Transcript Head Injury
Head Injury
Head Injury
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Any trauma to the scalp , skull , or brain
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Head trauma
includes an alteration in consciousness no matter how brief
Head Injury
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Causes
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Motor vehicle accidents
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Firearm-related injuries
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Falls
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Assaults
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Sports-related injuries
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Recreational accidents
Head Injury
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High potential for poor outcome Deaths occur at three points in time after injury:
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Immediately after the injury
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Within 2 hours after injury
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3 weeks after injury
Head Injury
Types of Head Injuries
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Scalp lacerations
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The most minor type of head trauma
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Scalp is highly vascular
profuse bleeding
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Major complication is infection
Head Injury
Types of Head Injuries
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Skull fractures
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Linear or depressed
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Simple, comminuted, or compound
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Closed or open
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Direct & Indirect
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Coup & Contrecoup
Head Injury
Types of Head Injuries
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Skull fractures
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Location of fracture alters the presentation of the manifestations
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Facial paralysis
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Conjugate deviation of gaze
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Battle’s sign
Head Injury
Types of Head Injuries
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Basal Skull fractures
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CSF leak (extravasation) into ear (Otorrhea) or nose (Rhinorrhea)
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High risk infection or meningitis
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“HALO Sign (Battle Sign)” on clothes of linen
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Possible injury to Internal carotid artery
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Permanent CSF leaks possible
Battle’s Sign Fig. 55-13
Nursing Care of Skull Fractures
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Minimize CSF leak
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Bed flat Never suction orally; never insert NG tube; never use Q-Tips in nose/ears; caution patient not to blow nose
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Place sterile gauze/cotton ball around area
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Verify CSK leak:
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DEXTROSTIX: positive for glucose
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Monitor closely: Respiratory status+++
Head Injury
Types of Head Injuries
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Minor head trauma
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Concussion
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A sudden transient mechanical head injury with disruption of neural activity and a change in LOC
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Brief disruption in LOC Amnesia
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Headache Short duration
Head Injury
Types of Head Injuries
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Minor head trauma
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Postconcussion syndrome
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2 weeks to 2 months
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Persistent headache
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Lethargy
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Personality and behavior changes
Head Injury
Types of Head Injuries
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Major head trauma
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Includes cerebral contusions and lacerations
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Both injuries represent severe trauma to the brain
Head Injury
Types of Head Injuries
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Major head trauma
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Contusion
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The bruising of brain tissue within a focal area that maintains the integrity of the pia mater and arachnoid layers
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Lacerations
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Involve actual tearing of the brain tissue
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Intracerebral hemorrhage is generally associated with cerebral laceration
Head Injury
Pathophysiology
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Diffuse axonal injury (DAI)
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Widespread axonal damage occurring after a mild, moderate, or severe TBI
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Process takes approximately 12-24 hours
Head Injury
Pathophysiology
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Diffuse axonal injury (DAI)
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Clinical signs:
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LOC ICP
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Decerebration or decortication
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Global cerebral edema
Head Injury
Complications
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Epidural hematoma
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Results from bleeding between the dura and the inner surface of the skull
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A neurologic emergency
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Venous or arterial origin
Head Injury
Complications
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Subdural hematoma
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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
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Subdural hematoma
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Usually venous in origin
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Much slower to develop into a mass large enough to produce symptoms
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May be caused by an arterial hemorrhage
Head Injury
Complications
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Subdural hematoma
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Acute subdural hematoma
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High mortality
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Signs within 48 hours of the injury
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Associated with major trauma (Shearing Forces)
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Patient appears drowsy and confused
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Pupils dilate and become fixed
Head Injury
Complications
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Subdural hematoma
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Subacute subdural hematoma
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Occurs within 2-14 days of the injury
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Failure to regain consciousness may be an indicator
Head Injury
Complications
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Subdural hematoma
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Chronic subdural hematoma
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Develops over weeks or months after a seemingly minor head injury
Head Injury
Diagnostic Studies and Collaborative Care
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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
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GCS score
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Neurologic status
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Presence of CSF leak
Head Injury
Nursing Management Nursing Diagnoses
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Ineffective tissue perfusion
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Hyperthermia
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Acute pain
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Anxiety
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Impaired physical mobility
Head Injury
Nursing Management Planning
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Overall goals:
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Maintain adequate cerebral perfusion
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Remain normothermic
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Be free from pain, discomfort, and infection
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Attain maximal cognitive, motor, and sensory function
Head Injury
Nursing Management Nursing implementation Health Promotion
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Prevent car and motorcycle accidents
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Wear safety helmets
Head Injury
Nursing Management Nursing implementation Acute Intervention
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Maintain cerebral perfusion and prevent secondary cerebral ischemia
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Monitor for changes in neurologic status
Head Injury
Nursing Management Nursing implementation Ambulatory and Home Care
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Nutrition
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Bowel and bladder management
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Spasticity
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Dysphagia
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Seizure disorders
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Family participation and education
Head Injury
Nursing Management Evaluation Expected Outcomes
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Maintain normal cerebral perfusion pressure
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Achieve maximal cognitive, motor, and sensory function
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Experience no infection, hyperthermia, or pain