Dr.

Eman Osman Ali

Medical Surgical Nursing
Definition of head injury :-
Is an any trauma to the scalp, skull, or brain.

 Head injuries can include fractures to the skull and

face, direct injuries to the brain and indirect injuries to
the brain (such as a concussion, contusion, or
intracranial hemorrhage).
The most common causes are:-
 Falls (35.2%)
 Motor vehicle crashes (17.3%)
 Being struck by objects (16.5%)
 Assaults (10%).
 Accidents at home work, outdoors, or while playing
sports
 Concussion—a mild diffuse axonal injury resulting in
a transient disturbance of neurological function that
may or may not include a loss of consciousness.

 Contusion—a focal injury resulting in bruising of the

brain tissue. Actual small amounts of bleeding into the
brain tissue associated with edema formation and
possible tissue necrosis and infarction.
Intracranial hemorrhage
 Significant bleeding into a space or a potential space
between the skull and the brain.

 This is a serious complication of a head injury with a

high mortality because of rising intracranial pressure
(ICP) and the potential for brain Herniation.
Intracranial hemorrhages
- Can be classified as:-

 Epidural hematomas (Skull and dura mater)

 Subdural hematomas (dura and the brain)

 Subarachnoid hemorrhages (arachnid membrane and

pia mater) depending on the site of bleeding.
Primary Assessment
1. Airway: assess for vomitus, bleeding, and foreign
objects. Ensure cervical spine immobilization.
2. Breathing: assess for abnormally slow or shallow
respirations. An elevated carbon dioxide partial
pressure can worsen cerebral edema.
3. Circulation: assess pulse and bleeding.
4. Disability: assess the patient’s neurologic status.
Primary Interventions
1. Open the airway using the jaw-thrust technique
without head tilt. Oral suction equipment (to handle
heavy vomitus) should be at hand. Make sure that
you do not stimulate the gag reflex as this can cause
increases in ICP.
2. Administer high-flow oxygen.

3. Assist inadequate respirations with a bag-valve-mask,

as necessary. Prophylactic hyperventilation is
contraindicated.
4. Control bleeding—do not apply pressure to the injury
site. Apply a bulky, loose dressing.

5. Initiate two IV lines. The administration of fluid and

rate of flow should be determined by the patient’s
hemodynamic status.
Subsequent Assessment
• 1. History:-

• Mechanism of injury.

• Presence and duration of loss of consciousness.

• Amnesia of the event. Position found.

2. LOC:-

 Change in mental status is the most sensitive indicator

of a change in the patient’s condition.
 3-7 / Severe / Unresponsive
 8 -12 / Mild / Comatose
 13-15 / Normal / Best score
3. Vital signs.
 Hypertension and bradycardia are late signs of
increasing ICP.
 Patients with a head injury may have associated
cardiac dysrhythmias, noted by an irregular or rapid
pulse.
 Changing patterns of respiration or apnea may
indicate a head injury.
 Elevated temperature—high temperatures may be
associated with head injury.
4. Unequal or unresponsive pupils.
5. Confusion or personality changes
6. Impaired vision
7. One or both eyes appear sunken.
8. Seizure activity.
9. Peri auricular ecchymosis—“Battle sign,” a bluish
discoloration behind the ears (indicates a possible basal
skull fracture).
10. Rhinorrhea or otorrhea (indicative of leakage of CSF).
11. Periorbital ecchymosis (indicates anterior basilar fracture).
 If basilar skull fracture or severe midface fractures are
suspected, a nasogastric (NG) tube is contraindicated.
An orogastric tube may be considered for insertion.
General Interventions
1. Keep the neck in a neutral position with the cervical
spine immobilized.
2. Establish an IV line of normal saline or lactated
Ringer solution—fluid volume should be based on
the patient’s hemodynamic status.
3. Be prepared to manage seizures—if seizures occur,
they should be controlled immediately.
4. Maintain normothermia.
5. Pharmacologic interventions may include:-
a. Anticonvulsants—to control seizures
b. Mannitol or hypertonic saline—to reduce cerebral
edema and decrease ICP.
c. Antibiotics.
d. Antipyretics to control hyperthermia.
1- Which a long-term complication of traumatic brain
injury?
2- Patient administered to emergency room with a severe
head injury and the nurse suspected a tear in the dura
as a result of the basilar skull fracture. Which signs
confirms this fracture ?
3- Which of the following types of head injury involves
bleeding between the dura mater and the arachnoid
mater?
4- A patient is being admitted to the neurologic ward
following an acute head injury that has resulted in
cerebral edema. When planning this patients care, the
nurse would expect to administer what medication to
decreasing cerebral edema?
5- The nurse had a call for help from the emergency
department waiting room. There is an elderly patient
lying on the floor has bead injury. What is the
immediate action that the nurse must perform?
a. Perform the chin lift or jaw thrust maneuver
b. Establish unresponsiveness
c. Initiate emergency assessment
d. tart with initial assessment
6- A 23-year-old client has been hit on the head with a
baseball bat. The nurse notes clear fluid draining from his
ears and nose. Which of the following nursing
interventions should be done first
a. Suction the nose to main airway patency
b. Insert nasal and ear packet with sterile gauze
c. Position the client flat in the bed
d. Check the fluid for dextrose with a dipstick
7- Which one is contraindicated for a patient with a mild
head injury to take as a painkiller:-
a. Acetaminophen
b. Paracetamol
c. Ibuprofen
d. Aspirin
8- What is a common symptom of a concussion in
patients with head injuries:-
a. Hypertension
b. Visual disturbances
c. Seizures
d. Memory loss
9- In cerebral _____ ,a moderate to severe head injury,
the brain is bruised and damaged in a specific area
because of sever acceleration-deceleration force or
blunt trauma?
a. Concussion
b. Skull injury
c. Scalp injury
d. Contusion