Battle’s sign
Head Injury
Types of Head Injuries
Fig. 55-13
Nursing Care of Skull
Fractures
• 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
Epidural Hematoma
Subdural Hematoma
Fig. 55-15
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
– 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
Expected Outcomes
• Maintain normal cerebral perfusion
pressure
• Achieve maximal cognitive, motor, and
sensory function
• Experience no infection, hyperthermia,
or pain