Head Injury Chapter 57 Copyright 2014 by Mosby
![Head Injury Chapter 57 Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Head Injury Chapter 57 Copyright © 2014 by Mosby, an imprint of Elsevier Inc.](https://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-1.jpg)
Head Injury Chapter 57 Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Head Injury • Any trauma to the • Skull • Scalp • Brain • Head Injury • Any trauma to the • Skull • Scalp • Brain •](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-2.jpg)
Head Injury • Any trauma to the • Skull • Scalp • Brain • Traumatic brain injury (TBI) • High incidence Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Head Injury • Causes • Motor vehicle collisions • Falls • Firearm-related injuries • Head Injury • Causes • Motor vehicle collisions • Falls • Firearm-related injuries •](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-3.jpg)
Head Injury • Causes • Motor vehicle collisions • Falls • Firearm-related injuries • Assaults • Sports-related injuries • Recreational accidents • War-related injuries Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Head Injury • High potential for poor outcome • Deaths occur at three points Head Injury • High potential for poor outcome • Deaths occur at three points](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-4.jpg)
Head Injury • High potential for poor outcome • Deaths occur at three points in time after injury: 1. Immediately after the injury 2. Within 2 hours after the injury 3. 3 weeks after the injury. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Case Study Jupiterimages/Comstock/Thinkstock • K. D. , a 33 -year-old woman, is brought by Case Study Jupiterimages/Comstock/Thinkstock • K. D. , a 33 -year-old woman, is brought by](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-5.jpg)
Case Study Jupiterimages/Comstock/Thinkstock • K. D. , a 33 -year-old woman, is brought by paramedics to ED following a motor vehicle collision. • She has a laceration to her forehead and bruises from her seat belt. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Case Study Jupiterimages/Comstock/Thinkstock • She is stuporous and does not answer questions. • What Case Study Jupiterimages/Comstock/Thinkstock • She is stuporous and does not answer questions. • What](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-6.jpg)
Case Study Jupiterimages/Comstock/Thinkstock • She is stuporous and does not answer questions. • What is the most likely cause of her change in LOC? Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Types of Head Injuries • Scalp Lacerations • External head trauma • Scalp is Types of Head Injuries • Scalp Lacerations • External head trauma • Scalp is](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-7.jpg)
Types of Head Injuries • Scalp Lacerations • External head trauma • Scalp is highly vascular → Profuse bleeding • Major complications – blood loss and infection Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Types of Head Injuries • Skull Fractures • Linear or depressed • Simple, comminuted, Types of Head Injuries • Skull Fractures • Linear or depressed • Simple, comminuted,](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-8.jpg)
Types of Head Injuries • Skull Fractures • Linear or depressed • Simple, comminuted, or compound • Closed or open Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Types of Head Injuries • Skull Fractures • Location determines manifestations. • Complications • Types of Head Injuries • Skull Fractures • Location determines manifestations. • Complications •](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-9.jpg)
Types of Head Injuries • Skull Fractures • Location determines manifestations. • Complications • Infections • Hematoma • Tissue damage Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Raccoon Eyes and Battle’s Sign Copyright © 2014 by Mosby, an imprint of Elsevier Raccoon Eyes and Battle’s Sign Copyright © 2014 by Mosby, an imprint of Elsevier](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-10.jpg)
Raccoon Eyes and Battle’s Sign Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Types of Head Injuries • Diffuse (generalized) • Focal (localized) • Minor (GCS 13 Types of Head Injuries • Diffuse (generalized) • Focal (localized) • Minor (GCS 13](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-11.jpg)
Types of Head Injuries • Diffuse (generalized) • Focal (localized) • Minor (GCS 13 -15) • Moderate (GCS 9 -12) • Severe (GCS 3 -8) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Types of Head Injuries • Diffuse Injury • Concussion • Brief disruption in LOC Types of Head Injuries • Diffuse Injury • Concussion • Brief disruption in LOC](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-12.jpg)
Types of Head Injuries • Diffuse Injury • Concussion • Brief disruption in LOC • Retrograde amnesia • Headache • Short duration • May result in postconcussion syndrome Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Types of Head Injuries • Postconcussion Syndrome • Persistent headache • Lethargy • Personality Types of Head Injuries • Postconcussion Syndrome • Persistent headache • Lethargy • Personality](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-13.jpg)
Types of Head Injuries • Postconcussion Syndrome • Persistent headache • Lethargy • Personality and behavior changes • Shortened attention span, decreased short-term memory • Changes in intellectual ability Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Types of Head Injuries • Diffuse Axonal Injury • Widespread axonal damage • Decreased Types of Head Injuries • Diffuse Axonal Injury • Widespread axonal damage • Decreased](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-14.jpg)
Types of Head Injuries • Diffuse Axonal Injury • Widespread axonal damage • Decreased LOC • Increased ICP • Decortication, decerebration • Global cerebral edema Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Types of Head Injuries • Focal Injury • Lacerations • Contusions • Hematomas • Types of Head Injuries • Focal Injury • Lacerations • Contusions • Hematomas •](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-15.jpg)
Types of Head Injuries • Focal Injury • Lacerations • Contusions • Hematomas • Cranial nerve injuries Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Types of Head Injuries • Lacerations • Tearing of brain tissue • With depressed Types of Head Injuries • Lacerations • Tearing of brain tissue • With depressed](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-16.jpg)
Types of Head Injuries • Lacerations • Tearing of brain tissue • With depressed and open fractures and penetrating injuries • Intracerebral hemorrhage • Subarachnoid hemorrhage • Intraventricular hemorrhage Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Types of Head Injuries • Contusion • Bruising of brain tissue • Associated with Types of Head Injuries • Contusion • Bruising of brain tissue • Associated with](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-17.jpg)
Types of Head Injuries • Contusion • Bruising of brain tissue • Associated with closed head injury • Can cause hemorrhage, infarction, necrosis, edema Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Coup-Contrecoup Injury Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Coup-Contrecoup Injury Copyright © 2014 by Mosby, an imprint of Elsevier Inc.](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-18.jpg)
Coup-Contrecoup Injury Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Types of Head Injuries • Contusion • Can rebleed • Focal and generalized manifestations Types of Head Injuries • Contusion • Can rebleed • Focal and generalized manifestations](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-19.jpg)
Types of Head Injuries • Contusion • Can rebleed • Focal and generalized manifestations • Monitor for seizures • Potential for increased hemorrhage if on anticoagulants Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Complications • Epidural Hematoma • Bleeding between the dura and the inner surface of Complications • Epidural Hematoma • Bleeding between the dura and the inner surface of](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-20.jpg)
Complications • Epidural Hematoma • Bleeding between the dura and the inner surface of the skull • Neurologic emergency • Venous origin slow • Arterial origin rapid Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Glasgow Coma Scale Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Glasgow Coma Scale Copyright © 2014 by Mosby, an imprint of Elsevier Inc.](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-21.jpg)
Glasgow Coma Scale Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Case Study Jupiterimages/Comstock/Thinkstock • An emergent CT scan on K. D. reveals an epidural Case Study Jupiterimages/Comstock/Thinkstock • An emergent CT scan on K. D. reveals an epidural](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-22.jpg)
Case Study Jupiterimages/Comstock/Thinkstock • An emergent CT scan on K. D. reveals an epidural hematoma. • What is an epidural hematoma? • What type of emergency treatment would you expect the health care provider to order? Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Complications • Epidural Hematoma • Initial period of unconsciousness • Brief lucid interval followed Complications • Epidural Hematoma • Initial period of unconsciousness • Brief lucid interval followed](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-23.jpg)
Complications • Epidural Hematoma • Initial period of unconsciousness • Brief lucid interval followed by decrease in LOC • Headache, nausea, vomiting • Focal findings • Requires rapid evacuation Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Epidural Hematoma Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Epidural Hematoma Copyright © 2014 by Mosby, an imprint of Elsevier Inc.](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-24.jpg)
Epidural Hematoma Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-25.jpg)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Complications • Subdural Hematoma • Bleeding between the dura mater and the arachnoid • Complications • Subdural Hematoma • Bleeding between the dura mater and the arachnoid •](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-26.jpg)
Complications • Subdural Hematoma • Bleeding between the dura mater and the arachnoid • Most common source is the veins that drain the brain surface into the sagittal sinus. • Can also be arterial Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Complications • Acute Subdural Hematoma • Within 24 to 48 hours of the injury Complications • Acute Subdural Hematoma • Within 24 to 48 hours of the injury](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-27.jpg)
Complications • Acute Subdural Hematoma • Within 24 to 48 hours of the injury • Symptoms related to increased ICP • ↓ LOC, headache • Ipsilateral pupil dilated and fixed if severe Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Complications • Subacute Subdural Hematoma • Within 2 to 14 days of the injury Complications • Subacute Subdural Hematoma • Within 2 to 14 days of the injury](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-28.jpg)
Complications • Subacute Subdural Hematoma • Within 2 to 14 days of the injury • May appear to enlarge over time Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Complications • Chronic Subdural Hematoma • Weeks or months after injury • More common Complications • Chronic Subdural Hematoma • Weeks or months after injury • More common](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-29.jpg)
Complications • Chronic Subdural Hematoma • Weeks or months after injury • More common in older adults • Presents as focal symptoms • ↑ Risk for misdiagnosis Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-30.jpg)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Intracerebral Hematoma • Bleeding within the brain tissue • Usually within frontal and temporal Intracerebral Hematoma • Bleeding within the brain tissue • Usually within frontal and temporal](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-31.jpg)
Intracerebral Hematoma • Bleeding within the brain tissue • Usually within frontal and temporal lobes • Size and location of hematoma determine patient outcome. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Epidural and Subdural Hematomas Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Epidural and Subdural Hematomas Copyright © 2014 by Mosby, an imprint of Elsevier Inc.](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-32.jpg)
Epidural and Subdural Hematomas Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Diagnostic Studies • CT scan • Best diagnostic test to determine craniocerebral trauma • Diagnostic Studies • CT scan • Best diagnostic test to determine craniocerebral trauma •](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-33.jpg)
Diagnostic Studies • CT scan • Best diagnostic test to determine craniocerebral trauma • MRI, PET, evoked potential studies • Transcranial Doppler studies • Cervical spine x-ray • Glasgow Coma Scale (GCS) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Case Study Jupiterimages/Comstock/Thinkstock • What would be the initial priority care for K. D. Case Study Jupiterimages/Comstock/Thinkstock • What would be the initial priority care for K. D.](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-34.jpg)
Case Study Jupiterimages/Comstock/Thinkstock • What would be the initial priority care for K. D. upon admission to the ED? Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Collaborative Care Emergency Treatment • Patent airway • Stabilize cervical spine. • Oxygen • Collaborative Care Emergency Treatment • Patent airway • Stabilize cervical spine. • Oxygen •](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-35.jpg)
Collaborative Care Emergency Treatment • Patent airway • Stabilize cervical spine. • Oxygen • IV access • Intubate if GCS <8. • Control external bleeding. • Remove patient’s clothing. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Collaborative Care Emergency Treatment • Maintain patient warmth. • Ongoing monitoring • Anticipate possible Collaborative Care Emergency Treatment • Maintain patient warmth. • Ongoing monitoring • Anticipate possible](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-36.jpg)
Collaborative Care Emergency Treatment • Maintain patient warmth. • Ongoing monitoring • Anticipate possible intubation. • Assume neck injury. • Administer fluids cautiously. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Collaborative Care • Treatment principles • Prevent secondary injury • Timely diagnosis • Surgery Collaborative Care • Treatment principles • Prevent secondary injury • Timely diagnosis • Surgery](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-37.jpg)
Collaborative Care • Treatment principles • Prevent secondary injury • Timely diagnosis • Surgery if necessary • Concussion and contusion • Observation and management of ICP Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Collaborative Care • Skull fractures • Conservative treatment • Surgery if depressed • Subdural Collaborative Care • Skull fractures • Conservative treatment • Surgery if depressed • Subdural](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-38.jpg)
Collaborative Care • Skull fractures • Conservative treatment • Surgery if depressed • Subdural and epidural hematomas • Surgical evacuation • Craniotomy, burr-holes • Craniectomy if extreme swelling Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Nursing Assessment • Subjective Data • Past medical history • Mechanism of injury • Nursing Assessment • Subjective Data • Past medical history • Mechanism of injury •](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-39.jpg)
Nursing Assessment • Subjective Data • Past medical history • Mechanism of injury • Medications • Anticoagulants Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Nursing Assessment • Subjective Data • Alcohol/drug use; risk-taking behaviors • Headache • Mood Nursing Assessment • Subjective Data • Alcohol/drug use; risk-taking behaviors • Headache • Mood](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-40.jpg)
Nursing Assessment • Subjective Data • Alcohol/drug use; risk-taking behaviors • Headache • Mood or behavioral changes • Mentation changes; impaired judgment • Aphasia, dysphasia • Fear, denial, anger, aggression, depression Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Case Study Jupiterimages/Comstock/Thinkstock • K. D. ’s past medical history is negative except for Case Study Jupiterimages/Comstock/Thinkstock • K. D. ’s past medical history is negative except for](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-41.jpg)
Case Study Jupiterimages/Comstock/Thinkstock • K. D. ’s past medical history is negative except for the births of two children. • Her family denies any drug or alcohol use. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Case Study Jupiterimages/Comstock/Thinkstock • She was not taking any anticoagulant medications. • What objective Case Study Jupiterimages/Comstock/Thinkstock • She was not taking any anticoagulant medications. • What objective](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-42.jpg)
Case Study Jupiterimages/Comstock/Thinkstock • She was not taking any anticoagulant medications. • What objective data will you assess K. D. for when she is admitted to the ICU after surgery? Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Nursing Assessment • Objective Data • Altered mental status • Lacerations, contusions, abrasions • Nursing Assessment • Objective Data • Altered mental status • Lacerations, contusions, abrasions •](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-43.jpg)
Nursing Assessment • Objective Data • Altered mental status • Lacerations, contusions, abrasions • Hematoma • Battle’s sign • Periorbital edema and ecchymosis • Otorrhea • Exposed brain Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Nursing Assessment • Objective Data • Rhinorrhea • Impaired gag reflex • Altered/irregular respirations Nursing Assessment • Objective Data • Rhinorrhea • Impaired gag reflex • Altered/irregular respirations](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-44.jpg)
Nursing Assessment • Objective Data • Rhinorrhea • Impaired gag reflex • Altered/irregular respirations • Cushing’s triad • Vomiting • Bowel and bladder incontinence Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Nursing Assessment • Objective Data • Uninhibited sexual expression • Altered LOC • Seizures Nursing Assessment • Objective Data • Uninhibited sexual expression • Altered LOC • Seizures](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-45.jpg)
Nursing Assessment • Objective Data • Uninhibited sexual expression • Altered LOC • Seizures • Pupil dysfunction • Cranial nerve deficit(s) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Nursing Assessment • Objective Data • Motor deficit • Palmar drift • Paralysis • Nursing Assessment • Objective Data • Motor deficit • Palmar drift • Paralysis •](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-46.jpg)
Nursing Assessment • Objective Data • Motor deficit • Palmar drift • Paralysis • Spasticity • Posturing • Rigidity or flaccidity • Ataxia Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Nursing Assessment • Objective Data • Abnormal CT scan or MRI • Abnormal EEG Nursing Assessment • Objective Data • Abnormal CT scan or MRI • Abnormal EEG](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-47.jpg)
Nursing Assessment • Objective Data • Abnormal CT scan or MRI • Abnormal EEG • Positive toxicology screen or alcohol level • ↑ or ↓Blood glucose level • ↑ ICP Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Case Study Jupiterimages/Comstock/Thinkstock • K. D. arrives in the ICU with a head dressing Case Study Jupiterimages/Comstock/Thinkstock • K. D. arrives in the ICU with a head dressing](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-48.jpg)
Case Study Jupiterimages/Comstock/Thinkstock • K. D. arrives in the ICU with a head dressing and Jackson Pratt drain in place. • She responds to painful stimuli by withdrawing but does not follow commands. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Case Study Jupiterimages/Comstock/Thinkstock • What nursing diagnoses related to K. D. ’s neurologic status Case Study Jupiterimages/Comstock/Thinkstock • What nursing diagnoses related to K. D. ’s neurologic status](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-49.jpg)
Case Study Jupiterimages/Comstock/Thinkstock • What nursing diagnoses related to K. D. ’s neurologic status would be most appropriate when planning her care? Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Nursing Diagnoses • Risk for ineffective cerebral tissue perfusion • Hyperthermia • Impaired physical Nursing Diagnoses • Risk for ineffective cerebral tissue perfusion • Hyperthermia • Impaired physical](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-50.jpg)
Nursing Diagnoses • Risk for ineffective cerebral tissue perfusion • Hyperthermia • Impaired physical mobility • Anxiety • Potential complication: increased ICP Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Nursing Planning • Overall Goals • Cerebral oxygenation & perfusion • Normothermic • Control Nursing Planning • Overall Goals • Cerebral oxygenation & perfusion • Normothermic • Control](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-51.jpg)
Nursing Planning • Overall Goals • Cerebral oxygenation & perfusion • Normothermic • Control pain and discomfort • Free of infection • Adequate nutrition • Maximal cognitive, motor, and sensory function Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Nursing Implementation • Health Promotion • Prevent car and motorcycle accidents. • Wear safety Nursing Implementation • Health Promotion • Prevent car and motorcycle accidents. • Wear safety](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-52.jpg)
Nursing Implementation • Health Promotion • Prevent car and motorcycle accidents. • Wear safety helmets. • Use seat belts and child car seats. • Home safety to prevent falls Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Case Study Jupiterimages/Comstock/Thinkstock • You invite K. D. ’s family into her room once Case Study Jupiterimages/Comstock/Thinkstock • You invite K. D. ’s family into her room once](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-53.jpg)
Case Study Jupiterimages/Comstock/Thinkstock • You invite K. D. ’s family into her room once you have her settled in. • What would be important to explain to the family at this point? Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Nursing Implementation • Acute Intervention • Maintain cerebral perfusion. • Prevent secondary cerebral ischemia. Nursing Implementation • Acute Intervention • Maintain cerebral perfusion. • Prevent secondary cerebral ischemia.](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-54.jpg)
Nursing Implementation • Acute Intervention • Maintain cerebral perfusion. • Prevent secondary cerebral ischemia. • Monitor for changes in neurologic status. • Patient and family teaching Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Nursing Implementation • Acute Intervention • Major focus of nursing care relates to increased Nursing Implementation • Acute Intervention • Major focus of nursing care relates to increased](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-55.jpg)
Nursing Implementation • Acute Intervention • Major focus of nursing care relates to increased ICP. • Eye problems • Eye drops, compresses, patch • Hyperthermia • Goal 36°to 37° C • Prevent shivering Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Nursing Implementation • Acute Intervention • Measures for patients leaking CSF • Head of Nursing Implementation • Acute Intervention • Measures for patients leaking CSF • Head of](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-56.jpg)
Nursing Implementation • Acute Intervention • Measures for patients leaking CSF • Head of bed elevated • Loose collection pad • No sneezing or blowing nose • No NG tube • No nasotracheal suctioning Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Nursing Implementation • Acute Intervention • Measures for immobilized patients • Antiemetics • Analgesics Nursing Implementation • Acute Intervention • Measures for immobilized patients • Antiemetics • Analgesics](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-57.jpg)
Nursing Implementation • Acute Intervention • Measures for immobilized patients • Antiemetics • Analgesics • Pre-op preparation, if needed Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Case Study Jupiterimages/Comstock/Thinkstock • K. D. survives the initial traumatic brain injury and surgery. Case Study Jupiterimages/Comstock/Thinkstock • K. D. survives the initial traumatic brain injury and surgery.](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-58.jpg)
Case Study Jupiterimages/Comstock/Thinkstock • K. D. survives the initial traumatic brain injury and surgery. • She is hemodynamically stable, extubated, and breathing on her own. • She opens her eyes spontaneously and follow commands. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Case Study Jupiterimages/Comstock/Thinkstock • K. D. remains confused and restless. • She also has Case Study Jupiterimages/Comstock/Thinkstock • K. D. remains confused and restless. • She also has](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-59.jpg)
Case Study Jupiterimages/Comstock/Thinkstock • K. D. remains confused and restless. • She also has some balance and motor deficits. • She is dependent on others for activities of daily living. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Case Study Jupiterimages/Comstock/Thinkstock • The family asks what the next step in her care Case Study Jupiterimages/Comstock/Thinkstock • The family asks what the next step in her care](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-60.jpg)
Case Study Jupiterimages/Comstock/Thinkstock • The family asks what the next step in her care will be and if she will ever return to her ‘original self. ’ • How will you respond? Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Nursing Implementation • Ambulatory and Home Care • Acute rehabilitation • Motor and sensory Nursing Implementation • Ambulatory and Home Care • Acute rehabilitation • Motor and sensory](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-61.jpg)
Nursing Implementation • Ambulatory and Home Care • Acute rehabilitation • Motor and sensory deficits • Communication issues • Memory and intellectual functioning • Nutrition • Bowel and bladder management Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Nursing Implementation • Ambulatory and Home Care • Seizure disorders • Mental and emotional Nursing Implementation • Ambulatory and Home Care • Seizure disorders • Mental and emotional](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-62.jpg)
Nursing Implementation • Ambulatory and Home Care • Seizure disorders • Mental and emotional difficulties • Progressive recovery • Family participation and education Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Nursing Evaluation • Expected Outcomes • Maintain normal cerebral perfusion pressure. • Achieve maximal Nursing Evaluation • Expected Outcomes • Maintain normal cerebral perfusion pressure. • Achieve maximal](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-63.jpg)
Nursing Evaluation • Expected Outcomes • Maintain normal cerebral perfusion pressure. • Achieve maximal cognitive, motor, and sensory function. • Experience no infection or hyperthermia. • Achieve pain control. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Audience Response Question The nurse is caring for a patient after a head injury. Audience Response Question The nurse is caring for a patient after a head injury.](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-64.jpg)
Audience Response Question The nurse is caring for a patient after a head injury. How should the nurse position the patient in bed? a. b. c. d. Prone with the head turned to the right side High-Fowlers position with the legs elevated Supine position with the head on two pillows Side-lying with the head elevated 30 degrees Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Meningitis • Infection and inflammation seen in pia mater, arachnoid, subarachnoid space and CSF Meningitis • Infection and inflammation seen in pia mater, arachnoid, subarachnoid space and CSF](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-65.jpg)
Meningitis • Infection and inflammation seen in pia mater, arachnoid, subarachnoid space and CSF • Purulent exudate and infectious debris blocks outflow of CSF leading to hydrocephalus Causes increased ICP May involve cranial nerve s Causes include bacterial, viral (fall, winter or spring and often secondary to viral resp disease) Bacterial caused by septic meningitis includes strep pneumonia, Neisseria meningitis (college campus, prisons, military bases) Viral or aseptic meningitis can be secondary to lymphoma, leukemia or HIV Haemophilus influenza is a common cause for children but is rare now due to vaccination • • • Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Meningitis • • Bacterial if untreated has a 100% mortality rate 40% that recover Meningitis • • Bacterial if untreated has a 100% mortality rate 40% that recover](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-66.jpg)
Meningitis • • Bacterial if untreated has a 100% mortality rate 40% that recover have long term neurological deficits (especially hearing) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Meningitis signs and symptoms • • Prodromal: respiratory illness then within 24 hours see: Meningitis signs and symptoms • • Prodromal: respiratory illness then within 24 hours see:](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-67.jpg)
Meningitis signs and symptoms • • Prodromal: respiratory illness then within 24 hours see: Severe HA Fever Photophobia Rash (meningococcus) Nuchal rigidity Positive Kernig's and Brudzinski’s signs Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Meningitis Diagnostics Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Meningitis Diagnostics Copyright © 2014 by Mosby, an imprint of Elsevier Inc.](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-68.jpg)
Meningitis Diagnostics Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Meningitis treatment • Antibiotics such as PCN, ampicillin, cephalosporins, Vanco for resistant strains • Meningitis treatment • Antibiotics such as PCN, ampicillin, cephalosporins, Vanco for resistant strains •](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-69.jpg)
Meningitis treatment • Antibiotics such as PCN, ampicillin, cephalosporins, Vanco for resistant strains • Antipyretics • Cooling blanket prn • Dark, quiet environment Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Encephalitis • • • Acute inflammation of the brain Caused by a virus Ticks Encephalitis • • • Acute inflammation of the brain Caused by a virus Ticks](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-70.jpg)
Encephalitis • • • Acute inflammation of the brain Caused by a virus Ticks and mosquitos Nonepidemic encephalitis HSV CMV Early diagnosis and treatment is important: Onset nonspecific with fever, HA, n/v. May be acute or subacute Prevention Acyclovir Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![Brain tumors and abcesses • • Brain abscesses Brain tumors • Incidence • Primary Brain tumors and abcesses • • Brain abscesses Brain tumors • Incidence • Primary](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-71.jpg)
Brain tumors and abcesses • • Brain abscesses Brain tumors • Incidence • Primary and secondary Primary tumors are further broken down: • Meningiomas-35% most common • Gliomas-30% of all primary and 80% of malignant More than half of the brain tumors are malignant Clinical manifestations depend on the location (See table 57 -13) : If tumor obstructs ventricle-hydrocephalus can result and can cause increasing ICP DX TX Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
![CRANIAL SURGERY • • • Indicatations Types Craniotomy Stereotactic surgery Post-op care: PRIMARY GOAL CRANIAL SURGERY • • • Indicatations Types Craniotomy Stereotactic surgery Post-op care: PRIMARY GOAL](http://slidetodoc.com/presentation_image_h/0c66a0ff51c14ab6cc9b9183b9393152/image-72.jpg)
CRANIAL SURGERY • • • Indicatations Types Craniotomy Stereotactic surgery Post-op care: PRIMARY GOAL IS PREVENTIO FOR INCREASED ICP Patient may be taken to ICU for close monitoring of ICP, F & E balance, monitoring for DI or severe hypovolemia Turning and positioning Elevated at least 30 degrees unless burr holes have been made in the posterior fossa-then HOB slightly flat or 15 degrees Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
- Slides: 72