Head Injury Flashcards by Brina Quintanilla Reyes

A lot of individuals die from head injuries, what are the 3 points in time that death can occur with a head injury?

immediately after the injury (majority)
within 2 hour after the injury progression of bleeding or injurt
3 weeks after the injury. multi-system failure

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what are the 3 complications of skull fractures ?

infections - open wounds
hematomas - bleeding
tissue damage - swelling

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its important to note that the location of the skull fracture will end up determining what ?

clinical manifestations that appear

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there are multiple type of skull fractures. I am going to provide the name of the type and I want you to describe to me what each of it means.

linear - cause by low velocity injury
simple - low to moderate impact
depressed - powerful blow
comminuted - high momentum impact
compound - severe injury
open or closed

break in bone without displacement
( crack in the bone, a line )

without fragments, break in skin or disruption of sinus cavity

depression or inward indentation of skull
(dent in your head)

multiple fracture and scalp laceration with pathway to brain

open fractures involve scalp laceration or sinus cavity integrity

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what are the 4 signs that we will see in a skull fracture ?

battle sign
raccoon eyes
blood behind the eardrum
(hemotampadn)

halo sign

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what is a battle sign?

bruising behind the ear, bruising of the mastoid process

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what is the raccoon eyes sign?

bleeding to the head and causes bilateral black eyes

(broken nose is very common)

blood from the head pulls it down to the eyes

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what is hemotampadn?

blood behind the eardrums
( looking into ear and seeing blood behind the eardrum )

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what is happening with halo sign ?

leaking of cerebral spinal fluid
- usually from your ears or your nose which is bad

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how do you test for the halo sign that its csf? (2)

glucose and it looks like a halo sign
( it looks like a halo )

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why do we care that a patient is having leakage of cerebral spinal fluid ?

infection and horrible headache

( csf protects your brain and spinal cord )

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fracture location
tell me what you’d find

front - brain exposed through frontal sinus, csf leak, air between cranium and dura matter (pneumocranium )

orbital - optical nerve injury

temporal - csf leak, arterial disruption, epidural hematoma

parietal - csf or brain leak, facial paralysis, loss of taste

basilar - base of skull fracture, csf or brain leak, facial paralysis, tinnitus, or healing problems, rhinorrhea, vertigo

posterior fossa - deafness, csf or brain otorrhea, facial paralysis, loss of taste

subs emphysema in forehead

raccoon eyes

battle sign, boggy temporal muscle

battle sign, building tm from blood or csf

battle sign, conjugate deviation of gaze, bulging tm from blood or csf

battle sign, building tm from blood or csf

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head trauma can be either
diffuse or focal (localized ) injury

what does it mean ?
which one do you think is worst?

diffuse
- damage to the brain is not limited to one location

focal (localized)
- damage is localized to one part of the brain

Diffuse worst

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what do you think a concussion is, a diffuse or a focal injury and why ?

diffuse, because its a sudden blow to the head
( disruption in neural activity, possible disruption in loc, headache, short durtation )

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sometimes patients who have concussions can have something called retrograde amnesia, what does this mean ?

you can remember things that happen yesterday and even earlier before that concussion, but can’t remember like 20minutes before leading up to the actual accident that made you have that concussion

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concussion usually have a short duration of unconscious and the symptoms are respected to the side of the head you actually got hit on, and treatment is usually pretty well, however it can result in something called post-concussion syndrome, meaning what?

persistent headache, lethargy

personality and behavior changes

shorten attention span, decreased short-term memory

changes in intellectual ability

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how long can post concussion syndrome last?

2 weeks to 2 months post injury

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its important to note that a post concussion, the symptoms of the original concussion has resolved, however you have what ?

personality changes, short attention spam, decreased short term memory, persistent headache

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post concussion syndrome is not normal however what ?

it can be expected to happen

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what is diffuse axonal injury ?

results from brain movement due to injury-tissue shearing causes tears in axons resulting in cellular death.

can be caused by functional changes after trauma resulting in swelling

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what are some clinical manifestation of diffuse axonal injury ? (3)

decreased loc, increased icp, global cerebral edema

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what is the posturing that we can see in a patient who received an diffuse axonal injury ?

decorticate or decerebrate posturing

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patients may also get something called a focal- lacerations which is what ?

tearing of brain tissue
( only a piece of the brain is lacerated )

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focal-lacerations our main concern is what?

hemorrhages - its in the name, lacerations/ bleeding

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most of the time in focal lacerations we try to go in and do a surgical repair, but what happens?

its so intense because of how deep, depressed and open fracture it is that its nearly impossible

what is a focal contusion?

bruising of brain tissue typically with closed head injury

what are the clinical manifestations of focal- contusion?

hemorrhage infarction necrosis edema

what is a coup-contrecoup injury ? think of the picture

brain moves within skull due to high impact injury injury at point of impact and opposite side coup - primary impact ( first time hitting head forward ) contre-coup = secondary impact ( head hitting a second time in the back )

which one is worst and why? coup or contrecoup?

contrecoup - because this is two injuries now and usually symptoms are contrecoup

its important to ask question to figure out how the head injury happened, but what is the first priority though ?

airway, breathing, circulation!!!! But remember its still helpful to aid with it

how can we see a focal contusion on the ct?

its rebleed in the brain "blossom"

focal-contusion can have focal and generalized manifestations, which examples are these??

two types of seizures pretty much ,dont look too into it, she doesn't talk much on it

if a patient has any form of head injury, in which csf leakage, icp happens or bleeding, seizures are very common in happening, so we like to do what?

have seizure precautions in place - rails up - stand by - anti-convulsants

what is an epidural hematoma?

medical emergency of bleeding between the dura and the inner surface of the skull

if we do not get rid of a epidural hematoma, they will die. it can be either what two types of hematoma?

venous or arterial

a venous epidural hematoma its going to be very what ? a arterial epidural hematoma its going to be very what? so which one is worst, so pretty much is saying which is going to be bleed out faster, the vein or the artery ?

slow rapid artery

what is the main clinical manifestation of epidural hematoma?

brief lucid interval followed by decrease in loc like you wake up then you just slowly knock out ( headaches, nausea, vomiting , focal findings are common )

a epidural hematoma requires rapid evacuation of hematoma to prevent what?

herniation and death

what is a subdural hematoma ?

bleeding between the dura mater and the arachnoid layer

most common source of subdural hematoma is the what ____that drains the brain surface into the _____sinus

veins sagittal sinus

acute subdural hematoma is within what time frame?

24-48 hours of the injury

subacute subdural hematoma is within what time frame ?

2-14 days of the injury

acute subdural hematoma clinical manfiestions are what ?

ipsilateral pupil dilated and fixed if severe ( one pupil dilated and fixed ) - decreased loc, headache, symptoms related to increase cranial pressure

what is the subacute subdural hematoma clinical manifestions?

slow change, may appear to enlarge over time enlargement is caused by breakdown of hematoma causing increase in fluid

what is the Time frame of a chronic subdural hematoma?

weeks or months after injury

we normally see which type of patients have chornic subdural hematoma and why ?

older adults - because they have brain atrophy which cause increase subdural space

Patients who have chronic subdural hematoma have increase risk for what?

misdiagnosis, symptoms difficult to diagnose

most of the time patients have what type of symptoms with chronic subdural hematoma and why ?

focal symptoms typically a certain area of the brain is developing that hematoma and so its just causing that one area to produce symptoms

what is intracerebral hematoma ? usually within frontal and temporal lobes size and location of hematoma determine patient outcome

bleeding within the brain tissue

how do we diagnose a head injury ?

CT scan MRI EEG blood glucose glasgow coma scale ICP level

what is the emergency treatment we are going to do for patient with head injuries ?

patent airway stabilize cervical spine oxygen IV access control external bleeding

its important to note that even when patients get a spinal cord or even head injury they can walk talk move all just fine, however its always important to what and why ?

stabilize cervical spine - to prevent further injury and rule out that it isn't a neck/head injury present

when do you think we should intubate a patient with a head injury? when during the GCS or a reflex is not present

GCS less than 8 or if gag reflex is affected

additional emergency treatment notes - remove patients clothing - maintain patient warmth - ongoing monitoring - anticipate possible intubation - assume neck injury - administer fluid cautiously

why do you think we need to keep a patient warm?

cause shivering will increase metabolic needs - calories and muscles and fat breakdown

collaborative care - Treatment principles - Prevent secondary injury - Timely diagnosis - Surgery if necessary - Concussion and contusion - Observation and management of ICP

if you have a depressed skull fracture you need what?

surgery

if you have subdural or epidural hematoma you need to have what?

surgical evacuation craniotomy craniectomy

notes story when a patient has hematoma, they might need to take a flap of your skull and put it into your abdomen, cause we need to put it back in and keep it sterile inside your body. remember abdomen is huge, gets blood supply, you won't lose it!

nursing assessment - subjective notes Mechanism of injury Medications-anticoagulants Alcohol/drug use; risk-taking behaviors Headache Mood or behavioral changes Mentation changes; impaired judgment Aphasia, dysphasia Fear, denial, anger, aggression, depression

nursing assessment objective notes altered mental status Lacerations, contusions, abrasions Hematoma Battle’s sign Periorbital edema and ecchymosis Otorrhea Exposed brain Rhinorrhea Impaired gag reflex Altered/irregular respirations Cushing’s triad Vomiting Bowel and bladder incontinence Uninhibited sexual expression Altered LOC Seizures Pupil dysfunction Cranial nerve deficits Motor deficit Palmar drift Paralysis Spasticity Posturing Rigidity or flaccidity Ataxia

nursing diagnoses Risk for ineffective cerebral tissue perfusion Hyperthermia Impaired physical mobility Anxiety Potential complication: increased ICP

nursing planning Overall Goals Cerebral oxygenation & perfusion Normothermic Control pain and discomfort Free of infection Adequate nutrition Maximal cognitive, motor, and sensory function

Health Promotion notes Prevent car and motorcycle accidents. Wear safety helmets. Use seat belts and child car seats. Home safety to prevent falls

Acute Intervention Maintain cerebral perfusion. Prevent secondary cerebral ischemia. Monitor for changes in neurologic status. Patient and family teaching

Acute Intervention notes Major focus of nursing care relates to increased ICP. Eye problems Eye drops, compresses, patch Hyperthermia Goal 36°to 37° C Prevent shivering

we dont want patients to sneeze or blowing nose when having a head injury and no ng tubes or suctioning why ?

because bleeding, pressure and infection are all high

Acute Intervention notes Bowel/bladder interventions, skin care, ROM Antiemetics - forceful vomit Analgesics Pre-op preparation, if needed

Ambulatory and Home Care Acute rehabilitation Motor and sensory deficits Communication issues Memory and intellectual functioning Nutrition Bowel and bladder management

Ambulatory and Home Care Seizure disorders-likely to develop in first week, but can appear years later Mental and emotional difficulties Progressive recovery-6 months or more Family participation and education

Expected Outcomes Maintain normal cerebral perfusion pressure. Achieve maximal cognitive, motor, and sensory function. Experience no infection or hyperthermia. Achieve pain control.

apparently patients with head injury become very what?

sexual

what medication can cause more bleeding if a patient is taking it ?

anti coagulants

vital meningitis most common causes are what?

enterovirus, arbovirus, HIV and HSV

how is viral meningitis spread?

direct contact with respiratory secretions

what are clinical moanifestaionts of vital meningitis?

headache, fever, photophobia and stiff neck

what is the diagnostic study to test for vital mengintis ?

test for csf

how do we treat meningitis ?

antibiotics after obtaining diagnostic sample but while awaiting test results

what is encephalitis ?

acute inflammation of the brain

what is encephalitis caused by ?

virus ( ticks or mosquitoes too )

what is cmv encephalitis caused by ?

progression of aids with patients with aids

what are clinical manifestations fo encephalitis? when do they appear

fever, headache, nausea, vomiting 2-3 days

what are diagnosis studies for encephalitis ?

CT, MRI, PET, PCR TESTS FOR HSV, BLOOD TESTS

Mosquito control for prevention Nursing management is symptomatic and supportive Intensive care may be required

what 2 medications are we going to give for encephalitis ?

acyclovir ( Zovirax ) vidarabine (vira-a) for hsv infection

sometimes we may give what type of drugs to prevent or control seizures that can happen with encephalitis ?

anti-seizures drugs

rifampin is used for vital meningitis too to try to prevent bacterial meningitis - very very continuous - vaccine against this too

Head Injury Flashcards

(87 cards)