Head injuries can range from minor scalp lacerations to major trauma involving the brain. Common causes include motor vehicle accidents, falls, and assaults. Complications may include epidural or subdural hematomas. Diagnosis involves a CT or MRI scan. Nursing management focuses on maintaining adequate cerebral perfusion, preventing infection and secondary injury, and maximizing recovery of cognitive and physical function.

1. Head Injury

2. Head Injury
• Any trauma to the scalp, skull, or brain
• Head trauma includes an alteration in
consciousness no matter how brief

3. Head Injury
• Causes
– Motor vehicle accidents
– Firearm-related injuries
– Falls
– Assaults
– Sports-related injuries
– Recreational accidents

4. Head Injury
• High potential for poor outcome
• Deaths occur at three points in time after
injury:
– Immediately after the injury
– Within 2 hours after injury
– 3 weeks after injury

5. Head Injury
Types of Head Injuries
• Scalp lacerations
– The most minor type of head trauma
– Scalp is highly vascular  profuse
bleeding
– Major complication is infection

6. Head Injury
Types of Head Injuries
• Skull fractures
– Linear or depressed
– Simple, comminuted, or compound
– Closed or open
– Direct & Indirect
– Coup & Contrecoup

7. Head Injury
Types of Head Injuries
• Skull fractures
– Location of fracture alters the
presentation of the manifestations
– Facial paralysis
– Conjugate deviation of gaze
– Battle’s sign

8. Head Injury
Types of Head Injuries
• Basal Skull fractures
– CSF leak (extravasation) into ear (Otorrhea)
or nose (Rhinorrhea)
– High risk infection or meningitis
– “HALO Sign (Battle Sign)” on clothes of
linen
– Possible injury to Internal carotid artery
– Permanent CSF leaks possible

9. Battle’s Sign
Fig. 55-13

10. Nursing Care of Skull
Fractures
• Minimize CSF leak
– Bed flat
– Never suction orally; never insert NG tube; 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+++

11. Head Injury
Types of Head Injuries
• Minor head trauma
– Concussion
• A sudden transient mechanical head
injury with disruption of neural activity
and a change in LOC
• Brief disruption in LOC
• Amnesia
• Headache
• Short duration

12. Head Injury
Types of Head Injuries
• Minor head trauma
– Postconcussion syndrome
• 2 weeks to 2 months
• Persistent headache
• Lethargy
• Personality and behavior changes

13. Head Injury
Types of Head Injuries
• Major head trauma
– Includes cerebral contusions and
lacerations
– Both injuries represent severe trauma
to the brain

14. Head Injury
Types of Head Injuries
• Major head trauma
– Contusion
• The bruising of brain tissue within a focal
area that maintains the integrity of the pia
mater and arachnoid layers
– Lacerations
• Involve actual tearing of the brain tissue
• Intracerebral hemorrhage is generally
associated with cerebral laceration

15. Head Injury
Pathophysiology
• Diffuse axonal injury (DAI)
– Widespread axonal damage occurring
after a mild, moderate, or severe TBI
– Process takes approximately 12-24
hours

16. Head Injury
Pathophysiology
• Diffuse axonal injury (DAI)
– Clinical signs:
•  LOC
•  ICP
• Decerebration or decortication
• Global cerebral edema

17. Head Injury
Complications
• Epidural hematoma
– Results from bleeding between the
dura and the inner surface of the skull
– A neurologic emergency
– Venous or arterial origin

18. Head Injury
Complications
• Subdural hematoma
– Occurs from bleeding between the
dura mater and arachnoid layer of the
meningeal covering of the brain

19. Epidural and Subdural Hematomas
Fig. 55-15
Epidural Hematoma
Subdural Hematoma

20. Head Injury
Complications
• Subdural hematoma
– Usually venous in origin
– Much slower to develop into a mass
large enough to produce symptoms
– May be caused by an arterial
hemorrhage

21. Head Injury
Complications
• Subdural hematoma
– Acute subdural hematoma
• High mortality
• Signs within 48 hours of the injury
• Associated with major trauma (Shearing
Forces)
• Patient appears drowsy and confused
• Pupils dilate and become fixed

22. Head Injury
Complications
• Subdural hematoma
– Subacute subdural hematoma
• Occurs within 2-14 days of the
injury
• Failure to regain consciousness may
be an indicator

23. Head Injury
Complications
• Subdural hematoma
– Chronic subdural hematoma
• Develops over weeks or months after
a seemingly minor head injury

24. Head Injury
Diagnostic Studies and
Collaborative Care
• 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

25. Head Injury
Nursing Management
Nursing Assessment
– GCS score
– Neurologic status
– Presence of CSF leak

26. Head Injury
Nursing Management
Nursing Diagnoses
– Ineffective tissue perfusion
– Hyperthermia
– Acute pain
– Anxiety
– Impaired physical mobility

27. Head Injury
Nursing Management
Planning
– Overall goals:
• Maintain adequate cerebral perfusion
• Remain normothermic
• Be free from pain, discomfort, and
infection
• Attain maximal cognitive, motor, and
sensory function

28. Head Injury
Nursing Management
Nursing implementation
Health Promotion
• Prevent car and motorcycle accidents
• Wear safety helmets

29. Head Injury
Nursing Management
Nursing implementation
Acute Intervention
• Maintain cerebral perfusion and
prevent secondary cerebral ischemia
• Monitor for changes in neurologic
status

30. Head Injury
Nursing Management
Nursing implementation
Ambulatory and Home Care
• Nutrition
• Bowel and bladder management
• Spasticity
• Dysphagia
• Seizure disorders
• Family participation and education

31. Head Injury
Nursing Management
Evaluation
Expected Outcomes
• Maintain normal cerebral perfusion
pressure
• Achieve maximal cognitive, motor, and
sensory function
• Experience no infection, hyperthermia,
or pain