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Head Injury
Introduction
 Head injury is any trauma to the scalp, skull
or brain.
 Alteration of consciousness
Contd….
 Head Injury is also called a traumatic
brain injury, is an insult to the brain
capable of producing physical, intellectual,
emotional, social and vocational changes
and it produces compromised neurological
functions resulting in focal or diffuse
symptoms.
Contd………………………
 Head injuries are fatal in >30% of cases
before the injured person arrives at hospital.
 An additional 20% die later because of
secondary brain injury
 
Contd…………………………
1. Motor vehicle
accidents are the
most common
cause
2. Caused by a sudden force to the head
 Acceleration injury: immobile head struck
by moving object
 Deceleration injury: head is hit by
stationary object.
 Deformation injury: force disrupts the
integrity of the skull.
3. Fractures
 Linear: simple break in the bone
 Depressed: break that results in fragments
of bone penetrating brain tissue.
 Basilar: occurs over the base of frontal and
temporal lobes
4.Hemorrhages (secondary brain injury)
Epidural:
 hematoma forms between the dura and the
skull;
Subdural:
 hematoma forms between the dura and
arachnoid layers
Intracerebral hematoma:
 collection of blood within brain parenchyma.
Contd….
Contd..
Contd….
5. Concussion:
 Temporary disruption of synaptic activity;
brief loss of consciousness less than 5
minutes.
6.Contusions
 Contusions is a structural alteration
characterized by extravasation of blood into
the brain (Brusing of brain tissure without
tearing of tissues)
Pathophysiology
Brain becomes swells or bleeds
which increases intracranial volume
Brain suffers traumatic injury
Contd…
Causing displacement of the brain
through or against the rigid structures of
the skull.
Rigid cranium has no space to expansion
of contents so increased intracranial
pressure
Contd…
Cells within the brain become anoxic and
cannot metabolize properly, resulting
ischemia, infraction, irreversible brain
damage
Pressure on the blood vessels within the
brain causes blood flow the brain to slow or
restrict decreasing oxygen delivery and
waste removal.
Contd…
Finally, brain coma and death occurred.
Resulting alteration in neurological
functions (cereballer function, motor
function, sensory function, intellectual
function, language problems, reflexes) and
level of conciousness
Clinical features
Obvious scalp lacerations cause local pain,
swelling hematoma and bleeding.
Breaks or depression in skull and bruises or
contusions on the face
Bleeding or escape of CSF from ears and
nose
Increased intracranial pressure
Contd….
Decreased level of consciousness,
restlessness
Confusion, disturbed in speech
Altered neurological and vital sign and
subnormal temperature
Feature of shock-skin cold and clamming,
BP low tachycardia.
Contd….
Pupillary abnormalities: Unique or dilated
pupils
Asymmetrical facial movement
Seizure disorder and flaccidity or rigidity of
muscles.
Loss of bladder and bowel function
Contd…
Altered sensory function e.g. auditory,
visual, tactile
Decreased or hyperactive reflexes.
Positive Babinski reflex
Absence of deep tendon reflexes e.g. biceps,
triceps.
  
  
Treatments
Treatment depends on the site and severity
of injury. The management focuses on
supporting all organ system. The support
includes:
1. Ventilatory support
2. Management of fluid balance and elimination.
3. Management of nutrition and gastro intestinal
function.
Contd…
4. Patient with minor injury with concussions,
the medical treatment includes:
 Keep the patient in observation for 24 hours
with complete bed rest.
Contd….
 Symptomatic treatment and discharge with
following instruction; report to the hospital
immediately if the following symptoms
 Severe headache, vomiting, drowsiness
 Unconsciousness or decreased level of
consciousness
 Behavioral changes.
Contd..
5. If the patient needs further management
and have severe brain injury he/she should
be admitted to the special unit and carried
out following treatment.
 For all the patients with head injury, prophylactic
antibiotic are given to prevent potential CNS
infection.
 Sedatives should be given if seizure
Contd..
 Mechanical decompression done to reduce
edema
o Dexamethazone/ injection mannitol,
frusamide
o Lumber puncture
o Administer oxygen via nasal cannula.
o Tetanous texoid vaccine should be given.
  
Assessment
1. Airway and breathing pattern
2. Neurological status through neurological
assessment and Glasgow coma scale.
3. Signs of Increased intracranial pressure
4. Circumstances of injury
5. Presence of glucose in clear drainage from
none or ears which indicates cerebrospinal
fluid.
Nursing Diagnosis
1. Ineffective airway clearance and impaired
gas exchange related to brain injury.
2. Decreased intracranial adaptive capacity
related to increased intracranial
cerebrospinal fluid.
3. Ineffective cerebral tissue perfusion related
to increased intracranial pressure (ICP).
Contd…
4.Deficient fluid volume related to decreased
LOC and hormonal dysfunction.
5. Imbalanced nutritional less than body
requirements related to increased metabolic
demands and inadequate intake.
Contd…
6. Risk for injury related to seizures.
7. Risk for imbalanced body temperature
related to damaged temperature regulating
mechanisms in the brain.
 
Contd…
Institute neurologic assessment every 15
minutes for several hours, progressing to
every hour and then every 4 hours.
Maintain airway
 Maintain airway by suctioning as necessary.
 Intubate the patient who has GCS less than 8
score.
 Placement of NG tube with intubation to prevent
aspiration
Promoting effective ventilation.
Closely monitors the breathing patterns of
the patient with altered level of
Conciousness.
Positions the patient of either side and keeps
the head of the bed elevated to at least 30-45
degrees.
Maintain mechanical ventilation to maintain
adequate oxygenation and prevent
hypercapnea.
Contd….
The effectiveness of the patient's gas exchange
should be evaluated with pulse oximetry and
arterial blood gases.
Checks the effectiveness of patient's respiratory
effort, breathing patterns and breathing sounds
because presence of decreased breathing
sounds indicates the potential for atelectasis
and hypoventilation.
Controlling intracranial pressure (ICP).
Avoid coughing as it increases intracranial
pressure; suction airway as necessary.
Keep the patient's head elevated 30 to 45
degrees to reduce venous pressure within
the cranial cavity.
Contd..
Administer glucocorticoids and/or diuretics
(mannitol) if ordered.
Assist client to avoid activities that increase
ICP such as the Valsalva maneuver, lifting,
sneezing and flexion of head
Valsalva Maneuvar
Supporting tissue perfusion
Prevent hypotension and maintain systolic
blood pressure above 110 mmHg.
Use of vasopressin and fluids albumin or
colloids to ensure that the patient receives
adequate hydration to maintain blood
volume and support blood pressure.
Contd…
Institute seizure precautions; administer
anti-convulsants (phenytoin) if ordered.
Monitor for fluid or electrolyte imbalances;
diabetes insipidus or syndrome of
inappropriate antidiuratic hormone may
occur
Perform supportive care
Support client's nutritional needs;
administer tube feedings or assist with small
frequent meals.
Position the patient to prevent pressure
ulcers.
Provide physiotherapy and splints to prevent
contractures.
Contd…
Antibiotic to prevent infection with open
skull fracture.
Maintain normal fluid volume.
Pain management by giving morphine.
Contd….
Utilize hypothermia as ordered to reduce
temperature and metabolic demands.
Encourage client and family to participate
planning and care.
Provide opportunity for expression of grief.
  
  
  

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Head injury

  • 2. Introduction  Head injury is any trauma to the scalp, skull or brain.  Alteration of consciousness
  • 3. Contd….  Head Injury is also called a traumatic brain injury, is an insult to the brain capable of producing physical, intellectual, emotional, social and vocational changes and it produces compromised neurological functions resulting in focal or diffuse symptoms.
  • 4. Contd………………………  Head injuries are fatal in >30% of cases before the injured person arrives at hospital.  An additional 20% die later because of secondary brain injury
  • 7. 2. Caused by a sudden force to the head  Acceleration injury: immobile head struck by moving object  Deceleration injury: head is hit by stationary object.  Deformation injury: force disrupts the integrity of the skull.
  • 8. 3. Fractures  Linear: simple break in the bone  Depressed: break that results in fragments of bone penetrating brain tissue.  Basilar: occurs over the base of frontal and temporal lobes
  • 9. 4.Hemorrhages (secondary brain injury) Epidural:  hematoma forms between the dura and the skull; Subdural:  hematoma forms between the dura and arachnoid layers Intracerebral hematoma:  collection of blood within brain parenchyma.
  • 13. 5. Concussion:  Temporary disruption of synaptic activity; brief loss of consciousness less than 5 minutes.
  • 14. 6.Contusions  Contusions is a structural alteration characterized by extravasation of blood into the brain (Brusing of brain tissure without tearing of tissues)
  • 15. Pathophysiology Brain becomes swells or bleeds which increases intracranial volume Brain suffers traumatic injury
  • 16. Contd… Causing displacement of the brain through or against the rigid structures of the skull. Rigid cranium has no space to expansion of contents so increased intracranial pressure
  • 17. Contd… Cells within the brain become anoxic and cannot metabolize properly, resulting ischemia, infraction, irreversible brain damage Pressure on the blood vessels within the brain causes blood flow the brain to slow or restrict decreasing oxygen delivery and waste removal.
  • 18. Contd… Finally, brain coma and death occurred. Resulting alteration in neurological functions (cereballer function, motor function, sensory function, intellectual function, language problems, reflexes) and level of conciousness
  • 19. Clinical features Obvious scalp lacerations cause local pain, swelling hematoma and bleeding. Breaks or depression in skull and bruises or contusions on the face Bleeding or escape of CSF from ears and nose Increased intracranial pressure
  • 20. Contd…. Decreased level of consciousness, restlessness Confusion, disturbed in speech Altered neurological and vital sign and subnormal temperature Feature of shock-skin cold and clamming, BP low tachycardia.
  • 21. Contd…. Pupillary abnormalities: Unique or dilated pupils Asymmetrical facial movement Seizure disorder and flaccidity or rigidity of muscles. Loss of bladder and bowel function
  • 22. Contd… Altered sensory function e.g. auditory, visual, tactile Decreased or hyperactive reflexes. Positive Babinski reflex Absence of deep tendon reflexes e.g. biceps, triceps.
  • 25. Treatments Treatment depends on the site and severity of injury. The management focuses on supporting all organ system. The support includes: 1. Ventilatory support 2. Management of fluid balance and elimination. 3. Management of nutrition and gastro intestinal function.
  • 26. Contd… 4. Patient with minor injury with concussions, the medical treatment includes:  Keep the patient in observation for 24 hours with complete bed rest.
  • 27. Contd….  Symptomatic treatment and discharge with following instruction; report to the hospital immediately if the following symptoms  Severe headache, vomiting, drowsiness  Unconsciousness or decreased level of consciousness  Behavioral changes.
  • 28. Contd.. 5. If the patient needs further management and have severe brain injury he/she should be admitted to the special unit and carried out following treatment.  For all the patients with head injury, prophylactic antibiotic are given to prevent potential CNS infection.  Sedatives should be given if seizure
  • 29. Contd..  Mechanical decompression done to reduce edema o Dexamethazone/ injection mannitol, frusamide o Lumber puncture o Administer oxygen via nasal cannula. o Tetanous texoid vaccine should be given.
  • 31. Assessment 1. Airway and breathing pattern 2. Neurological status through neurological assessment and Glasgow coma scale. 3. Signs of Increased intracranial pressure 4. Circumstances of injury 5. Presence of glucose in clear drainage from none or ears which indicates cerebrospinal fluid.
  • 32. Nursing Diagnosis 1. Ineffective airway clearance and impaired gas exchange related to brain injury. 2. Decreased intracranial adaptive capacity related to increased intracranial cerebrospinal fluid. 3. Ineffective cerebral tissue perfusion related to increased intracranial pressure (ICP).
  • 33. Contd… 4.Deficient fluid volume related to decreased LOC and hormonal dysfunction. 5. Imbalanced nutritional less than body requirements related to increased metabolic demands and inadequate intake.
  • 34. Contd… 6. Risk for injury related to seizures. 7. Risk for imbalanced body temperature related to damaged temperature regulating mechanisms in the brain.
  • 36. Contd… Institute neurologic assessment every 15 minutes for several hours, progressing to every hour and then every 4 hours. Maintain airway  Maintain airway by suctioning as necessary.  Intubate the patient who has GCS less than 8 score.  Placement of NG tube with intubation to prevent aspiration
  • 37. Promoting effective ventilation. Closely monitors the breathing patterns of the patient with altered level of Conciousness. Positions the patient of either side and keeps the head of the bed elevated to at least 30-45 degrees. Maintain mechanical ventilation to maintain adequate oxygenation and prevent hypercapnea.
  • 38. Contd…. The effectiveness of the patient's gas exchange should be evaluated with pulse oximetry and arterial blood gases. Checks the effectiveness of patient's respiratory effort, breathing patterns and breathing sounds because presence of decreased breathing sounds indicates the potential for atelectasis and hypoventilation.
  • 39. Controlling intracranial pressure (ICP). Avoid coughing as it increases intracranial pressure; suction airway as necessary. Keep the patient's head elevated 30 to 45 degrees to reduce venous pressure within the cranial cavity.
  • 40. Contd.. Administer glucocorticoids and/or diuretics (mannitol) if ordered. Assist client to avoid activities that increase ICP such as the Valsalva maneuver, lifting, sneezing and flexion of head
  • 42. Supporting tissue perfusion Prevent hypotension and maintain systolic blood pressure above 110 mmHg. Use of vasopressin and fluids albumin or colloids to ensure that the patient receives adequate hydration to maintain blood volume and support blood pressure.
  • 43. Contd… Institute seizure precautions; administer anti-convulsants (phenytoin) if ordered. Monitor for fluid or electrolyte imbalances; diabetes insipidus or syndrome of inappropriate antidiuratic hormone may occur
  • 44. Perform supportive care Support client's nutritional needs; administer tube feedings or assist with small frequent meals. Position the patient to prevent pressure ulcers. Provide physiotherapy and splints to prevent contractures.
  • 45. Contd… Antibiotic to prevent infection with open skull fracture. Maintain normal fluid volume. Pain management by giving morphine.
  • 46. Contd…. Utilize hypothermia as ordered to reduce temperature and metabolic demands. Encourage client and family to participate planning and care. Provide opportunity for expression of grief.