Head Injury/Test 3

Question 1

Head injury

Answer 1

*any trauma to scalp, skull or brain. Primarily signifies craniocerebral trauma, including an alteration in consciousness.

Question 2

Poor outcomes of head injuries:

Answer 2

presence of an intracranial hematoma; increasing age of the patient; abnormal motor responses; impaired or absent eye movements or pupil light reflexes; early sustained hypotension, hyoxemia, or hypercapnia; ICP levels are higher than 20 mm Hg

Question 3

Major head trauma: Contusion-

Answer 3

bruising of the brain tissue within a focal area. Develops areas of hemorrhage infarction necrosis and edema.

Question 4

Contusion: Coup is

Answer 4

site of direct impact

Question 5

Contusion: Countrecoup

Answer 5

(secondary) injury caused by movement of the brain inside the skull.

Question 6

Laceration is

Answer 6

actual tearing of brain tissue and often occurs in association with depressed and compound fractures and penetrating injuries. Tissue damage is severe and surgical repair is impossible because of the texture of the brain tissue.

Question 7

Delayed responses of laceration:

Answer 7

Hemorrhage, hematoma, formation, seizures and cerebral edema

Question 8

Head Injury: Pathophysiology:

Answer 8

Widespread axonal damage occurring after a mild, moderate or severe TBI. Increasing evidence that axonal damage is not preceded by an immediate tearing of the axon from the traumatic impact, but rather the trauma changes the function of the axon, resulting in axon swelling and disconnection. Takes approximately 12-24 hours to develop and may persist longer.

Question 9

S/S of head injury

Answer 9

• decreased LOC
• increased ICP
• decerebration or decortication
• global cerebral edema

Question 10

Complications of head injury:

Answer 10

epidural hematoma (bleeding between the dura and inner surface of the skull; neuro emergency.

Question 11

S/S of complications of head injury:

Answer 11

• Unconscious at the scene.
• HA
• N/V
• Focal findings
• Subdural hematoma (bleeding between duramater and arachnoid layer of menigeal covering of the brain.) usually venous in origin, slower to develop large enough to produce symptoms

Question 12

Subdural hematoma: Acute

Answer 12

• 24-48 hr after severe trauma
• Immediate deterioration
• Craniotomy, evacuation and decompression

Question 13

Subdural hematoma: Subacute

Answer 13

• 48 hr-2 week after severe trauma
• Pt will show lethargy and will only open eyes to shaking and loud voices calling their name.
• Initial unconsciousness, gradual improvement, deterioration over hrs, dilation of pupils and ptosis.
• Evacuation and decompression

Question 14

Subdural hematoma: Chronic

Answer 14

• Weeks to months, ususally >20 days after injury; often injury seemed trivial or forgotten by patient
• Nonspecific, nonlocalizing progression; progressive alteration in LOC
• Evacuation & decompression, membranectomy

Question 15

Scalp lacerations:

Answer 15

Most minor type of head trauma (many blood vessels with poor constrictive abilities)

Question 16

Scalp lacerations: Major complication:

Answer 16

Infection

Question 17

Skull fractures:

Answer 17

• Linear depression
• Simple
• Closed or open

Question 18

Assessment for CSF leakage:

Answer 18

• Testing to determine if leakage is CSF:
• color
• appearance
• amount of leaking fluid must be noted because both of these tests can give false-positive results

Question 19

Diagnostics for cerebral spinal fluid leakage (CSF);

Answer 19

• Dextrostix or Test-tape (positive for CSF leak)

* “lalo” or “ring” sing if the drainage is bloody, place on white dressing to see if there is a halo

Question 20

Head injury: Minor head trauma

Answer 20

Concussion

Question 21

Concussion:

Answer 21

a sudden transient mechanical head injury with disruption of neural activity and a change in LOC. May not lose total consciousness.

Question 22

Post concussion syndrome:

Answer 22

Two weeks to two months post injury. Persistent headache, lethargy, personality and behavioral changes, shortened attention span, decreased short term memory, changes in intellectual ability. Can significantly affect patient’s abilities to perform activities.

Question 23

Head injury: Major head trauma

Answer 23

• Contusion

* Laceratiion

Question 24

Epidural Hematomas:

Answer 24

• bleeding between the dura and inner surface of the skull; neuro emergency depending on size
• a collection of blood between the skull and the dura
• commonly associated with temporal and parietal fractures
• S/S unconsciousness at the scene, headache, n/v, focal findings

Question 25

Epidural Hematomas: Hallmark sign

Answer 25

*Transient LOC followed by lucid period then rapid neurological decline, unconsciousness at the scene.

Question 26

Symptoms of epidural hematomas:

Answer 26

• Severe headache
• Focal findings
• N/V
• Sleepiness
• Dizziness
• Contralateral hemiparesis or hemiplegia
• Abnormal posturing
• Pupillary changes in S/S unconsciousness at , n/v, focal findings

Question 27

Subdural Hematoma is:

Answer 27

• Bleeding beneath dura mater
• Usually venous in origin, slower to develop a large hematoma to produce symptoms
• From rupture of bridging veins
• Focal brain injuries from acceleration or deceleration forces
• Slower bleed
• Accute <48 hours or chronic

Question 28

Subdural hematoma: High Risk Patients:

Answer 28

• Elderly
• Anticoagulation
• Chronic alcohol users

Question 29

Subdural Hematoma: Acute

Answer 29

• Elderly
• Trips and falls
• strikes head
• 2 days later is confused
• Reported by family to be “acting funny”

Question 30

Subdural Hematoma:

Chronic

Answer 30

• Elderly person
• Normal cerebral atrophy
• Bridging vessels stretched
• Leads to leaking

Question 31

Head Injury: Diagnostic studies and collaborative care:

Answer 31

• CT considered best diagnostic test
• MRI; PET; evoked potentials; transcranial doppler, cervical spine x-ray, Glascow Coma Scale
• Teaching guide

Question 32

Nursing Management: Head Injury: Assessment-

Answer 32

• Glascow coma scale (potential for IICP)

* Presence of CSF leak

Question 33

Nursing Management Head Injury: Diagnosis

Answer 33

• Ineffective airway clearance r/t decreased LOC, immobility and inability to mobilize secretions as manifested by ineffective cough, inability to clear secretions, crackles on auscultation, thick secretions.
• Ineffective tissue perfusion (cerebral) r/t cerebral edema as manifested by Glasgow Coma Scale 20 mm Hg, 10 lb (4.5 kg), abrasions or lacerations.

Question 34

Nursing Management: Head Injury Planning

Answer 34

• Head injury vs. IICP
• protection of CS leak sites
• Positioning
• Avoidance of NG tubes/nasotracheal suctioning
• Protection from injury

Question 35

Nursing Management: head injury: Implementation-

Answer 35

*Long term mental/emotional problems (>6 hrs comatose, personality change) loss of concentration & memory with defective memory processing; personal drive may decrease; apathy & apparent laziness may increase; euphoria and mood swings; loss of social restraint , judgment, tact and emotional control

Question 36

Evaluation/expected outcomes:

Answer 36

• Maintain normal cerebral perfusion pressure
• Achieve maximal cognitive motor and sensory function
• Experience no infection, hyperthermia, or pain

Question 37

Nursing Management: Treatment

Answer 37

*In cases of larger acute subdural hematomas and epidural hematomas or/and associated with significant neurologic impairment, the blood must be surgically removed.