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Head Injury complex final
Nursing Care- Complex Health Problems II (11-63-375)
University of Windsor
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COMPLEX II FINAL: Head Injury - When the air hits the brain, it is never the same - Any trauma to the scalp, skull, or brain - Head trauma includes an alteration in consciousness no matter how brief Causes o Motor vehicle crash o Firearm related injuries o Falls o Assaults o Sports-related injuries o Recreational accidents - High potential for poor outcome - Deaths occur at three points in time after injury: immediately after the injury, within 2 hours after injury, or 3 weeks after injury Types of Head Injuries Scalp lacerations o The most minor type of head trauma o Scalp is highly vascular profuse bleeding, blood vessels do not vasoconstrict as readily o Major complication is infection Skull Fractures (more serious because what’s underneath that skull is brain tissue) o Linear or depressed Swollen, ecchymosis area on scalp Possible scalp laceration o Simple, comminuted, or compound o Closed or open Depressed o Direct & Indirect o Coup & contrecoup – two areas of injury with this one Basal Skull Fracture o Anterior fossa (front) Rhinorrhea Bilateral ecchymosis eyes May have injury to CN I May have facial fractures o Middle Fossa Otorrhea (ear) or Rhinorrhea (nose) Battle sign May have cranial nerve damage o Posterior Fossa May have epidural hematoma Cerebellar, brainstem or cranial nerve signs Visual changes, tinnitus, facial paralysis, conjugate eye deviation Nursing Care of Skull Fractures Minimize CSF leak ◦ Bed flat (which would be worse for the pt. increased ICP or having a leak? Increased ICP so these pt. need to be positioned up if they are at risk for increased ICP or have increased ICP. But if someone just has a CSF leak and do not have increased ICP then they can be nursed flat) ◦ Never suction orally; never insert NG tube (if you have to intubate a patient do it orally); 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+++ Concussion/mild Traumatic Brain Injury (mTBI) Occurs with head injury due to contact and/or acceleration/deceleration forces. It is typically defined as mild by a Glasgow Coma Scale of 13 to 15 measured at 30 minutes after the injury Concussion A sudden transient mechanical head injury with disruption of neural activity and a change in LOC Stretching of nerve fibers, no structural alteration Brief disruption in LOC Amnesia Headache (can be for a long time) Short duration Clinical Manifestations HALLMARK SYMPTOMS: • Confusion and amnesia • Often with preceding loss of consciousness Other symptoms may include: Headache Dizziness Lack of awareness of surroundings Nausea & vomiting Mood and cognitive disturbances Sensitivity of light & noise Sleep disturbance Minor Head Trauma Post-concussion syndrome 2 weeks to 2 months Persistent headache Lethargy Personality and behavior changes Dizziness Fatigue Irritability Anxiety Insomnia Loss of concentration and memory Noise and light sensitivity • When to Return to the Hospital • Repeated vomiting • Worsening or severe headache • Unable to stay awake • More confused and restless • Seizures • Difficulty walking or difficulty with balance • Difficulty with vision • Any symptom that concern the patient or their family or friends Sports-Related Concussion/mTBI • Traumatic biomechanical forces on the brain – concussion- related to a sports injury • Most resolve in a short period of time • Any first aid must be done – first • Assessment of concussion symptoms • Should not be allowed to return to play until symptom free • Gradual return to play protocol Repetitive Head Injury Syndrome Chronic traumatic encephalopathy (CTE) – does not change once the brain is damaged it cannot be reversed Think about the different layers, where they bleed is in between the layers depending on where they bleed is how they get the name. Epidural Hematoma (bleeding between the dura and skull) Results from bleeding between the dura and the inner surface of the skull Linear skull fractures A neurologic emergency Venous or arterial origin Precipitating event (ex: drunk and hit ur head, momentarily loses consciousness, think you are fine go home and go to bed and you don’t wake up) History: Short period of unconsciousness followed by lucid interval and then rapid deterioration Headache Increasing irritability to confusion Decreasing LOC Ipsilateral oculomotor paralysis – same side of injury that eye does not move Contralateral hemiparesis/hemiplegia- opposite side Any head injury needs to go to hospital!!! Subdural Hematoma Occurs from bleeding between the dura mater and arachnoid layer of the meningeal covering of the brain Usually venous in origin Much slower to develop into a mass large enough to produce symptoms May be caused by an arterial hemorrhage (rare but if it is arterial then it would develop much faster!) May occur spontaneously Prevalent in older patients with cerebral atrophy and alcoholics Acute Subdural Hematoma High mortality Signs within 48 hours of the injury Associated with major trauma (Shearing Forces) Patient appears drowsy and confused Ipsilateral oculomotor paralysis Contralateral hemiparesis/hemiplegia Subacute Subdural Hematoma Occurs within 2-14 days of the injury Failure to regain consciousness may be an indicator See this normally with older people Chronic Subdural Hematoma Develops over weeks or months after a seemingly minor head injury Fibroblast accumulate around the hematoma and encapsulate it Hemolysis of the clot (clot starts to break down) liberates plasma proteins this causes high osmotic pressure High osmotic pressure causes an influx of water and swelling of the mass Diagnostic Studies CT scan considered the best diagnostic test to determine craniocerebral trauma (don’t need a prep and can have answers within minutes) MRI- (have to go through a checklist so takes longer and remember can’t have anything magnetic going into this) Cervical spine x-ray (always suspicious of this if we find someone on the ground unconscious this is why you are not supposed to move someone if you find them unconscious on the ground) Glasgow Coma Scale (GCS) Collaborative Management Assessment, GCS score, neurologic status, presence of CSF leak
Head Injury complex final
Course: Nursing Care- Complex Health Problems II (11-63-375)
University: University of Windsor
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