6-head Injuries
Bradycardia, Bradypnea, hypertension
A nurse caring for a patient with head trauma will be monitoring the patient for Cushing's Triad what will the nurse recognized as the symptoms associated with Cushing's Triad?
Flaccid
A patient has a severe neurological impairment from a head trauma. What does the nurse recognize is the type of posturing that occurs with the most severe neurological impairment?
Brain injuries
Brain Injuries Brain injuries can be of two types: • Concussion: Generally mild. This is a temporary loss of function generally resulting from injury. The patient must be closely observed for memory loss, headache, or seizures, but will generally recover without incident. A classic concussion presents with loss of consciousness and there may be accompanying amnesia. • Contusion: Bruising or damage to the brain usually in the frontal or temporal lobes. This is a more severe type of injury resulting from acceleration-deceleration (typically seen in injuries where a helmet was not worn, or trauma). Symptoms include loss of consciousness, confusion, and possibly stupor.
Head injuries
Concussion: Repetitive questioning, brief LOC Skull Fracture: Battle sign (bruising of mastoid process), Raccoon's eyes, Cerebrospinal fluid leak, blood in EAC EDH, SDH, ICH: Seizure, Altered Mental Status, Pain, Focal Deficits In the elderly, clinical acumen cannot reliably exclude significant injury
Head injuries Treatments
Consider transfer to traumacenter Neurosurgical consult Hyperventilation controversial, Airway protection for GCS <8 or rapid decline Mannitol/Hypertonic saline for ICP Burr hole Correct platelets, coagulopathy Avoid hypotension/hypoxia
Head Injuries
Even subtle changes in mood, behavior, restlessness, irritability, confusion may indicate increased ICP
Head injuries and concussion
Head injury refers to trauma to the head, which can be a result of assaults, car accidents, falls or sporting collisions. Although they tend not to be dangerous, superficial head injuries can bleed profusely due to the vast number of blood vessels in the scalp. However, internal head injuries, may lead to permanent brain damage or death, and urgent medical attention is required. Concussion is a temporary loss or altered state of consciousness, generally occurring following a blow to the head. Concussions need to be treated seriously, as the victim might have internal damage. Although a victim who has been concussed may make a speedy recovery, they need to be monitored for some time following the concussion.
Head injuries
May involve skull fractures Hemorrhage and edema Direct injury to brain tissue Injury may be mild. Bruising of the tissue Can be severe and life-threatening Destruction of brain tissue Massive swelling of the brain
Head injuries
Skull Fractures Skull fractures can be of the following types: • Simple: Break in the bone Comminuted: Splintered break • Depressed: Depression of the bones in the skull due to injury. Requires surgical repair. • Basilar: Base of the skull • Open: Tear in the dura mater • Closed: No tear or disruption
0-10mmhg
The nurse is caring for a patient in the neurologic ICU who sustained head trauma in a physical altercation. What would the nurse know is an optimal range of ICP for this patient?
70mmhg
The patient is admitted to the hospital with an ICP reading of 20 MMHG and a mean arterial pressure of 90 MMHG. What would the nurse calculate the CPP to be?
Interventions
Turning and positioning the patient, assessing pedal pulses, monitoring urine output, evaluating PT and OT, maintaining airway, and keeping tubes patent and unkinked are applicable nursing interventions for head and spinal cord injuries.
Head Injuries
_________: Trauma to the skull can result in mild to severe brain damage. Complications include cerebral bleeding, hematomas, increased intracranial pressure (ICP), infections, seizures. personality changes, cranial nerve deficits, or cognitive impairment. Head injuries are either open or closed. In open injuries there's a scalp laceration, skull fracture and interruption of the dura mater. Closed injuries include concussions, contusions and fractures.