Introduction

Head injury refers to damage to any of the structures of the head as a result of trauma. It is most often used to refer to an injury to brain. It may also involve the bones, muscles, blood vessels, skin and other organs of face or head. Mostly head injuries are caused by blows to the head from the numerous causes including motor vehicle accidents and falls.

Definition

Injuries to the head involve trauma to the scalp, skull and brain.

Etiology

  • Motor vehicle accidents.
  • Falls.
  • Accidents.

Mechanism of Injury

  1. Acceleration: When head is fixed and objects are move.
  2. Deceleration: When head moving and objects are fixed.
  3. Deformation: Deformation refers to injuries in which the force results in deformation and disruption of the integrity of the impacted body part, e.g., skull fracture.

Brain Injury

Traumatic Brain Injury (TBI), also known as head injury, is the disruption of normal brain function due to trauma-related injury.

Types of Brain Injury

1. Concussion:

Transient interruption in brain activity, no structural injury noted on radiographic.

2. Cerebral Contusion:

Bruising of the brain with associated swelling.

3. Intracerebral Haematoma:

Bleeding into the brain tissue commonly associated with edema.

4. Epidural Haematoma:

Blood between the inner table of the skull and dura.

5. Subdural Haematoma:

Blood between the dura and arachnoid caused by venous bleeding.

Classifications

  1. Mild (GCS 13 to 15) with loss of consciousness to 15 minutes.
  2. Moderate (GCS 9 to 12) with loss of consciousness for up to 6 hours.
  3. Severe (GCS 3 to 8) with loss of consciousness greater than 6 hours.

Clinical Manifestations

  • Respiration may be normal.
  • Pupils are usually small.
  • Headache, vertigo.
  • Coma.
  • Cardiac arrhythmias.
  • Change in body temperature.
  • Altered LOC (Level of Consciousness).
  • Loss of normal eye movement.
  • Agitation (worry, disturb), restlessness.
  • Sudden onset of neurologic deficit.
  • Otorrhea may indicate leakage of CSF from ear due to posterior fossa skull fracture.
  • Abnormal bleeding due to coagulopathy.

Diagnostic Evaluations

  • History collection.
  • Physical examination.
  • CT scan.
  • MRI (Magnetic Resonance Imaging).
  • Radiography.

Complications

  • Increased ICP, hydrocephalus, brain herniation.
  • Permanent neurologic deficits (cognitive, motor, sensory, speech).
  • Neurobehavioural alterations (impulsivity, uninhibited aggression and emotion lability).

Management

Medical Management

  • Antiseizure medication, e.g., phenytoin.
  • Histamine antagonists (reduce risk of stress ulcer).
  • Mild analgesics.
  • Antibiotic therapy for prevention secondary infection.
  • Osmotic diuretics, e.g., mannitol, to reduce ICP.
  • Dexamethasone (steroid) - In case of increased ICP.

Surgical Management

  • Craniotomy: Removal of haematoma by incision to cranium.

Dietary Management

  • NPO (nothing by mouth) until peristalsis returns.
  • Enteral tube feeding with head elevated position.

Nursing Management

  • Open wound should be covered and pressure applied to control bleeding.
  • To clean the wound with antiseptic solution.
  • Check ABC (Airway, Breathing, Circulation) of patient and maintain them.
  • Manage ICP and cerebral edema.
  • Surgery to evacuate intracranial haematoma.
  • Make Glasgow Coma Scale.
  • Determine CSF.
  • Monitor neurological status of patient.

Nursing Diagnosis

  • Altered tissue perfusion related to hypotension, haematoma, intracranial haemorrhage.
  • Altered body temperature related to disturbed metabolic process.
  • Ineffective airway clearance related to coma, bleeding into airway.
  • Imbalanced nutrition less than body requirement related to loss of pharyngeal reflex or coma.
  • Infection related to open injury.
  • High risk for injury related to restlessness and confusion.
  • Constipation related to loss of muscle tone reflexes.
  • Urinary elimination impaired related to altered consciousness.
  • Sleep pattern disturbance related to frequent assessment and loss of REM sleep.
  • Impaired physical mobility related to motor sensory deficits or coma.
  • Deficient fluid volume related to inability to take fluids by mouth.
  • Risk for impaired skin integrity related to immobility.
  • Interrupted family process related to health crisis.
  • Risk for seizure related to intracranial bleeding, infarction, trauma, hypoxia, injuries to brain.
  • Deficient knowledge related to new procedures and treatment and expected outcome.
Study Note: This article is provided as a nursing education and study resource for ANM, GNM and BSc Nursing students.