Section 11 :: Chapter 57 :: Patient With Head Injury
Overview
A head injury includes any trauma to the scalp, skull, or brain.
Head injuries can range from a mild concussion with complete
recovery to severe diffuse axonal injury that could leave a patient
in a persistent vegetative state. In the United States,
approximately 1.7 million persons are treated and released with
traumatic brain injury (TBI) in hospital emergency departments.
Fifty thousand people die and 275,000 persons are hospitalized
with TBI. The majority of deaths after a head injury occur
immediately after the injury, either from the direct head trauma
or massive hemorrhage and shock. Deaths occurring within a few
hours of the trauma are caused by progressive worsening of the
head injury or from internal bleeding.
The patient with head trauma is always considered to have the
potential for developing increased intracranial pressure (ICP).
Complications of head trauma include epidural hematoma,
subdural hematoma, and intracerebral hematoma. Monitoring for
changes in neurologic status is critically important because the
patient's condition may deteriorate rapidly, necessitating
emergency intervention. Expert nursing care in the weeks
following the injury is crucial in decreasing mortality and in
optimizing patient outcome.
Objectives
• Describe relevant assessment data for a patient with head
trauma.
• Prioritize nursing care for a patient with increased ICP.
• Appropriately delegate nursing care for a postoperative
craniotomy patient.
• Discuss collaborative management of a patient with a head
injury.
• Analyze diagnostic findings for a postoperative craniotomy
patient with complications.
• Develop an individualized teaching plan for a patient
recovering from a traumatic brain injury.
, Case Study
The paramedics found D.M. lying on the side of the road. He
apparently lost control of his motorcycle and struck a concrete
road barrier. There was no one else involved in the accident. D.M.
appeared very dazed but was able to speak his name and
address. He does not remember what happened. He does not
seem to be oriented to time or place.
The paramedics put a hard cervical collar on as a precaution until
his neck is cleared of any injuries. They also started an IV and
have been infusing D5W at a keep-open rate.
Vital signs were taken right before he was brought into the
emergency department. His blood pressure (BP) was 118/72, his
heart rate was 68, and his respiratory rate was 16. His lungs were
clear and he was in normal sinus rhythm on the monitor.
His family has been notified and his wife is on the way to the
hospital.
Correct! Eye opening (2) + Verbal response (2) + Motor
response (4) = 8
Question: The emergency nurse understands that her priority
action at this point is to:
notify the emergency department physician of the patient's change in condition.
Correct! D.M.'s condition is deteriorating rapidly, necessitating emergency
medical intervention. Applying oxygen via nasal cannula may be useful but the
patient's airway needs to be protected, and he will most likely need endotracheal
intubation. Elevation of the head may help to decrease ICP but will not alleviate
the cause of the increased ICP and is thus not the highest priority action. The
patient needs imaging studies of the brain to diagnose the cause of the increased
ICP, not just a skull x-ray.
Administration of 100% oxygen :
Overview
A head injury includes any trauma to the scalp, skull, or brain.
Head injuries can range from a mild concussion with complete
recovery to severe diffuse axonal injury that could leave a patient
in a persistent vegetative state. In the United States,
approximately 1.7 million persons are treated and released with
traumatic brain injury (TBI) in hospital emergency departments.
Fifty thousand people die and 275,000 persons are hospitalized
with TBI. The majority of deaths after a head injury occur
immediately after the injury, either from the direct head trauma
or massive hemorrhage and shock. Deaths occurring within a few
hours of the trauma are caused by progressive worsening of the
head injury or from internal bleeding.
The patient with head trauma is always considered to have the
potential for developing increased intracranial pressure (ICP).
Complications of head trauma include epidural hematoma,
subdural hematoma, and intracerebral hematoma. Monitoring for
changes in neurologic status is critically important because the
patient's condition may deteriorate rapidly, necessitating
emergency intervention. Expert nursing care in the weeks
following the injury is crucial in decreasing mortality and in
optimizing patient outcome.
Objectives
• Describe relevant assessment data for a patient with head
trauma.
• Prioritize nursing care for a patient with increased ICP.
• Appropriately delegate nursing care for a postoperative
craniotomy patient.
• Discuss collaborative management of a patient with a head
injury.
• Analyze diagnostic findings for a postoperative craniotomy
patient with complications.
• Develop an individualized teaching plan for a patient
recovering from a traumatic brain injury.
, Case Study
The paramedics found D.M. lying on the side of the road. He
apparently lost control of his motorcycle and struck a concrete
road barrier. There was no one else involved in the accident. D.M.
appeared very dazed but was able to speak his name and
address. He does not remember what happened. He does not
seem to be oriented to time or place.
The paramedics put a hard cervical collar on as a precaution until
his neck is cleared of any injuries. They also started an IV and
have been infusing D5W at a keep-open rate.
Vital signs were taken right before he was brought into the
emergency department. His blood pressure (BP) was 118/72, his
heart rate was 68, and his respiratory rate was 16. His lungs were
clear and he was in normal sinus rhythm on the monitor.
His family has been notified and his wife is on the way to the
hospital.
Correct! Eye opening (2) + Verbal response (2) + Motor
response (4) = 8
Question: The emergency nurse understands that her priority
action at this point is to:
notify the emergency department physician of the patient's change in condition.
Correct! D.M.'s condition is deteriorating rapidly, necessitating emergency
medical intervention. Applying oxygen via nasal cannula may be useful but the
patient's airway needs to be protected, and he will most likely need endotracheal
intubation. Elevation of the head may help to decrease ICP but will not alleviate
the cause of the increased ICP and is thus not the highest priority action. The
patient needs imaging studies of the brain to diagnose the cause of the increased
ICP, not just a skull x-ray.
Administration of 100% oxygen :
