Head injury
Traumatic Brain
Injury
Dr/ Naglaa gamal
Assistant Professor of Critical Care Nursing
2024
Outlines
Introduction
Definition
Pathophysiology
Etiology of head injury
Clinical Presentation
Assessing the Severity of traumatic brain injury
Diagnostic Tests
Management
Complication
Nursing care for patient with head injuries
Introduction:
Traumatic brain injury is a global problem that leads to
morbidity and mortality particularly among young
people, Includes any injury or trauma to the scalp, skull,
or brain. A serious form of head injury is traumatic brain
injury. Statistics regarding the occurrence of head
injuries are incomplete because many victims die at the
injury scene or because the condition is considered
minor and health care services are not sought.
Definition:
• Traumatic brain injury (TBI) is a nondegenerative,
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.
• Traumatic brain injury refers to trauma to the scalp
and skull that may or may not include injury to the
brain.
Forms of traumatic brain injury
1-Primary injury is the initial damage to the brain that
results from the traumatic event. This may include
contusions, lacerations, and torn blood vessels due
to impact, acceleration/ deceleration, or foreign
object penetration.
2-Secondary injury evolves over the ensuing hours and
days after the initial injury and results from inadequate
delivery of nutrients and oxygen to the cell.
Pathophysiology
Trauma → intracranial hemorrhage and hematoma → brain
swelling → intracranial volume and ICP → displacement or
herniation of the brain. Pressure on cerebral blood vessels
→ ↓ blood flow to brain → ↓ O2 to brain → cerebral
hypoxia → cerebral ischemia, infarction, and irreversible
brain damage → brain death.
Etiology of head injury:-
1- Blunt
• Motor vehicle collision
• Pedestrian event
• Fall
• Assault
• Sports injury
2- Penetrating
• Gunshot wound
• Arrow
Clinical Presentation
• Persistent, localized pain; headache.
•Loss of consciousness, confusion, drowsiness, personality change,
Restlessness.
•Sudden onset of neurological deficits.
•Bruising over mastoid (Battle’s sign).
•Nausea and vomiting. Altered or absent gag reflex.
•CSF otorrhea (ears) or rhinorrhea (nose).
•Halo sign: Blood stain surrounded by a yellowish stain on bed linens or
head dressing that may indicate CSF leak.
•Abnormal pupillary response.
•Absent corneal reflex.
•Change in vital signs: altered respiratory pattern, widened pulse pressure,
bradycardia, or tachycardia.
Assessing the Severity
of traumatic brain
injury
Glasgow Coma Scale
(GCS): A 3- to 15-point
scale used to assess a
patient's level of
consciousness and
neurologic functioning,
scoring is based on best
motor response, best
verbal response, and eye
opening (eg, eyes open to
pain, open to command)
•Duration of loss of consciousness: Classified as mild
(mental status change or loss of consciousness [LOC] < 30
min), moderate (mental status change or LOC 30 min to24hr),
or severe (mental status change or LOC >24 hr)
•Posttraumatic amnesia (PTA): The time elapsed from
injury to the moment when patients can demonstrate
continuous memory of what is happening around them.
Diagnostic Tests
1-Check for cerebrospinal fluid leak.
2-X-ray, CT of the head, MRI, or PET to
assess hematoma, swelling, and injury.
3-Cerebral angiography.
4-CBC, chemistry panel, and blood
coagulation studies.
5-Urinalysis for specific gravity.
Management
1-Stabilize cardiac and respiratory function to ensure adequate
cerebral perfusion. Maintain optimum ABGs or O2 saturation.
Assess oxygenation and respiratory status.
2-Assess and monitor neurological status and ICP; calculate
CPP to maintain >70 mm Hg.
3-Perform frequent neurological checks, including Glasgow
Coma Scale.
4-Provide light sedation as necessary to ↓ agitation.
Administer analgesics for pain. Induce barbiturate coma if
necessary.
5-Administer hypertonic saline and osmotic diuretics as
needed.
6-Monitor and control for elevations in ICP.
7-Induce therapeutic hypothermia.
8-Prepare patient for craniotomy to lessen the pressure in the
brain if necessary.
9-Assess for vision and hearing impairment and sensory function.
10-Assess for hypothermia and hyperthermia. Control fever.
11-Institute seizure precautions. Minimize stimuli and excessive
suctioning.
12-Monitor ECG for cardiac arrhythmias. Institute deep vein
thrombosis.
13-(DVT) precautions.
14-Assess fluid and electrolyte balance. Control hemorrhage and
hypovolemia.
15-Administer stool softeners to prevent Valsalva maneuver.
16-Keep head and neck in neutral alignment; no twisting or flexing
of neck.
17-Keep head of bed elevated.
18-Maintain adequate nutrition orally or enterally. Assess and
maintain skin integrity.
19-Provide DVT and peptic ulcer prophylaxis.
Complication:
1-Altered consciousness
2-Cerebrospinal fluid may build up in the spaces in the brain
(cerebral ventricles) ----. Increase ICP and Hydrocephalus
3-Electrolyte imbalance.
4-Posttraumatic seizure disorder
5-Infection: Patient who on mechanical ventilation high risk for
ventilator associated pneumonia catheter bloodstream, urinary
tract infection, Meningitis.
6-Neurological deficits: cognitive, motor sensory, speech
Nursing care for patient with head injuries
A-nursing assessment:
•Airway: assess for vomitus, bleeding, and foreign
objects. Ensure cervical spine immobilization.
•Breathing: assess for abnormally slow or shallow
respirations. An elevated carbon dioxide partial
pressure can worsen cerebral edema.
•Circulation: assess pulse and bleeding.
•Disability: assess the patient's neurologic status.
B-Nursing diagnosis:
•Altered Cerebral Tissue Perfusion related to increased ICP.
•Ineffective Breathing Pattern related to ↑ICP or brain stem injury.
•Altered Nutrition: Less Than Body Requirements related to
compromised neurologic function and stress of injury.
•Altered Thought Processes related to physiology of injury.
•Risk for Injury related to altered thought processes.
•Ineffective Family Coping related to unpredictability of outcome.
