Head Injury

DEFINITION
A head injury is any trauma that leads to injury of the scalp, skull or brain. These
injuries can range from a minor bump on the skull to a devastating brain injury.
Head injury can be classified as either closed or penetrating. In a closed head
injury, the head sustains a blunt force by striking against an object. A concussion is a
type of closed head injury that involves the brain.
In a penetrating head injury, an object breaks through the skull and enters the
brain. This object is usually moving at a high speed like a windshield or another part of a
motor vehicle.
OTHER TERMS
 Head trauma
 Brain injury
 Craniocerebral Trauma
Prevalence:
 235,000 are hospitalized
 80,000 have permanent disabilities
 50,000 die
ANATOMY AND PHYSIOLOGY
Frontal Lobe
• Influence abstract thinking, sense of humor, and uniqueness of personality
• Control contraction of skeletal muscles and synchronization of muscular
movements
• Exert control over hypothalamus, influence basic bio rhythms
• Control muscular movements, necessary for speech found only on one
hemisphere
Parietal Lobe
 Translate nerve impulses into sensations (touch and temperature)
 Interpret sensations : provide appreciation of size, shape yexyure and weight
 Interpret sense of taste
Temporal Lobe
 Translate nerve impulses into sensations of sound and interpret sounds
 Interpret sense of smell
 Control behavior patterns
Occipital Area
 Translates nerve impulse into sights and interprets sights
 Provides appreciation of size, shape and color
CLINICAL MANIFESTATIONS
The signs and symptoms of a head injury immediately or develop slowly over
several hours. Even if the skull is not fractured, the brain can bang against the inside of
the skull and be bruised (concussion) or damaged. The head may look fine, but
complications could result from bleeding inside the skull.
The signs and symptoms of a mild traumatic brain injury (concussion) may include:
• A brief period of unconsciousness
• Amnesia for events immediately before and after the injury
• Headache
• Confusion
• Dizziness or loss of balance
• Sensory problems, such as blurred vision, ringing in the ears or a bad taste in the
mouth
• Mood changes
• Memory or concentration problems
If the injury is moderate to severe, the list of signs and symptoms grows to include:
• Persistent headache
• Repeated vomiting or nausea
• Convulsions or seizures
• Inability to awaken from sleep
• Dilation of one or both pupils of the eyes
• Slurred speech
• Weakness or numbness in the extremities
• Loss of coordination
• Profound confusion
• Agitation, combativeness
Children's symptoms
Children with brain injuries may lack the communication skills to report
headaches, sensory problems, confusion and similar symptoms. Instead, they may:
• Refuse to eat
• Appear listless and cranky
• Experience altered sleep patterns and school performance
• Lose interest in favorite toys or activities
DIAGNOSTIC EXAMS
• Glasgow Coma Scale

This 15-point test helps assess the severity of a brain injury by checking
your ability to follow directions, to blink your eyes or to move extremities. The
coherence of your speech also provides important clues. Your abilities are
scored numerically. Higher scores mean milder injuries.
Imaging tests:
• CT scans. CT scans employ an X-ray unit that rotates around your body and a
powerful computer to create cross-sectional images, like slices, of the head. CT
scans can quickly visualize fractures and uncover evidence of bleeding in the
brain (hemorrhage), large blood clots (hematomas), bruised brain tissue
(contusions) and brain tissue swelling.
• Some CT scans require you to drink a contrast liquid before the scan or have
contrast injected into a vein in your arm during the scan. A contrast medium
blocks X-rays and appears white on images, which can help emphasize blood
vessels, bowel or other structures. If your test involves a contrast medium, your
doctor may ask you to fast for a few hours before the test.
• MRIs- use a large magnet and radio waves to generate computerized images of
the brain without exposing the patient to x-ray radiation.
Before an MRI exam, eat normally and continue to take your usual medications, unless
otherwise instructed. You will be asked to change into a gown and to remove:
• Jewelry
• Hairpins
• Eyeglasses
• Watches
• Dentures
• Hearing aids
• Underwire bras
• Angiogram–A test to examine blood vessels in the brain. It involves injecting dye
into an artery supplying blood to the brain, usually by means of a catheter
inserted in the groin. The test takes 1 to 3 hours.
• EEG (electroencephalograph)–A test to measure electrical activity in the brain. It
uses electrodes, in the form of patches, applied to the head. This painless
procedure can be done at bedside or in a hospital's EEG department. The
duration of the test varies.
MEDICAL MANAGEMENT
• Diuretics. These types of drugs reduce the amount of fluid in tissue and increase
urine output. Unlike the "water pills" heart patients may take to reduce blood
pressure, the diuretics used for traumatic brain injuries are administered
intravenously. The most common diuretic used for brain swelling is Mannitol, but
some studies indicate that certain concentrations of saline solution may work just
as well — particularly in children.
• Anti-seizure drugs. People who've had a moderate to severe traumatic brain
injury are at higher risk of having seizures during the first week after their injury.
Some doctors recommend taking an anti-seizure drug during that first week, to
avoid any additional brain damage that might be caused by a seizure.
• Coma-inducing drugs. Doctors sometimes deliberately use drugs to put people

into temporary comas because a comatose brain needs less oxygen to function.
This is especially helpful if compressed blood vessels are unable to deliver the
usual amount of food and oxygen to brain cells.
• Therapy
Most people who have had a significant brain injury will require
rehabilitation. They may need to relearn basic skills, such as walking or talking.
The overall goal is to improve their abilities to function at home and in the
community.
The type of rehabilitation needed varies by individual, depending on the
severity of the brain injury and what part of the brain was injured. Therapy
focuses on regaining lost skills and learning ways to compensate for abilities that
have been permanently changed.
SURGICAL MANAGEMENT
• A portion of the scalp is shaved prior to brain surgery, then a flap of skin is cut
and folded back and a section of skull is removed so that the surgeon can access
the brain.
• Removing clotted blood (hematomas). Many people who have traumatic brain
injuries are taken straight from the emergency department to the operating room
for removal of large deposits of clotted blood trapped between the skull and the
brain. This reduces the pressure inside the skull and helps prevent additional
brain damage.
• Repairing skull fractures. Many skull fractures heal on their own, but repairs
are needed if any portion of the skull is pressing into the brain.
• Opening a window in the skull. If the pressure inside the skull cannot be
controlled by any other means, one surgical option is to create an opening in the
skull and leave it open until the swelling subsides — which usually happens
within just a few days.
NURSING MANAGEMENT
Maintain patent airway

1. Elevate the head of the bed 15-30 degrees to promote venous drainage
2. Protect the patient
• Pad side rails
• Prevent injury from equipments, restraints and etc.
3. Administer prescribed medications- usually
• Mannitol- to produce negative fluid balance
• Corticosteroid- to reduce edema
• Anticonvulsants- to prevent seizures
4. Reduce environmental stimuli
5. Avoid activities that can increase ICP like valsalva, coughing, shivering, and vigorous
suctioning.
6. Maintain fluid and nutritional balance
• Input an output monitoring
• IVF therapy
• Feeding through NGT
7. Provide mouth care
• Cleansing and rinsing of mouth
• Petrolatum on the lips
8. Maintain skin integrity
• Regular turning every 2 hours
• 30 degrees bed elevation
• Maintain correct body alignment by using trochanter rolls, foot board
9. Achieve thermoregulation
• Minimum amount of beddings
• Rectal or tympanic temperature
• Administer acetaminophen as prescribed
10. Prevent urinary retention
• Use of intermittent catheterization
11. Promote bowel function
• High fiber diet
• Stool softeners and suppository
12. Provide sensory stimulation
• Touch and communication
• Frequent reorientation
NURSING DIAGNOSIS
• Ineffective clearance and impaired gas exchange related to brain injury

• Ineffective cerebral tissue perfusion related to increased ICP
• Disturbed thought processes related to brain injury
• Risk for impaired skin integrity related to bed rest, immobility or restlessness
• Interrupted family processes related to unresponsiveness of patient, prolonged
recovery period

Head Injury

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DEFINITION

ANATOMY AND PHYSIOLOGY

• Glasgow Coma Scale

• Coma-inducing drugs. Doctors sometimes deliberately use drugs to put people

Maintain patent airway

• Ineffective clearance and impaired gas exchange related to brain injury

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