Head injury med surg presentation

basic anatomy, introduction, definition, classification, risk factor, causes, types, pathophysiology, sign and symptoms, diagnosis, medical management, nursing management, diet management.

1. HEAD INJURY

2. SUBMITTED TO:- SUBMITTED BY :- Mrs. Mamta Toppo Associated professor College of nursing rims , ranchi Neelam rani Roll no: 10 3 rd year basic b.sc nursing(2017-2021) College of nursing Rims , ranchi

3. CONTENT :- 1.BASICS ANATOMY 2.INTRODUCTION 3.DEFINITION 4.CLASSIFICATION 5.RISK FACTORS 6.CAUSES 7.TYPES 8.PATHOPHYSIOLOGY 9.SIGN AND SYMPTOMS 10.DIAGNOSIS 11.MEDICAL MANAGEMENT 12.MEDICATION 13.NURSING MANAGEMENT 14.DIET MODIFICATION 15.COMPLICATION 16.SUMMARY 17.RECENT ADVANCEs 18.REFERENCE CE 1 9 .BIBLIOGRAPHY

4. BASICS ANATOMY

5. Skull

6. Human brain

7. INTRODUCTION Head injury is a broad classification that includes injury to the scalp , skull or brain Head injury is a general term use to describe any trauma to the head and the most specifically to the brain itself. Head injury refers to trauma to the head

8. CLASSIFICATION According to glass gow coma scale Mild (GCS 13-15 with loss of consciousness to 15 min) Moderate (GCS 9-10 with loss of consciousness for up to 6 hr) Severe (GCS 3-8 with loss of consiousness greater than 6hr)

9. RISK FACTORS Color blindness Alcohol addictions Youngsters Vertigo Males,(about 1.5 times as likely as females to sustain a brain injury) Young children or teenager(especially infants to 4-year-olds and 15-19-years olds) Certain military personnel (for example, paratroopers) African Americans(who have the highest death rate from brain injury) .

10. CAUSES OF HEAD INJURY Penetrating trauma Blunt head trauma – direct blow Motor vehicle accident Assault Sport injury Cerebral edema Intra cranial hemorrhage Gunsot trauma

11. Types of head injury ACCORDING TO : Open an d closed injury OR Site of injury: A. scalp injury B. skull injury C. Brain injury

12. B. Skull injury : head injury may cause a minor headache skull fracture, which may or may not be associated with injury to the brain. Skull fracture : it is a break in the bone surrounding the brain and other structures within the skull

13. (1.) DEPRESSED SKULL FRACTURE : T hese are common after forceful impact by blunt objects-most commonly , hammers,rocks,or other heavy but fairly small objects. (2.) LINEAR SKULL FRACTURE : a common injury , espially in children.it is a simple break in the skull that follows a relatively straight line.

14. (3.) BASILAR SKULL FRACTURE : A fracture of the bones that form the base of the skull and results from severe blunt head trauma of significant force .

15. c. BRAIN INJURY Traumatic brain injury is the result of an external mechanical force applied to the cranium and intracranial contents, leading to temporay or permanent impairments ,functional disability ,or psychosocial maladjustment. TYPES: (1) .CONCUSSION :cerebral concussion is considered a mild brain injury and temporary loss of neurological function with no apparent structural damage. (2). CONTUSION :brain contusion are bruises of the brain tissue that occur as a result of brain trauma.In some cases ,brain contusion lead to hemorrhages which are absorbed into brain tissue.

16. (3) difFuse axonal injury Axon tear within the white matter of brain.

17. 4) .INTRACRANIAL HEMORRHAGE : Intracranial describes any bleeding with in the skull .bleeding in the skull major may not be associated with a skull fracture .it is a serious condition that often requires surgery and extensive recovery time.

18. There are three types : A. subdural hematoma – when a vein ruptures between the brain and duramater . B .epidural hematoma - it is caused by a rupture between the dura mater and the skull. c. intracerebral hematoma - when blood collects within the brain tissue.

19. DIAGNOSTIC EVALUATION History and physical examination CT scan and MRI X –Ray of skull Positron emission tomography Neuropsychological Electrocardiography Electroencephalography CSF analysis (halo ring)

20. COMPLICATIONS Coma Chronic headaches Loss of or changes in sensations, hearing, vision , taste, or smell Paralysis Seizures Speech and language problems death

21. MANAGEMENt

22. Immediate management The immediate management of head injury includes: Control of airway,by intubation and mechanical ventilation if necessary. Oxygen Therapy,and arterial blood gas analysis. Restoration of circulating blood volume, using fluid, colloid and blood infusion.adequate venous access is required (at least two large intravenous cannulae). Cervical spine examination and imaging. Temporary immobilisation of limb fractures.

23. MEDICAL MANAGEMENT 1 . Management of increased intra cranial pressure Administering manitol . Drainage of cerebrospinal fluid. Elevation of the head of the bed Complete bed rest Dopamine to maintain cerebral perfusion pressure above 50mgHg Glucocorticoids : dexamethasone to reduce cerebral edema

24. 2.ANTIBIOTICS THERAPY : Administration of antibiotics is required to prevent infection with open skull fractures and penetrating wound . 3.ANTIEPILEPTIC THERAPY : Medication to prevent seizures may be given to prevent or treat seizures that occur from the head injury. 4.SUPPORTIVE MEASURES: Ventilatory support Vasopressors may be required to maintain blood pressure Fluid and electrolyte maintenance Nutritional support Pain and anxiety management .

25. Surgical management Craniotomy it is used to remove the hematoma from the brain. Lumber puncture it is used to drain the CSF ,if the intracranial volume is increased. Cerebral angioplasty it is used to open partially blocked vertebral and carotid arteries in the neck ,as well as blood vessels within the brain. Elevation of depressed fractures of the skull. Suturing of severe scalp lacerations.

26. MEDICATIONS OSMOTIC DIURETICS ANTICONVULSANTS - phenytoin or phenobarbitone. Analgesics- diclofenace. Antibiotics -doxamethasone

27. NURSING MANAGEMENT NURSING ASSESSMENT:- ABC GCS SCORE NEUROLOGIC EXAMINATION SIGNS OF ELEVATED ICP SIGNS OF CSF LEAKAGE

28. NURSING DIAGNOSIS 1.Ineffective breathing pattern related to increased ICP or brain stem injury 2.ineffective airway clearance and ventilation related to hypoxia 3.Altered cerebral tissue perfusion related to ICP 4.Risk for injury related to disorientation ,restlessness and brain damage 5.Altered thought process related to head injury 6.Impaired gas exchange related to altered level of consciousness.

29. NURSING INTERVENTIONS Assist neurologic and respiratory status to monitor for sign of increased ICP and respiratory distress. Monitor and record vital sign . Assess for CSF leak as evidence by otorhea rhinorrhea . Provide suctioning ;if patient is able ,assist with turning ,coughing and deep breathing to prevent pooling of secretions. Turn the patient every 2 hrs or maintain in a rotating bed if condition allows to prevent skin breakdown . Keep the head of the bed elevated about 30 degree to decrease intracranial venous pressure Provide eye, skin , and mouth care to prevent tissue damage

30. DIET Modification The basics of a healthy diet Eat a variety of food including vegetables ,fruits ,and grains Eat lean meats ,poultry, fish, beans and low-fat dairy products Limits intake of salt ,sugar and alcohol Eat unsaturated fats in moderation,strictly limit saturated and trans fats.

31. EVALUTION Define head injury. Enlist the clinical manifestations of head injury. What are the causes of head injury. What are the nursing diagnosis of head injury( three)?. Glasgow coma scale has all, except-. A. Verbal response B. Motor response C .sensory impairment D. Eye opening

32. REFERENCE BOOK INTERNET TEACHER

33. BIBLIOGRAPHY PV a textbook of medical surgical nursing 11 page no - :306 to 312 . Wikipedia .com Head injury slideshare .net

34. SUMMARY Head injury is any trauma to the scalp ,skull, or brain . It can be open and closed head injury. Some common causes of head injuries are falls, motor vehicle accidents ,and sports injuries. The warning signs of head injury are repeated vomiting or nausea ,seizures, slurred speech or loss of coordination etc. and there treatment depends on the type of injury and how severe it is .