Head Injuries (Final Exam) Flashcards
Death occurs at which three points in time after injury?
1) immediately after = direct trauma and blood loss
2) within 2 hrs after = progressive or internal bleeding
3) 3 weeks after = multi-system failure
What are 5 types of head injuries?
1) scalp lacerations
2) skull fractures
3) diffuse (generalized)
4) focal (localized)
5) coup-contrecoup
What is a major complication of scalp lacerations?
blood loss and infection
What are 5 manifestations of skull fractures?
1) raccoon eyes
2) battle’s sign (bruising behind the ear)
3) Halo sign: yellow-ring staining behind bloody center spot on gauze found in CSF drainage
4) rhinorrhea: leakage of CSF from the nose
5) otorrhea: fluid leakage from the ear
What are 3 considerations for skull fracture manifestations?
1) provide meningitis-prophylactic antibiotics
2) NG tubes are CONTRAINDICATED, use orogastric tube
3) rhinorrhea could be hidden unless the patient is specifically assessed (drain gauze and look for halo sign)
In terms of a diffused head injury, what is a concussion and what may it result in?
a brief disruption in LOC; may result in postconcussion syndrome (2 weeks to 2 months)
What are signs and symptoms of diffused (generalized) head injury? (6)
1) persistent headache
2) lethargy
3) PERSONALITY/BEHAVIOR CHANGE
4) short attention span
5) decreased memory
6) CHANGES IN INTELLECTUAL ABILITY
A focal (localized) head injury contains which 2 subtypes?
1) lacerations
2) contusions
What is a laceration?
tearing of brain tissue
what is a contusion?
bruising of brain tissue
What can contusions lead to (2) and what medication can worsen bleeding?
Can rebleed or seizures can occur
Potential for increased hemorrhage if on anticoagulants !! (assess med regimen)
What is the main complication of a contusion?
EPIDURAL HEMATOMA (neurologic emergency, requires rapid evacuation)
Describe an epidural hematoma (4)
1) initial period of unconsciousness
2) brief lucid interval followed by a decrease in LOC
3) s/s: headache, nausea, vomiting
4) focal findings
What is a coup-contrecoup injury?
patient is hit on the front of the head and bounces back, causing bleeding at the BACK of the head
What is an acute subdural hematoma? (4)
1) occurs within 24-48 hours of injury
2) SYMPTOMS ARE RELATED TO INCREASED ICP
3) decreased LOC, headache
4) ipsilateral pupil dilated (pupil non-reactive to light on affected side) and FIXED IF SEVERE
When is intubation for a patient with a head injury needed? (3)
1) glasgow coma scale >8
2) PaCo2 >20 mmHg
3) C1-C4 injury
first step in emergency treatment for a patient with a head injury?
assume neck AND spinal cord injury = stabilize the cervical spine
Acute care and nursing implementations for a patient with a head injury? (4)
1) elevate the HOB
2) loose collection pad under the nose and over the ear
3) administer antiemetics and analgesics
4) preop preparation if needed = patient should be NPO
nursing care interventions that are CONTRAINDICATED for patients with a head injury? (4)
1) sneezing/blowing nose (pressure)
2) NG tubes
3) nasotracheal suctioning
4) DRINKING THROUGH A STRAW