2. HEAD INJURY
ï¶ Traumatic brain injury (TBI) is a noncongenital insult to
the brain from an external mechanical force, possibly
leading to permanent or temporary impairment of
cognitive, physical, and psychosocial functions, with an
associated diminished or altered state of consciousness
4. MECHANISM OF INJURY
ï¶ COUP-CONTRECOUP INJURY: The French word âcoupâ
means âblowâ.
ï¶ The client sustained a combined injury at the point of
impact & an injury on the site of the brain opposite from
the movement of the brain within the skull.
ï¶ Contrecoup: Means opposite side away from the injury.
6. MECHANISM OF INJURY contâŠ
ï¶ PENETRATING TRAUMA: A form of primary injury
include injury to the skull by any foreign body such as
knife, bullets or those made by bone fragments from a
skull fracture.
ï¶ SCALP INJURIES:
ïŒ Lacerations: A deep cut or tear on the skin
ïŒ Hematomas: Localized collection of blood outside the
blood vessels
ïŒ Contusion: Bleeding & swelling inside brain around the
area where the head was struck.
9. MECHANISM OF INJURY contâŠ
ï¶ SKULL FRACTURES:
ï Linear SF : Appear as thin lines on X-Ray & donât require
treatment, they are important only if there is significant
underlying brain damage.
ï Depressed SF: May be palpated & are seen on X-Ray.
ï A Compound fracture involves a break in, or loss of, skin
and splintering of the bone
10.
11. SKULL FRACTURES contâŠ
ï Comminuted fractures in which broken bones displace
inward
ï Basilar SF: Occur in bones over the base of frontal &
temporal lobes. Not observable on X-ray but,
manifested as âEcchymosisâ around the eyes or behind
the ears by leakage of blood or CSF from ears.
14. MECHANISM OF INJURY contâŠ
ï¶ BRAIN INJURIES:
ïŒ Concussion: A head trauma that may result in loss of
consciousness from 5mins or less & retrograde amnesia
there is no break in skull & no damage is visible on CT or
MRI scan.
ïŒ Contusion: A contusion is a bleeding bruise to the brain
caused by a direct impact to the head.
15. SIGN AND SYMPTOMS
ï CSF or other fluids draining from the ear or nose
ï Blood behind the tympanic membrane
ï Battleâs sign
ï Vision changes & damage of optic nerve
ï Hearing loss
ï Loss of sense of smell
ï Loss of eye movement
ï Nystagmus
19. MANAGEMENT
ï INITIAL MANAGEMENT
ï¶ A: Airway control including cervical spine
immobilization with a stiff collar.
ï¶ B: Breathing
ï¶ C: Circulation
20. MANAGEMENT contâŠ
ï CONTROL OF INTRACRANIAL PRESSURE:
ï¶ Position head up 30Âș
ï¶ Diuretics: Furosemide,
ï¶ Mannitol
ï¶ Seizure control: Barbiturates
ï CALCIUM CHANNEL BLOCKERS
ï OXYGENATION
21. SURGICAL MANAGEMENT
ï Craniotomy: Bone flap is temporarily removed
from the skull to access the brain
ï Craniectomy : Excision into the cranium to cut
away a bone flap
ï Cranioplasty : Surgical repair of a defect or
deformity of a skull
25. NURSING DIAGNOSIS
ï Ineffective tissue perfusion (cerebral)
ï Acute pain (headache) related to trauma and cerebral
edema
ï Hyperthermia related to loss of cerebral integrative
function secondary to possible hypothalamus injury
ï Impaired physical mobility related to decreased LOC and
treatment âimposed bed rest
26. NURSING DIAGNOSIS
ï Fluid volume deficit related to decrease LOC and
hormonal dysfunction.
ï Risk for injury related to decreased level of
consciousness.
ï Knowledge deficit regarding the treatment modalities and
current situation.
ï Anxiety related to abrupt change in health status,
hospital environment and uncertain future