Mr. Saneesh Dubey, a 28-year-old unmarried Hindu shopkeeper, suffered a head injury and was admitted to the ICU. Head injuries can damage the brain, bones, muscles and other head structures. Mr. Dubey underwent an endotracheal tube procedure. Head injuries are commonly caused by motor vehicle accidents and falls. Clinical exams and CT scans are used to diagnose and differentiate between types of head injuries. Nursing care involves monitoring vitals, neurological status using GCS, preventing pressure ulcers, managing increased ICP, and treating complications like infection or seizures.

1. HEAD INJURY
PRESENTED BY:-
MR. ASHISH H. ROY
(NURSING TUTOR)

2. Identification data
 Name
 Age
 Sex
 ward/ bed
 Registration No.
 Hospital
 Marital status
Mr. Saneesh Dubey
28 years
Male
Medical icu bed no. 5
18072
B.R.D medical college
hospital gkp.
Unmarried

3. Continued….
 Religion
 Occupation
 Address
 Diagnosis
 Date of admission
 Date of procedure
Hindu
SHOPKEEPER
151/B MIG -4
RAPTINAGAR
COLONY GKP.
Head injury
20/02/09
Endotracheal tube
on 20/02/09

4. Personal History
 Height
 Weight
 Habbits
 Nutrition
5.8
76 kg
No alcohol, drugs or
any other substances
Vegetarian

5. Personal History
 Appetite
 Hygiene
 Sleeping pattern
 Elimination
Good
Has always been very
meticulous about
hygiene
8 hours at night
Regular bowel and
bladder habits

6. Introduction of head trauma
 Head injury refers to any damage to any of the structure of
the head as a result of trauma. It is most often used to refer to
an injury to the brain. It may also involve the bones , muscles,
blood vessels, skin and othr organs of face or head.
 Mostly head injury are caused by blows to the head from the
numerous causes including motor vechicle accidents and
falls.
 Each has its own special management cosiderations and
prognostic implications.
 Clinical exam and CT scanning are the primary ways to
differentiate between the various types of head injury.

7. DEFINTION
AN TRAUMATIC BRAIN INJURY (TBI)
TO THE SKULL OR BRAIN THAT IS SEVERE
ENOUGH TO INTERFERE WITH NORMAL
FUNCTIONING.
OR
ANY INJURY TO THE HEAD OR BRAIN IN
WHICH DISTRUPTION OF THE BRAIN
FUNCTION OCCURS DUE TO TRAUMA.

8. CAUSES / ETIOLOGY OF BRAIN INJURY.
 Motor vechicle accident or Road Traffic
Accidents.
 Falls.
 Accidents.

9. Causes of TBI

10. EPIDEMIOLOGY OF HEAD INJURY
 India has the rather unenviable distinction of having the highest
rate of head injury in the world. In India, more than 100,000 lives
are lost every year with over 1 million suffering from serious
head injuries. In India, 1 out of 6 trauma victims die, while in the
United States this figure is 1 out of 200.
 It is estimated that nearly 1.5 to 2 million persons are injured
and 1 million succumb to death every year in India. Road
traffic injuries are the leading cause (60%) of TBIs followed by
falls (20%-25%)

11. Classification of Head Injury
 Blunt or penetrating injury
 Open or closed injury (open scalp and skull )
 Focal (i.e. Hemorrhagic or non hemorrhagic)
Focal lesions produce dysfunction specific to injured area.
Diffuse lesions are associated with disturbance of
consciousness cognitive or memory problems.

13. Head injury( involved)
1. Scalp injury( laceration, hematoma and abrasion to the skin)
2. Skull fracture ( temporal or frontal bones)
3. Brain injury
 Cerebral Contusion :
Cerebral contusion is a more severe injury in which the brain is bruised, with
possible surface haemorrhage.
The patient is unconscious for more than a few seconds or minutes.
 Cerebral Concussion :
A cerebral concussion after head injury is a temporary loss of neurologic
function with no apparent structural damage. A concussion generally
involves a period of unconsciousness lasting from a few seconds to a few
minutes.
 Epidural hematoma
 Subdural hematoma
 Intra-cerebral hematoma

14. Brain Injury
 Epidural hematoma
 Subdural hematoma
 Intra-cerebral hematoma

15. CEREBRAL HEMATOMAS
 EPIDURAL HEMATOMA

17. INTRA- CECEBRAL HEMATOMA
 Bleeding into the brain tissue
commonly associated with edema

18. EPIDURAL HEMATOMA
SUBDURAL HEMATOMA

19. MECHANISM OF INJURY
 ACCELERATION
When head is fixed and objects are in movement
 DECELERATION
When head is moving and objects are fixed.
 DEFORMATION
Deformation refers to injuries in which the force results in
deformation and disruption of the integrity of the impacted
body part i.e., skull.

20. MECHANISM OF INJURY
ACCELERATION-
DIRECT INJURY
(DEFORMATION)DECELERATION

21. Continued...
COUP- CONTRECOUP
INJURIES
 BECAUSE OF THE
MOVEMENT WITHIN THE
SKULL, THE SAME BLOW
MAY CAUSE INJURY TO
OPPOSITE SIDE OF THE
BRIAN

22. PATHOPHYSIOLOGY
(BRAIN INJURY)
HEAD TRAUMA LEADS TO BRAIN SWELLING OR INCREASED INTRACRANIAL
PRESSURE
RIGID CRANIUM DN’T ALLOW EXPENSION SO INCREASED ICP LEADS
PRESSURE ON BLOOD VESSELS CAUSES DECREASE BLOOD FLOW
CEREBRAL HYPOXIA AND ISCHEMIA OCCUR

24. CLINICAL MANIFESTATIONS
 LOSS OF CONSCIOUSNESS
 HEADACHE AND VOMIITING
 BLURRED VISION
 THERE MAY BE:- DIFFICULTY IN CONCENTRATING, INSOMNIA,
PHOTOPHOBIA AND DIFFICULT TO TOLERATE LOUD SOUNDS
 ABNORMAL POSTURE:- FLEXION OR EXTENSION
 SEIZURE
 FEVER
 SLUUGGISH PUPILLARY REACTION

25. Cont
 RESPIRATORY DISTRESS
 BLEEDING FROM THE NOSE, EAR ETC.
 RHINORRHOEA ( CSF FROM NOSE)
 OTORRHEA(CSF FROM EAR)
 PERIORBITAL EDEMA AND
ECCHYMOSIS(RACCOON EYES)
 BRUSHING OVER THE MASTOID PROCESS(BATTLE’S
SIGN)

27. SKULL FRACTURE
BATTLE ‘S SIGNRACCOON EYES

28. Glasgow Coma Scale
 The Glasgow Coma Scale (GCS) is a neurological scale
which aims to give a reliable and objective way of
recording the state of a person's consciousness for initial as
well as subsequent assessment. A person is assessed against
the criteria of the scale, and the resulting points give a
person's score between 3 (indicating deep
unconsciousness) and either 14 (original scale) or 15 (more
widely used, modified or revised scale)

30. CHARACTERIZATION OF TBI
 Clinical severity graded using GCS (Glassgow Coma Scale)
- MILD GCS 13-15
• normal to lethargic, mildly disoriented,
• loss of consciousness to 15-30 minutes.
- MODERATE, GCS 9-12
• Lethargic to obtundend, follows commands with arousal ,
confused, loss of consciousness for up to 6 hours.
- SEVERE , GCS 3-8
Comatose ,no eye opening or verbalization.
Does not follow commands.
Motor examination : ranges from localization to posturing.more
Loss of consciousness more than 6 hours to several days.

31. DECORTICATE
 Decorticate posturing is a posturing that indicates a severe
damage in the brain. This abnormal posturing makes a
person suffer from clenched fists, bent arms and legs that
are held out straight. However, this is not as serious as
decerebrate posture, wherein the particular kind of
posturing appears on both sides of one's body.

32. DECORTICATE

33. DECEREBRATE
 Decerebrate posturing is a sign that brain herniation - a
condition where parts of the brain are pushed past hard
structures within the brain - is occurring or is about to occur
these parts of the brain can herniate down over the dural
folds or through the foramen magnum when intracranial
pressure rises

34. DECEREBRATE

35. DIAGRAMS OF DECORTICATE
AND DECEREBRATE

38. DIAGNOSTIC EVALUATION
 HISTORY
 PHYSICAL EXAMINATION
 X-RAY OF THE SKULL
 CT SCAN
 MRI
 CEREBRAL ANGIOGRAPHY
 CHEST X-RAY
 ABG( ARTERIAL BLOOD GASES)
 ELECTROLYTES

39. PREVENTION OF HEAD INJURY
 PRIMARY PREVENTION
 SECONDARY PREVENTION

40. Complications
 Infection
 Neurological deficit ( difficulty in speaking, seeing,
hearing, walking or understanding)
 Paralysis
 Coma
 Death

41. TREATMENT
 MINOR INJURY TEATED AT HOME(APPLY ICE FOR 20-30
HOUR EVERY 2 HOUR)
 DEHYDRATION THERAPY:- MANNITOL(DIURETICS)
 ANTICONVULSANTS ( PHENYTOIN SODIUM)
 ANTIPYRETICS(PARACETAMOL)
 ANALGESICS(MORPHINE)
 NEUROMUSCULAR BLOCKING AGENT(VANCURONIUM)
 ANTIBIOTICS(MONOCEF)
 OXYGEN ADMINISTRATION
 INTUBATION WITH MECHANICAL VENTILATION)
 CRANIOTOMY

42. SURGICAL MANAGEMENT
 Craniotomy : removal of hematoma by incision to cranium.

43. DIETARY MANAGEMENT
 NPO ( Nill per orally ) nothing to give by mouth until
peristalsis returns.
 Ryles tube feeding or Enteral tube feeding with elevated
position.
 ( Remember to aspirate whenever you provide feed to the
patient and record the aspirated fluid and feeds given)

44. NURSING DIAGNOSIS
 INEFFECTIVE AIRWAY CLEARENCE RELATED TO INABILITY TO
COUGH
 INEFFECTIVE CEREBRAL TISSUE PERFUSION RELATED TO
INCREASED ICP
 IMPAIRED GASES EXCHANGES RELATED BRAIN INJURY
 RISK FOR INJURY RELATED SEIZURE ACTIVITY
 FLUID VOLUME DEFICIT RELATED INABILITY TO TAKE FLUIDS
 ALTERED NUTRITIONAL PATTERN RELATED INCREASED
METABOLIC DEMANDS
 RISK FOR IMPAIRED SKIN INTEGRITY RELATED IMMOBILITY
 URINARY ELIMINATION IMPAIRED RELATED TO ALTERED
CONSCIOUSNESS

45. CONTINUED…
 Altered tissue perfusion related to hypotension, hematoma,
intracranial haemorrhage.
 Altered body temperature related to disturbed metabolic
process.
 Ineffective airway clearance related to coma, bledding into
airway.
 Imbalanced nutrition less than body requirement related to
loss of pharyngeal reflex or coma.
 Infection related to open injury
 High Risk for injury related to restlessness and confusion.
 Constipation related to loss of muscle tone reflexes.
 Risk for impaired skin integrity related to immobility.
 Interrupted family process related to health crisis.

46. Continued…
 Sleep pattern disturbed related to frequent assessment and
loss of REM sleep.
 Impaired physical mobility related to sensory deficits or
coma
 Risk of seizures related to intracranial bleeding, infarction ,
trauma, hypoxia, injuries to the brain.
 Deficient Knowledge related to new procedures and
treatment and expected outcome.

47. NURSING MANAGEMENT
 Monitor vitals specially temperature, blood pressure and
spo2(oxygen saturation) per hourly.
 Monitor neurological status of the client.
 Make a GCS (Glasgow Coma Scale) Charting
 In order to prevent from bed sores or debicutus ulcers
provide air mattress to the patient and change position per
2 hours and as per the doctor advices.
 Inspect and Record the pupil size and constriction and
dilation.
 Urine output should be checked and recorded per 2
hourly.
 Suctioning of the patient secretions and provide oral care
to the patient with proper universal precaution.

48. Continued…
 Check ABC (AIRWAY BREATHING CIRCULATION) of the client.
 Manage ICP (Intra cerebral pressure) and cerebral Oedema.
 Open wound should be covered and pressure applied to
control bleeding.
 To clean the wound with antiseptic solution.
 Dressings should be properly done it should be too tight or too
losses.
 Resist the patient who is fully disoriented and unconsciousness
so that he or she may not fall from the hospital bed.
 Check the Blood Sugar as per the requirement.
 Medication and vitals should be recorded and if any
complications occurs should directly consulted to the doctor.

49. THANKYOU FOR YOUR ACTIVE
LISTENING AND ATTENTION..
IF ANY QUERY REGARDING THE
TOPIC KINDLY ASK….
THE END.