● Spasticity

04/01/24 ● Headache
● Vertigo
HEAD INJURY ● Movement disorders
● Seizures
● This involves injury to the scalp, skull and or brain
tissues Medical Management

Traumatic Head Injury ● Nondepressed skull fractures generally do not require

surgical treatment; however, close observation of the
● It is the most serious form of head injury patient essential
● The most common causes of traumatic brain injury ● Nursing personnel may observe the patient in the
are motor vehicle crashes, violence, and falls hospital, but if no underlying brain injury is present,
● Highest risk for traumatic brain injury are persons age the patient may be allowed to return home
15 to 24 years and males, who suffer traumatic brain
injury at a rate almost twice that of females TRAUMATIC BRAIN INJURY
● 15-24 years old male - because they are more likely to
engage in risky behaviors ● This is a major cause of death and disability in adults
● Young males make up a large proportion of brain
Scalp Injury injury victim

● Isolated scalp trauma is generally classified as a minor Pathophysiology

head injury
● Because its many blood vessels constrict poorly, the
scalp bleeds profusely when injured
● Trauma may result in an abrasion (brush wound),
contusion, laceration, or hematoma beneath the
layers of tissue of the scalp (subgaleal hematoma)

Skull Fractures

● It is a break in the continuity of the skull caused by

forceful trauma
● It may occur with or without damage to the brain
● Classified as:
○ Linear
○ Comminuted
○ Depressed
○ Basilar
Etiology
Clinical Manifestations
● Motor vehicle accidents
● Altered level of consciousness ● Falls
● Confusion ● Sports-related injuries, and
● Pupillary abnormalities (changes in shape, size, and ● Violence
response to light)
● Altered or absent gag reflex Classification of Traumatic Brain Injury
● Absent corneal reflex
● Sudden onset of neurologic deficits 1. Closed Head Injury or Nonpenetrating Injury
● Changes in vital signs (altered respiratory, pattern, ● It is used when there has been rapid back and forth
hypertension, bradycardia, tachycardia, hypothermia, movement of the brain causing bruising and tearing
or hyperthermia) of brain tissues and vessels, but the skull is intact
● Vision and hearing impairment
● Sensory dysfunction 2. Acceleration Injury
 ● It is the term used to describe a moving object hitting
a stationary head

3. Deceleration Injury
● Occurs when the head is in motion and strikes a
stationary surface

Types of Brain Injury

1. Cerebral Concussion
● It is considered a mild brain injury ○ Level of consciousness may deteriorate
● If there is a loss of consciousness, it is for 5 minutes or further as ICP increases
less ● Chronic Subdural Hematoma
● Characterized by headache, dizziness, or nausea and ○ Develop weeks to months after the injury
vomiting ○ Patient may be forgetful, lethargic, or irritable
● Patient may complain of amnesia of events before or or may complain of a headache
after the trauma ○ If the hematoma persists or increases in size,
the patient may develop hemiparesis and
2. Cerebral Contusion pupillary changes
● It is characterized by bruising of brain tissue, possibly
accompanied by hemorrhage b. Epidural Hematoma
● There may be multiple areas of contusion, depending ● Collection of blood between the dura mater and skull
on the causative mechanism and usually arterial in nature
● Symptoms depend on the area of the brain involved ● Often associated with skull fracture
● Brainstem contusions affect level of consciousness ● Patient loses consciousness directly after the injury
● Decreased level of consciousness may be transient or ● He or she then regains consciousness and is coherent
permanent for a brief period
● Respirations, pupil reaction, eye movement, and ● The patient then develops a dilated pupil and
motor response to stimuli may also be affected paralyzed extraocular muscles on the side of the
● The autonomic nervous system may be affected by hematoma and becomes less responsive
edema or by hypothalamic injury, causing rapid heart ● Signs and symptoms:
rate and respiratory rate, fever, and diaphoresis ○ Unconsciousness
○ Headache
3. Hematoma ○ Nausea and vomiting
a. Subdural hematoma
b. Epidural hematoma c. Intracerebral Hematoma
c. Intracerebral hematoma ● It occurs from bleeding within the parenchyma and
occurs in approximately 16% of head injuries
a. Subdural Hematoma ● It usually occurs within the frontal and temporal
● May be acute or chronic lobes, possibly from the rupture of blood vessel at the
● Acute Subdural Hematoma time of injury
○ It is characterized by appearance of
symptoms within 24 hours following injury. Diagnostic Test
The bleeding is typically venous in nature and
accumulates between the dura and arachnoid ● CT scan
membranes ● MRI
○ Altered level of consciousness
○ As the subdural hematoma increases in size, Medical Management
the patient may exhibit one-sided paralysis of
extraocular movement, extremity weakness, 1. ICP Monitoring
or dilation of the pupil ● Insert an ICP monitor to allow measurement of the
○ Extraocular movement: ICP

2. Osmotic Diuretic
 ● Mannitol utilizes osmosis to pull fluid into the processing) related to brain injury
intravascular space and eliminate it via the renal 6. Risk for injury (self-directed and directed at others)
system related to seizures, disorientation, restlessness, or
● Serum osmolarity and electrolytes must be carefully brain damage
monitored when mannitol is being administered
Nursing Management
3. Mechanical Hyperventilation
● Hyperventilation is effective in lowering ICP because it ● Care of client with increased ICP
causes vasoconstriction. Vasoconstriction allows less ● Monitor the drainage from the ears and nose
blood into the cranium, thereby lowering ICP ● Monitor the client for signs and symptoms of
meningitis, atelectasis, pneumonia, urinary tract
infection

SPINAL CORD INJURY

● Is an insult to the spinal cord resulting in a change,

either temporary or permanent, in the cord's normal
motor, sensory, or autonomic function
● Occurs when there is any damage to the spinal cord
that blocks communication between the brain and
the body

Surgical Management Causes

1. Burr Hole ● Traumatic Injuries:

● Opening into the cranium with a drill ○ Motor vehicle accidents
● Used to remove localized fluid and blood beneath the ○ Falls
dura ○ Violence
○ Football
2. Craniotomy ○ Gymnastics
● Opening into the cranium with removal of a bone flap ○ Diving into shallow water
and opening the dura to remove a lesion, repair a ● Spinal cord injuries affect more men than women.
damage area, drain blood or relieve increased ICP The majority of people who sustain a spinal cord
injury are young adults between the ages of 16 and
3. Craniectomy 30 because of riskier behaviors
● Excision into the cranium to cut away a bone flap
Levels of Injury
4. Cranioplasty
● Repair of a cranial defect resulting from trauma, 1. High Cervical Nerves (C1-C4)
malformation, or previous surgical procedure ● Most severe of the spinal cord injury levels
● Paralysis in arms, hands, trunk and leg
Nursing Diagnosis ● Patient may not be able to breathe on his or her own,
cough, or control bowel or bladder movements
1. Ineffective cerebral tissue perfusion related to ● Ability to speak is sometimes impaired or reduced
increased ICP ● When all four limbs are affected, this is called
2. Ineffective airway clearance related to reduced cough tetraplegia or quadriplegia
reflex and decreased level of consciousness ● Requires complete assistance with activities of daily
3. Deficient fluid volume related to decreased LOC and living, such as eating, dressing, bathing, and getting in
hormonal dysfunction or out of bed
4. Imbalanced nutrition, less than body requirements, ● May be able to use powered wheelchairs with special
related to metabolic changes, fluid restriction, and controls to move around on their own
inadequate intake ● Will not be able to drive a car on their own
5. Disturbed thought processes deficits in intellectual ● Requires 24-hour-a day personal care
function, communication, memory, information
2. Low Cranial Nerves (C5-C8) as paraplegia)
● Most likely use a manual wheelchair
a. C5 Injury ● Can learn to drive a modified car
● Person can raise his or her arms and bend elbows ● Can stand in a standing frame, while others may walk
● Likely to have some or total paralysis of wrists, hands, with braces
trunk and legs
● Can speak and use diaphragm but breathing will be b. T6-T12 Injury
weakened ● Usually results in paraplegia and normal upper-body
● Will need assistance with most activities of daily movement
living, but once in a power wheelchair, can move from ● Fair to good ability to control and balance trunk while
one place to another independently in the seated position
● Should be able to cough productively (if abdominal
b. C6 Injury muscles are intact)
● Nerves affect wrist extension ● Little or no voluntary control of bowel or bladder but
● Paralysis in hands, trunk, and legs, typically can manage on their own with special equipment
● Should be able to bend wrists back ● Most likely use a manual wheelchair or bladder
● Can speak and use diaphragm but breathing will be ● Can learn to drive a modified car
weakened ● Some can stand in a standing frame, while others may
● Can move in and out of wheelchair and bed with walk with braces
assistive equipment
● May also be able to drive an adapted vehicle 4. Lumbar Nerves (L1-L5)
● Little or no voluntary control of bowel or bladder, but ● Injuries generally result in some loss of function in the
may be able to manage on their own with special hips and legs
equipment ● Little or no voluntary control of bowel or bladder but
can manage on their own with special equipment
c. C7 Injury ● Depending on the strength in the legs, may need a
● Nerves control elbow extension and some finger wheelchair and may also walk with braces
extension
● Most can straighten their arm and have normal 5. Sacral Nerves Injury (S1-S5)
movement of their shoulders ● Injuries generally result in some loss of function in the
● Can do most activities of daily living by themselves hips and legs
but may need assistance with more difficult tasks ● Little or no voluntary control of bowel or bladder but
● May also be able to drive an adapted vehicle can manage on their own with special equipment
● Little or no voluntary control of bowel or bladder, but ● Most likely will be able to walk
may be able to manage on their own with special
equipment

d. C8 Injury
● Nerves control some hand movement
● Should be able to grasp and release objects
● Can do most activities of daily living, but may need
assistance with more difficult tasks
● May also be able to drive an adapted vehicle
● Little or no voluntary control of bowel or bladder, but
may be able to manage on their own with special
equipment

3. Thoracic Nerves
Diagnostic Test
● CT Scan
a. T1-T5 Injury
● MRI
● Corresponding nerves affect muscles, upper chest,
mid-back and abdominal muscles
Emergency Management
● Arm and hand function is usually normal
● Careful monitoring of vital signs and airway
● Injuries usually affect the trunk and legs (also known
 ● Keeping the patient immobilized
● Intravenous normal saline may be used for fluid
replacement
● Vasoactive drugs may be required

Therapeutic Interventions
● Patients with spinal cord injuries typically are brought
to the emergency department
● They should be kept immobilized until they are
assessed by a physician
● If injury to the spinal cord is detected, the patient
needs to remain immobilized
● Respiratory Management
● Gastrointestinal Management
● Genitourinary Management
● Immobilization