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Complex 2 > Head Injury > Flashcards

Head Injury Flashcards

1
Q

Head injury

A

Any trauma to the scalp, Skull, or brain

Includes…. an alteration in consciousness no matter how brief

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2
Q

Cause of Head injury

A 
MVA
Firearms
Falls
Assault
Sports
Recreational accidents
Substance abuse
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3
Q

High potential for poor outcomes (DEATH) 3 times

A
  1. Immediately after injury
  2. Within 2 hours after injury
  3. 3 weeks after injury
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4
Q

Types:

Scalp Lacerations

A
  • The most minor type of head trauma
  • Scalp is highly vascular-> profuse bleeding, blood vessels do not vasoconstrict as readily
  • Major complication is INFECTION
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5
Q

Types:

Skull fracture

A 
Linear or depressed
  -Swollen, eccymotic area on scalp
  -Possible scalp laceration
Simple, comminuted or compound
closed or open
  -depressed
Direct and indirect 
Coup and Contrecoup
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6
Q

Basal Skull Fracture:

Anterior Fossa

A
  • Rhinorrhea
  • Bilateral ecchymotic eyes / Raccoon eyes
  • May have injury to CN I
  • May have facial fracture
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7
Q

Basal Skull Fracture:

Middle Fossa

A

Otorrhea or rhinorrhea
Battle signs
May have cranial nerve damage

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8
Q

Basal Skull Fracture:

Posterior Fossa

A

May have epidural hematoma
Cerebellar, brainstem or cranial nerve signs
-visual changes, tinnitus, facial paralysis , conjugate eye deviation

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9
Q

Skull fracture

A

Location of fracture alters the presentation of the manifestations
Frontal=Cranial nerve I
Temporal= Facial paralysis =Cranial nerve VIII
Deviated gaze
Battle sign

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10
Q

Nursing Care of Skull Fractures

A 
Minimize CSF leak 
  - Sit pt up 30-40*
  -Never suction orally; 
  -never insert NG tube
  -NO q Tips 
  -Caution pt not to blow nose
Place sterile gauze /cotton ball around area
Verify CSF leak: 
  -Dextrostix : positive For glucose  (HALO ring)
  -Monitor closely : resp status
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11
Q

Mild Traumatic brain injury

A

Occurs with head injury due/to contact and/or acceleration/deceleration forces

  • Defined as a 13-15 on GCS measured 30 mins post injury
  • Concussion
  • A sudden transient mechanical head injury with disruption of neural activity and change in LOC
  • Stretching of nerve fibres no structural alteration
  • Brief disruption in LOC
  • Anemias
  • Headache
  • Short duration
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12
Q

Hallmark symptoms of Mild traumatic brain injury

A

Confusion and amnesia

Often with preceding loss of consciousness

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13
Q

Minor head trauma:

Postconcussion syndrome

A 
2 weeks to 2 months
Persistent headache
Lethargy
Personality and behaviour changes
Dizziness
Fatigue 
Irritability 
Anxiety
Insomnia
Loss of concentration and memory
Noise and light sensitivity
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14
Q

Major Head Trauma

A

Includes cerebral contusion and laceration

Severe trauma to the brain

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15
Q

Types of major trauma:

A

Contusion: bruising of brain within a focal area that maintains the integrity if the pia mater and arachnoid layers still intact

Lacerations: Involves actual tearing of the brain tissue
Intracerebral hemorrhage is generally associated with cerebral laceration

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16
Q

Diffuse Axonal Injury: DAI

A

Axonal Disruption is widespread throughout the cerebral hemisphere and anatomic interruption of neuronal pathways
-Process takes approx 12-24 hrs (for swelling to take place)
Loss of consciousness ^ICP

17
Q

Clinical signs: DAI

A

Decreased LOC
^ICP
Abnormal posturing
Global cerebral edema

18
Q

Layers of the brain

A

Skull

  • Dura Mater
  • Subdural Mater
  • Arachnoid
  • Subarachnoid
  • Pia Mater
19
Q

EPIDURAL Hematoma

A

Results from bleeding b/w the dura and the inner surface of surface of the skull
-Linear skull fracture
A neurologic emergency
Venous or arterial origin

  • hx: Short period of unconsciousness followed by lucid interval and then rapid deterioration
    Headache
    ^ Irritability to confusion
    decreased LOC
    Ipsilateral oculomotor paralysis -fixed pupils
    Contralateral hemiparesis/hemiplegia
20
Q

SUBDURAL HEMATOMA

A

Occurs from bleeding b/w the dura mater and arachnoid layer of the meningeal covering of the brain

  • Usually venous in origin
  • Much SLOWER to develop into a mass large enough to produce system
  • May Occur spontaneously
  • Prevalent in older pt with cerebral atrophy and alcoholics
21
Q

Acute Subdural Hematoma

A 
High mortality
SIGNS w/i 48 hrs of the injury 
-Associated with major trauma (shearing forces)
-Patient appears drowsy and confused 
-Ipsilateral oculomotor paralysis 
-Contralateral hemiparesis/hemiplegia
Shows signs of ^ICP earlier
22
Q

SUBACUTE Subdural Hematoma

A

Occurs w/i 2-14 days of injury
FAILURE to regain consciousness may be an indicator
-See in older pts

23
Q

CHRONIC Subdural Hematoma

A

Develops over weeks or months after a seemingly minor head injury

  • Fibroblast accumulate around the hematoma and encapsulates it
  • Hemolysis of the clot liberates plasma proteins causing high osmotic pressure
  • High osmotic pressure causes an influx of water and swelling of the mass
24
Q

Diagnostic Studies:

A

CT scan *** best to determine test to determine
MRI
C-Spine
GCS

25
Q

Collaborative management:

A

Assessment
GCS
Neurologic status
Presence of CSF

26
Q

Collaborative management:

Overall goals

A
  • Maintain adequate cerebral perfusion
  • Remains normothermic
  • be free from pain, discomfort and infection
  • Attain maximal cognitive, motor , and sensory function
  • detect/treat crania; , intracranial , extracranial
  • prevent/monitor for clinical indications of intracranial hypertension (^ICP)
  • Maintain airway, ventilation, oxygenation
  • Assume spinal injury until cleared
  • Use oral airway
  • Prevent further bleeding: Osmotic diuretics (pulls fluid from tissue to vascular . B/c the tamponade effect of the hematoma helps to stop the bleeding
  • monitor for post op re-bleeding and /or cerebral edema
  • Prevent seizure
  • Monitor complications: Intracranial pressure
  • Hydrocephalus ^CSF
  • CNS
  • Diabetes insipidus
  • SIADH
  • Seziure
27
Q

Ambulatory and Home Care

A 
Nutrition
Bowel and bladder management
Spasticity
Dysphagia
Seizure disorders
Rehabilitation
Fam participation and education
28
Q

Health promotion

A

Prevent car and motorcycle accident

Wear saftey helmets

Complex 2 (4 decks)

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