Head injury.pptx (medicl surgical nursing)

medicine

1. Head injury

2. Introduction https://www.slideshare.net/slideshow/head-injury-234906500/234906500 https://www.slideshare.net/slideshow/head-injury-234906500/234906500#5 https://www.slideshare.net/slideshow/head-injury-97270885/97270885?from_search=2 https://www.slideshare.net/slideshow/head-injury-240172365/240172365?from_search=1 https://www.slideshare.net/slideshow/head-injurypptx-257510175/257510175 https://www.slideshare.net/slideshow/head-injury-240172365/240172365

3. Introduction Any injury that results in the trauma to the scalp, skull or brain. Head injury can be defined as any alteration in mental or physical functioning related to a blow to the head 

4. Introduction Head injury and traumatic brain injury are often used interchangeably Traumatic brain injury (TBI) encompasses a broad range of pathologic injuries to the brain of varying clinical severity that result from head trauma.

5. Introduction

6. Introduction Head injury and traumatic brain injury are often used interchangeably Traumatic brain injury (TBI) encompasses a broad range of pathologic injuries to the brain of varying clinical severity that result from head trauma.

7. etiology Motor vehicle crashes (50%) Violence, Physical assaults Fall injuries Sporting and leisure injuries Workplace injuries and others.

8. Classification Closed brain injury: The brain tissue is damaged, but there is no opening through the skull and dura. Open brain injury It occurs when an object penetrates the skull, enters the brain, and damages the soft brain tissue in its path

9. Classification

10. Mechanism if injury Primary injuries: Occur on impact resulting in direct injury to the area of the brain beneath the contact site Skull fractures commonly occurs. Diffuse injury: Occurs when the blow is received that does not cause fractures but causes the brain to move enough to shear or tear some of the veins going from the cortex of the brain to skull.

11. Mechanism if injury

12. Mechanism if injury

13. Scalp Injuries There can be scalp contusion, abrasion and/or lacerations Tremendous vascularity of the scalp can cause profuse bleeding

14. Skull fractures It is a break in the continuity of the skull caused by forceful trauma. It may occur with or without damage to the brain. A fracture may be open, indicating a scalp laceration or tear in the dura ( eg , from a bullet), or closed, in which the dura is intact)

15. Types of brain injuries

16. Concussion A concussion after head injury is a temporary loss of neurologic function with no apparent structural damage. Generally involves loss of consciousness for 5 minute or less and retrograde amnesia. There is no break in the skull , dura or no damage is visible in the CT or MRI scan.

17. Contusion It is more severe degree of brain injury manifested by areas of hemorrhage in the brain parenchyma but without surface laceration Neurological deficit which persists more than 24 hour Associated cerebral edema and defects in the blood brain barrier

18. Diffuse Axonal Injury Results from mechanical shearing at grey- white interface due to severe acceleration and deceleration force No obvious structural damage Severity may range from mild damage with confusion to coma and even death

19. Cerebral laciration Severe degree of brain injury associated with a breach in the surface parenchyma Tearing of brain surface may be due to skull fracture or due to shearing forces Focal neurological deficit may be present

20. Epidural haematoma Collection of blood between the cranial bones and duramater Confusion, irritability, drowsiness, hemiparesis to the same side of injury Features of raised ICP: hypertension, bradycardia, vomiting

21. Sub-dural Hematoma Collection of blood between the dura and the brain. May be acute, sub acute or chronic depends on the size of the involved vessel and the amount of bleeding.

22. pathophysiology

23. Clinical manifestations Altered level of consciousness, Confusion Leakage of CSF from ENT Pupillary abnormality: Change in pupil shape, size, and response to light. Altered or absent gag reflexes. Absent corneal reflexes Sudden onset of neurological deficit Changes in Vital signs

24. Clinical manifestations… Vision or hearing impairment Sensory dysfunction Blood behind tympanic membrane , bruises Spasticity Headache,Vertigo Vomitting Movement disorder Seizure

25. Signs of base of skull fracture Bilateral orbital bruising confined to the orbital margin (‘panda eyes’). Subconjunctival haemorrhage . CSF otorrhoea or rhinorrhoea . Battle’s sign

26. Symptoms and signs of rise in ICP   Headache Vomiting without nausea Altered level of consciousness

27. Diagnosis History Taking Clinical signs and symptoms Physical and neurological Examination Laboratory studies CBC, coagulation profile, electrolyte levels, ABG values, Radiological examination: X-Ray ,CT& MRI

28. Treatment of Head Injury Patients with no H/O unconsciousness and vomiting: Observation for 24 hours Complete bed rest Symptomatic treatment Prophylactic antibiotics to prevent potential CNS infections. Sedative such as paraldehyde or phenobarbitone may be given. Discharge with following instructions; Advice the patient to report to the hospital immediately if he/she develops severe headache, vomiting, drowsiness or unconsciousness.

29. Management of TBI Resuscitation: Firstly R/O cervical spine injury by X-Ray Maintain ABC & stabilize the patient. Treatment of Increased ICP: Surgical evacuation of blood clots and elevation of depresses fracture of the skull, suturing of severe scalp laceration. Adequate oxygenation, elevation of head of the bed and maintenance of normal blood volume. Mannitol ( 1 mg/ kg to decrease ICP)

30. Management cont … Supportive Measures: Ventilatory support, seizure prevention, maintenance of fluids and electrolytes and management of pain and anxiety. Anti seizure medications to control seizure. If patient is agitated, give benzodiazepine. NG tube Insertion: Head injury increase the chance of regurgitation and aspiration due to reduced gastric motility and continuous vomiting

31. Complications Infections: systemic (respiratory, urinary), neurologic (meningitis, ventriculitis) Increased ICP, brain herniation Post-traumatic seizure disorder Permanent neurologic deficits: cognitive, motor, sensory, speech Neurobehavioral alterations: impulsivity, and emotional lability Diabetes Insipidus

32. Nursing management

33. Nursing assessment Take immediate health history including following questions: When did the injury occur? What caused the injury? A high-velocity missile? An object striking the head? A fall? What was the direction and force of the blow? 6/23/2024 38 pammi

34. Nursing assessment History of unconsciousness or amnesia. Assessment of Patient’s LOC Ability to respond to verbal commands (if conscious) Response to tactile stimuli (if unconscious), Pupillary response to light, Status of corneal and gag reflexes , motor function, and Glasgow Coma Scale score . 6/23/2024 39 pammi

35. Nursing diagnosis Ineffective airway clearance and impaired gas exchange related to brain injury Ineffective cerebral tissue perfusion related to increased ICP and decreased CPP Deficient fluid volume related to decreased LOC and hormonal dysfunction Imbalanced nutrition, less than body requirements, related to metabolic changes, fluid restriction, and inadequate intake 6/23/2024 40 pammi

36. Nursing diagnosis…. Risk for injury related to seizures, disorientation, restlessness, or brain damage Potential for impaired skin integrity related to bed rest, hemiparesis , hemiplegia , and immobility Disturbed thought processes related to brain injury Potential for disturbed sleep pattern related to brain injury and frequent neurologic checks 6/23/2024 41 pammi

37. Nursing Interventions General Assessment: Examine the face and scalp for injury and drainage from the ear and nose Assess the level of consciousness( GCS) Pupillary reaction 6/23/2024 42 pammi

38. Nursing Interventions Monitoring of declining Neurologic functions Record Level of consciousness, GCS regularly. Assess and maintain body temperature Assess motor functions . Carefully observe other neurological signs: size and equality of pupils and their reactions to light, facial nerve palsy e.g., anosmia 6/23/2024 43 pammi

39. Contn .. Assess and maintain airway Keep airway open by removing pillow if patient is vomiting, put head to one side. Give oxygen as necessary keep ready for intubations and tracheostomy Watch for respiratory obstruction. Assess Vital signs Care of wound Carefully clean the wound under aseptic conditions and dressed with a dry sterile dressing. Suture the wound if necessary 6/23/2024 44 pammi

40. Care of Environment: Prevent bright light, noise and keep side rails. The room should be well ventilated and visitors should be restricted. Monitor fluids and electrolytes balance Oral or NG feeding if patient’s condition permits. Administer parenteral fluid to provide caloric and body fluids balance. Maintain strict I/O 6/23/2024 45 pammi

41. Contn … Skin Care: Inspect skin daily and keep clean and dry. Turn patient every 2 hours to improve circulation. Care for Bladder and bowel dysfunctions Insert Foley’s catheter if the patient has urinary incontinence or retention. Administer Stool softeners to prevent constipation. 6/23/2024 46 pammi

42. Contn … Provide rest and comfort Carry all nursing procedure at a time. Observe patient for possible seizures. Prophylactic anticonvulsive drug therapy should be given. Care of eye, ear and nose Loss of corneal reflex, Periorbital echymosis and edema are common problems due to dysfunction of trigeminal nerves. Protect the eye from injury, may be necessary to close the eyelids. 6/23/2024 47 pammi

43. Contn … An eye shield should be applied and care may be done with normal saline. Do not pack the nose and ear if there is leakage of CSF. Clean orifices with sterile cotton Prevention of Orthopedic Deformities A physiotherapy programme should be initiated to provide ROM at least 4 hours per day Reposition of patient every 2 hours in good body alignment to prevent musculoskeletal disability Foot board is used to prevent foot drops 6/23/2024 48 pammi

44. 6/23/2024 49 pammi

45. Lets summarize 6/23/2024 50 pammi

46. 6/23/2024 51 pammi