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    Head Injuries

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    Head injuries are the leading cause of death among people ages 0-35. They result from impacts or penetrations to the skull and can cause damage to the brain from direct injury or secondary forces. Head injuries range from mild concussions to severe traumatic brain injuries and hemorrhages. Nursing management focuses on monitoring for increased intracranial pressure, preventing infections, maintaining proper body functions, and promoting rest and rehabilitation.

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    Head Injuries

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    api-3822433
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    Head injuries are the leading cause of death among people ages 0-35. They result from impacts or penetrations to the skull and can cause damage to the brain from direct injury or secondary forces. Head injuries range from mild concussions to severe traumatic brain injuries and hemorrhages. Nursing management focuses on monitoring for increased intracranial pressure, preventing infections, maintaining proper body functions, and promoting rest and rehabilitation.

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    HEAD INJURIES

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    Head injuries are the leading cause of death among people ages 0-35. They result from impacts or penetrations to the skull and can cause damage to the brain from direct injury or secondary forces. Head injuries range from mild concussions to severe traumatic brain injuries and hemorrhages. Nursing management focuses on monitoring for increased intracranial pressure, preventing infections, maintaining proper body functions, and promoting rest and rehabilitation.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    670 views7 pages

    Head Injuries

    Uploaded by

    api-3822433
    Head injuries are the leading cause of death among people ages 0-35. They result from impacts or penetrations to the skull and can cause damage to the brain from direct injury or secondary forces. Head injuries range from mild concussions to severe traumatic brain injuries and hemorrhages. Nursing management focuses on monitoring for increased intracranial pressure, preventing infections, maintaining proper body functions, and promoting rest and rehabilitation.

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    of 7

    HEAD INJURIES

    INCIDENCE
    • 100,000 Deaths a year
    • Can result from: Industry, MVC, Military accidents
    • #1 cause of death from ages 0-35
    • Babies – shaken baby syndrome
    • 70% of MVC will result in some type of head injury
    • 2nd highest incident in the elderly population: Fall or jeark of head
    • 2/3 are < 30 years old

    ETIOLOGY
    • Results form penetration or impact of the cranial vault
    • Damage caused by:
    o Direct injury
    o Secondary to compression, tension or shearing forces
     Due to movement of brain in vault
    • Results in injury to the scalp, skull and/or brain tissue –  ICP
    • DO NOT move client until spinal cord traumas is ruled out

    PATHOPHYSIOLOGY
    • Results from penetration or impact
    • Damage can be caused either by the direct injury itself or secondary to compression, tension, or
    shearing forces
    o Note: Brain tissue does not rebuild itself; once it is dead it is gone
    • Specific patho of each injury depends on
    o Type of injury
    o Resulting damage
    • Remember head injury and spinal cord injury often occur together
    o Risk for spinal cord injury before being moved
    o ER do not move until cervical x-rays

    CLASSIFICATION OF HEAD INJURIES


    • Open Head Injury
    o Break or penetration of dura, exposing the cranial vault to the environment
    o In order to have an Open Head Injury you must have a Skull Fracture
    o  risk for infection,  risk for edema
    o Results from: Bullets, knives, bone fragments, or direct blows to the head

    • Closed Head Injury – BLUNT TRAUMA


    o Dura intact; caused by rapidly moving blunt object “blunt trauma”; ex: baseball bat, MVC.
    o The worst type of injury because of risk for  ICP
     Coup
    • Injury occurs at the point of impact
     Countercoup
    • Injury occurs opposite point of impact (if injured on rt side will have rt sided weakness)
     Acceleration – Deceleration
    • Caused by MV accidents
    • Head moving back and forth several times
    TYPES OF HEAD INJURIES
    • SCALP INJURIES
    o Result in profuse bleeding because scalp is very vascular and bleeds profusely.
    o Abrasion (scrape), Contusion (bruising), Laceration (cut), Avulsion (torn off part of
    scalp)
     Clean area shave only with ok by MD
     Irrigate with NS to clean glass, dirt, etc.
     Subgleal hematoma – knot on head

    • SKULL FRACTURES
    o Linear
     Simple break in continuity of bone
     Straight line break
     70% of skull fx
    • Treatment: Neurological checks, NO treatment
    o Comminuted
     Fragmentation bone broken into several pieces
     Surgery R/F brain injury
    o Depressed
     Cracked skull with inward depression of bone fragment
    • Simple
    o Dura with scalp intact; not penetrated dura
    • Compound
    o Scalp injury;scalp is open; dura with open wound. Dura may or
    may not be torn
    o At risk for  ICP
    o Basal Skull Fracture
     Hard to see on X-Ray
     Occurs at base of the skull
    • Most protected – protects the brain stem

    CLASSIC SIGNS
     Battle’s Sign – Bruising behind mastoid and raccoon eyes
     Rhinorrhea – CSF – Leak – will have glucose
     Otorrhea – CSF – Leak
    • Glucose test determines post crainy leaking
    • Halo Test
     Compensating for  ICP
     Increased Risk for Infection

    NURSING IMPLICATIONS OF SKULL FRACTURES


    • Observe for ICP and S/S of infection – Notify MD
    • Don’t administer respiratory depressants – sedatives, barbiturates, or morphine
    • Observe patient closely for first 24 hours
    • Start IV if necessary but limit fluids to 1500-2000cc daily as ordered per MD
    • Maintain accurate I&O records
    • Frequent Neuro and VS checks – at least Q2o
    • Cleanse and assist with suturing scalp lacerations of present

    INJURIES TO THE BRAIN


    • Concussion
    o Least serious
    o Temporary loss of neuro function with no structural brain damage
    o Brief loss of consciousness but will recover and do ok
    o TX: Monitor for changes in LOC
    o Discharge Teaching: Head Injury Instruction Sheet
    o Note: You don’t have to wake the patient just turn light on or touch
     Bring back to ER if:
    • You can’t arouse them
    • Sudden vomiting – Projectile
    • Severe Nausea
    • Headache Typically get worse and worse
    • Weakness on one side of the body
    • Confusion
    • Vision Changes

    • Contusions and Lacerations


    o Bruising or part of the brain – Bleeding – not good
    o Laceration is a cut – Profuse bleeding
    o Loss of consciousness, Days, weeks, months, years
    o If they survive the injury the blood will absorb itself with no residual brain damage
    they should be OK.
    o If the bleeding is bad enough they may die from ICP or have residual brain damage
    o The longer a person stays unconscious the more severe the injury

    • Difuse Axonal Injury


    o Axons have been destroyed

    TRAUMATIC INTRACRANIAL HEMORRHAGE


    o EPIDURAL HEMATOMA
     Bleeding between the skull and dura matter. The most life-threatening of
    intracranial hemorrhages as the bleeding is usually arterial. Usually results
    from tear in wall of middle meningeal artery.
     50% mortality Rate
     Have to have surgery

    SIGNS AND SYMPTOMS OF EPIDURAL HEMATOMA


     Loss of consciousness, followed by a few hours of lucidity, then coma
     Hemiplegia on opposite side from hematoma
     Pupillary changes
    o SUBDURAL HEMATOMA
     Collection of blood between dura matter and arachnoid membrane. Usually
    venous in origin.
     Most common type of hematoma
     Can be chronic (gradual bleed over days to months) or acute (faster bleed of
    24-72 hrs)

    SIGNS AND SYMPTOMS OF EPIDURAL HEMATOMA


     Acute – presents as epidural
     Subacute - >48o
    • 2 weeks S/S similar to acute
     Headache
     Altered LOC
     Hemiplegia on opposite side from hematoma
     Irritability
    • Mental confusion
     Unequal pupils
     Convulsions
     Positive babinski response

    o INTRACEREBRAL HEMATOMA
     Hematoma is not confined by meninges, therefore bleeding can be widely
    dispersed.
     Causes more direct damage
     Difficult to evacuate surgically
    • Too widespread

    SIGNS AND SYMPTOMS OF INTRACEREBRAL HEMATOMA


     Headache
     Drowsiness
     Signs of ICP
     Hemiplegia on opposite side from bleeding
     Dizziness
     Vomiting

    DIAGNOSIS
    • Skull Films
    • CAT Scan
    • MRI

    MEDICAL MANAGEMENT
    • Surgical evacuation of heamtomas when possible
    • Neurosurgical procedures for open head injuries
    • Control of  ICP – osmotic diuretics, steroids(not 1st line with head trauma), ventricular
    drainage, hyperventilation, etc.

    NURSING MANAGEMENT
    • Immediate Care – Baseline Assessment
    o Find cause; loss of LOC, how long
    o 1st ABC’s, LOC, Cause
    • Post acute Phase
    o Maintenance of airway
    o Prevention of aspiration
     Suctioning, never place unconscious pt on back; place on side
    o Cardiovascular complications
     Hypovolemic shock with multi system injury, not from head trauma
    o Cerebrospinal fluid fistulas
     Communicate between brain, environment
     CSF; sniffing, swallowing; do not suction; antibiotics
    o Prevent straining
      ICP
    o Maintenance of proper body temperature
      fever =  ICP
    o Frequent assessments
     Need rest (nursing care IICP); 24-48o frequent assessments
    o Nutrition
     IV, NG or oral
     Monitor I&O
    o Restlessness – Disorientation
     1st :check airway, assess pain, 2nd: distended bladder 3rd : Waking up
    o Seizures
     Occur years after trauma – Post traumatic epilepsy
    o Stress ulcers
     Antacids
    o Promotion of rest
     Must assess
    o Rehabilitation techniques
     ROM, Prevent disuse syndrome
    o Eye care
     Corneal reflexes absent
    o Psychological
     Family and patient support

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