Week 10 - Head Injuries Flashcards
describe the continuum of head injuries
- can be mild ex. concussion
- or sever ex. traumatic brain injury (TBI)
what are examples of causes of head injuries (4
- car accidents
- falls
- assaults
- sports & recreation
the presentation of head injuries depend on.. (2)
- severity of injury
- location (frontal, occipital, parietal, basilar etc.)
who are involved in the care of head injuries
- neurosurgery physicians/team
what diagnostics are used for head injuries
- CT head
- Xray of the cervical spine (high risk of vertebral fracture)
describe when head CT’s are done for head injuries
- at time of arrival/injury
- repeat CT scan 48 hr later and compare
what is a risk associated w head injuries
- IICP
describe the prognosis associated w head injuries
- very high risk of death
- either occurs immediately after injury (d/t damage of brain structures or hemorrhage)
- 2hr after injury (secondary to organ trauma)
- if survive 2hr period, death usually does not occur until 3 weeks after event (d/t multiple organ failures)
what is a basilar skull fracture
- fracture that occurs at the base of the skull
what are 2 signs of a basilar skull fracture
- battle sign
- raccoon eyes
what is the battle sign
- post auricular ecchymosis
- bruising around the ear
what is the racoon eyes sign
- bilateral periorbital ecchymosis
- bruising around the eyes
what influences the clinical manifestations of skull fractures
- location of the skull fracture
if the pt is awake with a skull fracture, what are common compliants by the pt? (4)
- tinnitus
- poor hearing
- vertigo
- facial paralysis
what is a complication of facial and skull fractures
- dural tear ) CSF leak)
what is a dural tear
- tear of dura mater (membranes surround brain) = leak of CSF
what is it called when CSF leaks through the ear
- ottorhea
what is it called when CSF leaks through the nose
- rhinorrhea
what is a risk associated with a dural tear (and therefore a facial and skull fracture)
- meningitis risk
what safety concern is associated w skull fractures
- risk of NG tube insertion going into the brain
what are ways to determine if nasal drainage is mucus or CSF
- halo sign
- dextrose stirp test
describe the halo sign to determine if leakage is CSF
- soak exudate w 4x4
- watch for a few min to see if halo appears
- blood will be in the center, with the CSF creating a halo around
describe the dextrose strip test to determine if nasal drainage is CSF
- CSF = rich in sugar
- mucus = no sugar
- use a strip test to see if has glucose or not
note: blood also rich in sugar, therefore if blood is in the drainage may get a false positive
what is a focal head injury
- head injury that occurs in a specific area ( not diffuse bleeding all over)
- bruising of brain tissue within a focal area
what signs are seen w a focal head injury (3)
- focal signs
- but can lead to overall IICP
- seizures common
what is the prognosis of a focal head injury
- depends on severity of contusion & whether it continues to evolve
what diagnostic is used for focal head injuries
- CT scan (can detect the extent of bleeding)
what is a contre-coup injury
- an injury that occurs both at the site of trauma and the opposite side of the brain from the force of the impact
- leads to multiple contusions
what are priorities with a focal head injury (3)
- CT
- monitor for IICP
- no treatment to stop brain bleeds
what is a diffuse axonal injury
- widespread axonal damage that occurs after a TBI
- shearing of neurons –> axons swell and disconnect d/t trauma
describe the severity of DAI
- can be mild (concussion)
- or severe
describe the recovery of a pt with severe DAI
- 90% remain in a vegetative state
at what point after a TBI does DAI occur
- 12-24 hrs after initial TBI
what does DAI result in (3)
- global cerebral edema
- IICP
- decerebrate posturing
what is a complication of a head injury
- hemorrhage
what are two types of hemorrhage that can occur as a complication of head injury
- epidural hematoma = emergent
- subdural hematoma
what is an epidural hematoma
- bleeding between the dura and skull
describe the severity of an epidural hematoma
- emergency
- usually arterial = bleeds fast = ICP increases fast
what is the treatment for an epidural hematoma
- immediate surgery to remove the bleed
what is included in nursing care for an epidural hematoma (2)
- nursing care for IICP
- will have a monitor and drain in place
what is a subdural hematoma
- bleeding that occurs between the dura and arachnoid space
a subdural hematoma is usually… what does this mean
- venous = less urgent
what is an acute subdural hematoma? subacute? chronic?
- acute = up to 48 h after TBI
- subacute = within 48h to 2 weeks after TBI
- chronic (weeks or months after injury)
what is the treatment for subdural hematoma
- surgery to remove bleed
what is the nursing care for subdural hematoma
- nursing care for IICP`
what are the overall goals of head injury nursing mngmt (4)
- maintain adequate cerebral perfusion
- remain normothermic
- be free from pain, discomfort, and infection
- attain maximal cognitive motor & sensory function
what are key nursing assessments for head injuries (3)
- monitor changes in LOC and neuro status –> sometimes q2min
- halo test for CSF leak
- treat IICP
what are initial, at the scene, emergency mngmt interventions (6)
- calm, gentle approach
- patent airway
- stabilize cervical spine until xray
- apply pressure to external bleeding
- warm blankets
- assess for rhinorrhea, otorrhea, scalp wounds
what are emergency mngmt interventions once the pt has access to the hospital (11)
- O2 via NP or re-breath mask
- establish 2 large bore IVs
- keep warm
- frequent neuro VS checks
- ongoing monitoring of VS, O2 sats, cardiac rhythm, GCS, pupils, limb strength
- support pt & family
- watch for pain & infection
- if pt off baseline, CT
- support other organ systems
- meds
- prep for surgery if needed
what meds are used during emergency interventions for a pt w a head injury once at the hospital (3)
- pain meds
- prevent seizures
- drugs to decrease ICP and increase CPP
describe fluid admin in a pt w head injury
- give cautiously
describe ways to keep a pt w a head injury warm (3)
- IV fluids
- warming lights
- warm blankets
what is included in frequent VS neuro checks for a pt w head injury (2)
- monitor for IICP
- monitor for decreased CPP
