T3-Blueprint: Head Injuries Flashcards
What are the normal percentages of head? What happens if one of these percentages changes?
Brain: 80%
CSF: 10%
Blood: 10%
Body has to adjust
What concerns might the nurse have about sedation in the acute head injury patient?
Interferes with the need to perform periodic neurological exams to assess for LOC and extent of injury
Why do infants handle ICP better?
Fontanels are not closed yet–more room for growth
What are signs of ICP?
- Headache (on awakening, in absence of eating)
- Vomiting
- Personality changes
- Irritability, fatigue
- Gait changes
- Double/blurred vision
- Pupils react more slowly, then dilate and become fixed
- Increased head circumference
- Bulging fontanels
- LOC: sleepy to coma (decreased recognition of parents)
What are late signs of ICP?
- Cushings triad
- Bradycardia
- Increased BP
- Irregular breathing
What is cushings triad (late sign of ICP)?
Bradycardia
High BP
Slow breathing
What does ICP monitoring tell?
Amount of pressure build up in head
What does a ventricular catheter do?
Surgical insertion that burrs a hole (external ventricular drain)…it drains excess CSP
What is the name of the catheter the surgeon can manipulate?
Bolt catheter
What are some treatments for ICP?
- Mannitol
- Steroids
- Versed
- Antibiotics
- Anti-epleptics
- Barbituates
- Phenobarbital
Should we do neck compression for ICP? Explain
Avoid; keep the head midline and elevate HOB
How should environment be for child with ICP?
Calm environment
How should child eat if they have ICP?
NG feedings
How do we hydrate child with ICP?
2/3 maintenance–dont want to increase ICP even more by adding lots of extra fluids
Signs of ICP?
- Headaches
- Irritability
- High pitched cry
- Vomiting
- Visual changes
- Ataxia
- Seizures
What is a neurological sign of ICP?
“Cat cry”
What are the 5 LOC states?
- Lethargy
- Obtunded
- Stupor
- Coma
- Persistent vegetative state
Falls asleep quickly
Lethargy
What is obtunded?
Arousable with stimulation
Deep sleep, responds to vigorous, repeated stimulation
Stupor
What is coma?
No response to decerebrate posturing to pain
Eyes open, limbs spastic, no words, some swallow
Persistent vegetative state
What are 3 parts to glasgow coma?
- Eye opening (up to 4 pts)
- Verbal response (up to 5 pts)
- Motor resposne (up to 6 pts)
How is glasgow coma scored?
3-15
What is a good glasgow coma score?
15
What is a poor score for glasgow coma?
8 or less (3=worst)
What is the last sense to be lost with coma?
Hearing
What are nursing interventions for a child with an acute head injury?
Anti-inflammatory meds and pain management
What are nursing interventions for the unconscious child?
- ABC (only suction if needed)
- Pain control
- ICP monitoring
- Bowel functioning
- Skin care
What are long term issues of a child with an acute head injury?
Physical problems
Cognitive impairments
Premature closures of the sutures/absence of sutures
Craniostenosis
Craniostenosis is the result for premature closure of the sutures/absence of sutures. What does that cause?
Increased ICP–> seizures, coma, death
What are manifestations of craniostenosis? What age?
Early CORONAL sutures will show depression of the ORBITAL roof leading to visual changes like exophthalmia, strabismus, and other eye findings
18 months
What is the mangement for craniostenosis?
Frequent positional changes in newborns and infants
What is the treatment for craniostenosis?
Need surgical correction to realign cranial bones which relieves ICP pressure and helps cosmetic issues
If craniostenosis is not treated, what happens?
Brain damage and mental retardation can occur
What is the post-op for craniostenosis?
- Emotional support
- PRESSURE DRESSINGS
- Careful monitor of Hct and Hgb!
Small skull due to lack of brain growth
Microcephaly
What are 5 etiologies for microcephaly?
- Cromosomal abnormality
- Radiation exposure in preg.
- Maternal infections like rubella or toxoplasmosis
- Maternal alcoholism
- 3rd trimester trauma, metabolic disorders, anoxia
Hypoxic-ischemic brain injury: What are near drownings for infants and toddlers?
Infants: bath tub
Toddlers: toilet bowel
What happens in hypoxic-ischemic brain injuries?
- Laryngospasm
- Swallow water
- Vomit, gasp, aspirate
- Blood shunts to the brain and heart
- Hypoxia leads to brain damage!!!
What happens in shaken baby syndrome?
Retinal hemorrhages
Torn subdural vessels
What is the most common head injury?
Concussion
What is the hallmark signs of concussion?
Amnesia
Confusion
Cranial injury: What kind of fracture? Treatment?
Skin laceration and fracture
Compound–antibiotics and surgery
Cranial injury: What type of fracture?
Result in dural year, hemorrhage into nose and middle ear
Basilar
Cranial injury: What are 2 key signs of basilar fractures?
- Raccoon eyes
2. Battle sign
Cranial injury–basilar fracture
What is raccoon eyes?
Anterior basal fractures!
Bilateral periorbital ecchymosis–associated with orbital fractures
Cranial injury–basilar fracture
What is the battle sign?
Effusion of blood under ear
Retroauricular ecchymosis
Fracture of auditory canal/lower areas of the skull!
Cranial injuries: What type of fracture?
Traumatic separations of cranial sutures
Diastatic
Why do kids get cranial injury easier?
- Insufficient musculoskeletal support of head
- Thinner, softer brain
- Thinner and compliant skull of younger children
If a child has unilateral dilated pupils, what does this mean?
Intracranial mass
If a child has a brainstem herniation what will their pupils be like?
Fixed and dilated
What does it mean if a child has bilateral fixed and dilated pupils?
Brainstem herniation from increased ICP
What kind of pupils for inter cranial mass?
Unilateral dilated
What kind of injury if child has fixed and dilated pupils?
Brainstem herniation
What kind of pupils will child have if they have a brainstem herniation from increased ICP?
Bilateral fixed and dialted
