BRAIN INJURY

 The most important consideration in any head injury CATEGORIES

is whether or not the brain is injured. Even
seemingly minor injury can cause significant brain 1. EPIDURAL HEMATOMA
damage secondary to obstructed blood flow and - After a head injury, blood may collect in the
decreased tissue perfusion. epidural (extradural) space between the skull
and the dura.
2 WAYS 2. SUBDURAL HEMATOMA
- A subdural hematoma is a collection of blood
1. Closed (Blunt) Brain Injury between the dura and the brain, a space
- the head accelerates and then rapidly normally occupied by a thin cushion of fluid
decelerates or collides with another object and 3. INTRACEREBRAL HEMORRHAGE AND
brain tissue is damaged, but there is no HEMATOMA
opening through the skull and dura. - bleeding into the substance of the brain.
2. Open Brain Injury
- an object penetrates the skull, enters the brain,
and damages the soft brain tissue

TYPES

1. CONCUSSION
- A cerebral concussion after head injury is a
temporary loss of neurologic function with no
apparent structural damage. A concussion
generally involves a period of unconsciousness
lasting from a few seconds to a few minutes ETIOLOGY AND PATHOPHYSIOLOGY
2. CONTUSION
- Cerebral contusion is a more severe injury in
which the brain is bruised, with possible
surface hemorrhage. The patient is
unconscious for more than a few seconds or
minutes.
3. DIFFUSE AXONAL INJURY
- Diffuse axonal injury involves widespread
damage to axons in the cerebral hemispheres,
corpus callosum, and brain stem. It can be
seen in mild, moderate, or severe head trauma
and results in axonal swelling and
disconnection (Porth, 2002).
4. INTRACRANIAL HEMORRHAGE
- Hematomas (collections of blood) that develop
within the cranial vault are the most serious
brain injuries (Porth, 2002). A hematoma may
be epidural (above the dura), subdural (below
the dura), or intracerebral (within the brain)

Intracranial hemorrhage/hematoma

- any bleeding (hemorrhage) or collection of

blood (hematoma) within the intracranial vault,
including the brain parenchyma and
surrounding meningeal spaces. They are
classified by location.

Made by: TABAYAAY, Neslie Ann

  Where were the head or other parts of the body
stuck?
CLINICAL MANIFESTATIONS  Can you provide any information about the force of
The symptoms, apart from those of the local injury, depend injury?
on the severity and the distribution of brain injury  Was the person's body whipped around or severely
jarred?
 Persistent, localized pain usually suggests that a
fracture is present. IMAGING TESTS
 Fractures of the cranial vault may or may not  CT SCAN
produce swelling in the region of the fracture;  MRI
therefore, an x-ray is needed for diagnosis.  INTRACRANIAL PRESSURE MONITOR
 Fractures of the base of the skull tend to traverse - Doctors may insert a probe through the skull to
the paranasal sinus of the frontal bone or the middle monitor the pressure
ear located in the temporal bone . Thus, they
frequently produce hemorrhage from the nose, MANAGEMENT AND TREATMENTS
pharynx, or ears, and blood may appearunder the
conjunctiva 1. CT scan and MRI are the primary neuroimaging
 An area of ecchymosis (bruising) may be seen over diagnostic tools and are useful in evaluating soft
the mastoid (Battle’s sign). tissue injuries. Positron emission tomography (PET
 Basal skull fractures are suspected when scan) is also used in diagnosing brain injuries.
- Assessment and diagnosis of the extent of
cerebrospinal fluid escapes from the ears (CSF
injury are accomplished by the initial physical
otorrhea) and the nose (CSF rhinorrhea).
and neurologic examinations.
 A halo sign (a blood stain surrounded by a yellowish
- Any individual with a head injury is presumed to
stain) may be seen on bed linens or the head
have a cervical spine injury until proven
dressing and is highly suggestive of a CSF leak.
otherwise. From the scene of the injury, the
 serious problem because meningeal infec tion can
patient is transported on a board with the head
occur if organisms gain access to the cranial
and neck maintained in alignment with the axis
contents through the nose, ear, or sinus through a
of the body.
tear in the dura mater.
- Treatments to prevent this include stabilization
 Bloody CSF suggests a brain laceration or
of cardiovascular and respiratory function to
contusion. maintain adequate cerebral perfusion, control
of hemorrhage and hypovolemia, and
maintenance of optimal blood gas values.
ASSESSMENT AND DIAGNOSTIC PROCEDURES - As the damaged brain swells with edema or as
blood collects within the brain, a rise in ICP
1. GLASGOW COMA SCALE occurs; this requires aggressive treatment.
- is a tool for assessing a patient's response to - If the increased intracranial pressure (ICP)
stimuli remains elevated, it can decrease the CPP.
- abilities are scored from 3-15. Higher scores Initial management is based on the principle of
mean less severe injuries preventing secondary injury and maintaining
adequate cerebral oxygenation.
2. SURGERY
- This is required for evacuation of blood clots,
debridement and elevation of depressed
fractures of the skull, and suture of severe
scalp lacerations.
- ICP is monitored closely; if increased, it is
managed by maintaining adequate
oxygenation, elevating the head of the bed, and
maintaining normal blood volume. Devices to
monitor ICP or drain CSF can be inserted
during surgery or at the bedside using aseptic
technique.
- The patient is cared for in the intensive care
unit, where expert nursing care and medical
treatment are readily available.
3. Ventilatory support, seizure prevention, fluid and
INFORMATION ABOUT THE INJURY electrolyte maintenance, nutritional support, and
pain and anxiety management.
Answers to the following questions may be beneficial in - Comatose patients are intubated and
judging the severity of injury: mechanically ventilated to ensure adequate
oxygenation and protect the airway.
 How did the injury occur?
4. NGT INSERTION
 Did the person lose consciousness?
- To reduce gastric motility and reverse
 How long was the person unconscious? peristalsis are associated with head injury
 Did you observe any other changes in alertness, making regurgitation and aspiration common in
speaking, coordination or other signs of injury? the first few hours.
Made by: TABAYAAY, Neslie Ann
 NURSING DIAGNOSIS

1. Ineffective airway clearance and impaired gas

exchange related To brain injury
2. Risk for ineffective cerebral tissue perfusion related
to increased ICP,decreased CPP, and possible
seizures
3. Deficient fluid volume related to decreased LOC
and hormonal dysfunction
4. Imbalanced nutrition: less than body requirements
related to
5. increased metabolic demands, fluid restriction, and
inadequate intake
6. ·Risk for injury (self-directed and directed at others)
related to seizures, disorientation, restlessness, or
brain damage
7. ·Risk for imbalanced body temperature related to
damaged temperature-regulating mechanisms in
the brain
8. Risk for impaired skin integrity related to bed rest,
hemiparesis, hemiplegia, immobility, or restlessness
9. Ineffective coping related to brain injury
10. Disturbed sleep pattern related to brain injury and
frequent neurologic checks
11. Interrupted family processes related to
unresponsiveness of patient, unpredictability of
outcome, prolonged recovery period, and the
patient’s residual physical disability and emotional
deficit
12. Deficient knowledge about brain injury, recovery,
and the rehabilitation process The nursing
diagnoses for the unconscious patient and the
patient with increased ICP also apply

Made by: TABAYAAY, Neslie Ann