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HEAD INJURY - Coggle Diagram
HEAD INJURY
Important Assessments (including ongoing assessments)
Disturbance in level of consciousness from slightly drowsy to unconscious.
Headache, vertigo, agitation, and restlessness.
Cerebrospinal fluid leakage at ears and nose, which may indicate skull fracture.
Contusions about eyes and ears indicating skull fractures.
Irregular respirations
Cognitive deficit
Pupillary abnormality
Sudden onset of neurologic deficits
Otorrhea indicating posterior fossa skull fracture
Rhinorrhea indicating anterior fossa skul fracture.
Nursing Interventions
Provide analgesia as required according to pain scale.
Patient receives hourly observations as per additional observations above for 4 hours as a minimum
If any deterioration in patient condition is detected then medical officer must be immediately notified
If the patient requires increasing amounts of analgesia to manage their pain, notify the medical officer
Patient must be discharged into the care of a responsible adult or carer
Provide patient / carer with head injury discharge information in addition to discharge letter
Document assessment findings, interventions and outcomes
Pathophysiology
Concussion
– transient interruption in brain activity; no constructural injury noted on radiographics.
Cerebral contusion
– bruising of brain with associated swelling.
Intracerebral hematoma
– bleeding into the brain
tissue commonly associated with edema.
Epidural hematoma
– blood between the inner table of the skull and dura.
Subdural hematoma
– blood between the dura and arachnoid caused by bleeding commonly associated with additional brain injury.
Diffuse axonal injury
– axonal tears within the white matter of the brain.
Patient Education
Rest
— Encourage and instruct the person to lie down or choose a quiet activity. Allow the patient to sleep if desired. It is not dangerous to sleep after a minor head injury, although the a nurse should monitor the patient.
Inform that a mild headache, nausea, and dizziness are common, especially during the first few hours after the injury. If the person is nauseous or has vomited, try offering clear liquids (eg, soda, clear juice, gelatin).
Bleeding
— If the head is bleeding, clean the area with soap and water and apply pressure to the area with a clean cloth (sterile gauze, if available). Bleeding should stop within 10 minutes. If bleeding does not stop or the cut is large, the person should be evaluated to determine if stitches are needed.
Swelling
— Swelling (a large lump or "goose egg") is also common after a head injury. To reduce swelling, an ice or a cold pack can be applied to the area for 20 minutes. Swelling usually begins to improve within a few hours, but may take one week to completely resolve.
Pain
— Acetaminophen (eg, Tylenol) may be given for a headache. If the person's headache is severe or worsens, the person should be evaluated by a health care provider.
Medical Interventions
CT identifies and localizes lesions, cerebral edema, and bleeding.
Skull and cervical spine X-ray identify fracture and displacement.
Complete blood count, coagulation profile, electrolyte levels,
serum osmolarity, arterial blood gases, and other laboratory tests monitor for complications.
Neuropsychological test during rehabilitation phase determine cognitive deficits.
Medication
Diuretics.
These drugs reduce the amount of fluid in tissues and increase urine output. Diuretics, given intravenously to people with traumatic brain injury, help reduce pressure inside the brain.
Anti-seizure drugs.
People who've had a moderate to severe traumatic brain injury are at risk of having seizures during the first week after their injury.
An anti-seizure drug
may be given during the first week to avoid any additional brain damage that might be caused by a seizure. Continued anti-seizure treatments are used only if seizures occur.
Coma-inducing drugs.
Doctors sometimes use drugs to put people into temporary comas because a comatose brain needs less oxygen to function. This is especially helpful if blood vessels, compressed by increased pressure in the brain, are unable to supply brain cells with normal amounts of nutrients and oxygen.