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![PRESENTATION ON
HEAD INJURIES AND NURSING
MANAGEMENT
RAKCON
BSC.[H] NUSRING](https://image.slidesharecdn.com/material20on20head20injury-220205074714/75/Head-injury-and-nursing-management-1-2048.jpg)
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Head injury and nursing management
- 1. PRESENTATION ON HEAD INJURIESAND NURSING MANAGEMENT RAKCON BSC.[H] NUSRING
- 2. INTRODUCTION Head injury isa broad classification that include injury to scalp, skull or brain. It is the most common cause of death from trauma. Trauma involving the control nervous system can be life threatening. Even if it is not life threatening, brain and spinal cord injury way result in major physical and psychological dysfunction, and can alter the life completely.
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- 4. HEAD INJURY DEFINITION A headinjury is a any trauma to the scalp, skull or brain. The injury may be a minor bump on the skull or a serious brain injury.
- 5. CAUSES • Motor vehicleaccidents • Falls • Assaults • Sports related injuries • Firearm related injuries • Act of violence
- 6. ANATOMY AND PHYSIOLOGY OFSKULL Cranial Bones * Frontal * Occipital * Temporal * Sphenoid * Partial * Ethmoid Layers of skull * Duramater- Outer layer living skull * Arachnoid (mater)- Contain blood vessel * Subarachnoid space- Filled with CSF * Piamater- Covers the brain .
- 8. TYPES OF HEADINJURY 1. Skull Injuries/ laceration Scalp laceration are associated with profuse bleeding. These are easily recognised because the scalp contain many blood vessels with poor constrictive abilities, even small wounds can bleed significantly
- 10. 2. Skull Fractures Itfrequently occur with head trauma. Fractures may be closed or open, depending on the presence of a scalp laceration or extension of fracture into air sinuses or dura. .
- 12. Types of skullfracture 1. Linear- Break in continuity of bone without alteration of relationship of parts. 2. Depressed- Inward indentation of skull 3. Simple- Linear or depressed skull fracture without fragmentation or communicating lacerations. 4. Comminuted- Multiple linear fractures with fragmentation of bone into many pieces. 5. Compound- Depressed skull fracture and scalp laceration with communicating pathway to intracranial cavity
- 13. 3. Minor HeadTrauma • CONCUSSION A sudden transient mechanical head injury with disruption of neuronal activity and a change in the LOC. It occurs when the brain suddenly shifts inside the skull and knocks against the skull bony surface.
- 14. Typical Signs:- * Briefdisruption of LOC * Concussion can lost from a few over 3 minutes or less than 5 minutes. * Retreegrade auninesia * Headache
- 15. 4. Major Head Trauma •Contusion * It is the bruising of the brain tissue within a focal area. * It is usually associated with a closed head injury. * In this type of injury contusion occur both at the site of the direct impact of the brain on the skull (coup) and at a secondary area of damage on the opposite side away from injury (conrecoup) leading to multiple contusion areas.
- 17. TEST TO DETERMINECSF LEAKAGE There are 2 methods:- 1. Method 1 - Use dextrestix or tes-tape strip to determine whether glucose is present. CSF give positive reading for glucose. If blood is present in the fluid, the test becomes unreliable because blood itself contains glucose. Then go for method 2.
- 18. Method 2- (Holeor Ring sign) * Allow the leaking fluid drip onto a white pad or towel and abserve the drainage. * Within a few minutes, the blood coalesces into the center, and a yellowish ring encircles the blood if CSF is present.
- 19. CLINICAL MANIFESTATION • Alteredlevel of consciousness • Confusion • Pupillary abnormalities (change in shape , size and response to light). • Sudden onset of neurologic deficits • Changes in vital signs (altered respiratory pattern, hypertension, bradycardia, tachycardia hypothermia or hyperthermia). • Trouble walking and speaking • Drainage of bloody or clear fluids from ears or nose • Vomiting • Seizures • Weakness or numbness in legs or arms
- 20. COMPLICATIIONS Intracranial Haemorrhage I).Extra- axial hemorrhage * Epidural * Subdural - Acute - Sub-acute - Chronic * Subarachnoid II). Intra axial hemorrhage * Intra- karenchymal * Intra- ventricular
- 22. • Severe headinjury is best managed in a neurointensive care setting • The patient should be positioned with the head up 30 degrees • It is important to ensure that the cervical immobilisation collar does not obstruct venous return from the head • Maintain a noruocapnia MANAGEMENT
- 23. Medications 1. Osmotic diuretics- Mannitol 25% 1.5- 2g/kg IV injured over 30-60 minutes 2. Anti-convulsant- Phenytoin where it may inhibit spread of seizures activitiy in motor cortex Dosage- Load 10-150mg/kg 3. Barbiturates- Pentobarbital It will reduce the brain metabolic rate and helps reduce ICP Dosage- 100mg IV or 150-200mg IM
- 24. SURGICAL MANAGEMENT 1) Burr- holeor treplanning – A hole is drilled or scraped into the human skull, exposing the duramater to treat health problems related to intracranial disease.
- 25. 2.Craniotomy- Bone flapis temporarily removed from the skull to access the brain
- 26. 3.Craniectomy - Excisioninto cranium to cut away a bone flap.
- 27. 4.Cranioplasty - Surgicalrepair of a defect or deformity of a skull
- 28. NURSING MANAGEMENT • Ineffectivecerebral tissue perfusion related to increased ICP and decreased CPP. • Fluid volume deficit related to decreases level of consciousness and hormonal dysfunction. • Risk for injury related to decrease level of consciousness. • Ineffective thermoregulation is regulated to damage to hypothalamic centre. • Impaired skin integrity related to compromised circulation shifting of fluid from intravascular to interstitial space. • Anxiety related to outcome of disease as evidenced by poor concentration on work isolation from other rude behaviour.
- 29. Nursing Diagnosis 1-Ineffective cerebral tissue perfusion related to cerebral edema as evidenced by unconsciousness and change in vital signs. Goal- Maintain level of consciousness, motor/ sensory Intervention * Neurological examination can be done assess the glassgow soma scale. * Provide rest b/w two procedures. * Give a continuous observation * Administer IV mannitol
- 30. Nursing Diagnosis 2- Ineffectivethermoregulation related to damage to hypothalamic centre as evidenced by persistent elevation of body, temperature , warmth and dry skin. Goal- Maintain body temperature to normal range. Intervention-* Monitor temperature of point frequently and continuously * Provide adequate fluid to the patient * Provide adequate fluid to the patient * Maintain proper ventilation in room
- 31. Nursing Diagnosis 3-Ineffective airway clearance related to increased production of secretion retained as evidenced by change in the rate of respiratory use of accessory muscles. Goal-Maintain patent airway Intervention * Auscultate breath sound * Assess for any obstruction in airway * Provide humidified oxygen * Administer O2 therapy * Give suctioning, if necessary
- 32. Nursing Diagnosis 4- Riskfor infection related to CSF leakage from nose Goal- Prevent or decrease the risk for infection Intervention * Aseptic techniques should be maintained * Maintain sterility * Hand washing should be done before and after the procedure * Assess the skin for any lesions so that any micro- organism do not invade from there. * Provide antibiotics
- 33. RESEARCH • Head injuryis defined as any trauma to the head other than superficial injuries to the face. Head injury is the commnest cause of death and disability in people aged 1-40yrs in the U.K . Between 33 percent and 50 percent of these are children aged under 15years. Annually about 200000 people are admitted to hospital with head injury. the incidence of death from head injury is low, with as few as 0.2percent of all patients attending emergency department with a head injury dying as a result of this injury.
- 34. SUMMARY We have discussedabout the intro, definition, causes, anatomy and physiology of skull, types of head injury, it is clinical manifestation, pathophysiology, complications, diagnostic measures, medical management , surgical management and nursing management of head injury. .
- 35. CONCLUSION • Head injuryis the most common result of traffic accident. • For further prognosis and treatment of patients with head injury substrate an CT of the brain is essential for the further prognosis and treatment. • It is usually minor head injury with associated extremity injuries, while severe head injuries associated with chest trauma. • Severe head injury is important factor of the final outcome
- 36. BIBLIOGRAPHY • Brunner andsiddharth textbook of medical surgical nursing, 4th edition, volume 2 page number 1737- 1738. • Lewis’s medical surgical nursing, assessment and management of clinical problems, chintamani page number 1445- 1449 • Google – www.slideshare.net .