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Traumatic brain/head injury (A traumatic brain injury/head injury is…
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Diffuse:Concussion- is a sudden transient mechanical head injury that causes a disruption to neural activity and a change in LOC. Signs of a concussion include a headache, retrograde amnesia and vomiting/nausea. Post concussion syndrome may occur in some patients between 2 weeks-2 months after the injury. Symptoms include shortened attention span, decreased short term memory, changes in intellectual abilities, lethargy, behavioral/personality changes and persistent headache. Patients with a previous history of head traumas or concussions should be monitored closely for neurological changes and complications.
Diffuse axonal injury (DAI): Is defined as widespread axonal damage in the subcortical white matter of the basil ganglia, brain-stem, thalamus and cerebral hemispheres. It occurs after a mild, moderate or severe TBI. Clinical signs vary but can include increased ICP, decreased LOC, decortication/decerebration and global cerebral oedema. These patients are typically cared for in ICU and monitored closely for deterioration's.
Focal injury: Can be localised to an area of a minor or severe injury such as a laceration or contusion. Lacerations are the tearing of brain tissue and are often associated with depressed and open fractures or penetrating traumas. Nursing management includes antibiotics until meningitis is ruled out and prevention or secondary injury related in increased ICP. If the bleeding is deep in the brain tissue, then focal or generalised signs can develop.Contusion is burising of the brain tissue within a focal area and is associated with a closed head injury. It may contain areas of haemorrhage, necrosis, infarction and oedema if at a fracture sight.
Coup-countercoup injury- Primary impact sifted from the front of the head to the back as a secondary impact. These injuries can be minor to severe depending on the severity of brain movement inside the skull and the mechanism of injury. This type of injury is also commonly associated with shaken baby syndrome and high impact MVA's.
Scalp lacerations: External head trauma that is easily recognized and results in a wound. Due to the many blood vessels in the scalp, these types of injuries can bleed significantly. The main complications associated are bleeding and infection.
Skull fractures: Frequently occur with head trauma and can be closed or open depending on the presents of a fracture or scalp laceration. The main complications are intracranial infections, meningeal and brain tissue damage and haematoma.
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Zomorodi, Meg. (2015). Acute intracranial problems. In D. Brown, H. Edwards, L. Seaton & T. Buckley. (Eds.). Lewis's medical surgical nursing. Assessment and management of clinical problems. (2nd Ed., pp. 1416-1421). Sydney, Australia: Elsevier.