Head Trauma- also known as head injury, is the disruption of normal brain function due to

trauma-related injury resulting in compromised neurologic function resulting in focal or

diffuse symptoms.
Etiology: External Physical Force. Motor vehicle accident (most common etiology injury)
Types of Traumatic Brain Injury:
1. Concussion- transient interruption in brain activity, no constructural injury noted on
radiographs
2. Cerebral contusion- bruising of brain with associated swelling
3. Intracerebral hematoma- bleeding into the brain tissue commonly associated with
edema
4. Epidural hematoma- blood between the inner table of the skull and dura.
5. Subdural hematoma- blood between the dura and arachnoid caused by bleeding
commonly associated with additional brain injury.
6. Diffuse axonal injury- axonal tears within the white matter of the brain.
Predisposing Factors: Precipitating Factors:
* Gender (Common-Men) * Vehicular accidents
* Ages * Lifestyle
Children (newborn to 4 years old) * Fall
Young Adult (between 15 to 24 years old) * Assault/ Violence
Adult (60 and older) * Sports Injuries
* Explosive blasts & other
combat
injuries

Signs and Symptoms: Children Sign and Symptoms:

* Loss of consciousness * Changes to eating or nursing habits
* Headache * Unusual or easy irritability
* Nausea and Vomiting * Persistent crying
* Fatigue and Drowsiness * Changes to sleep
* Sensitivity to light and sounds * Seizures
* Mood changes or mood swings * Sad or depressed mood
* Loss of interest in favorite
toys/activities

If Treated: If not Treated:

* Cold pack to area to reduce swelling * Infections
* Tylenol (avoid NSAIDS) * Increased Intracranial Pressure
* Anti-seizure drugs * Posttraumatic seizure disorder
* Diuretics * Permanent neurological deficits
* Rehabilitation program * Death

Complications:
* Altered Consciousness (Coma, Vegetative State, Brain Death)
Intellectual Problems
* Physical complications (Seizures, Infections, Blood vessel damage, Headache, Vertigo)
* Cognitive Problems (Memory, Learning, Reasoning, Judgment, Attention/ Concentration)
* Executive Functioning Problems (Problem solving, Multitasking, Organizing, Decision
Making)
Communication Problems
* Social Problems (Difficulty in understanding nonverbal signals, trouble in topic selection,
reading cues from listener, trouble starting or stopping conversation, inability to use muscles
needed to form words- dysarthria)
* Cognitive Problems (Difficulty in speaking, understanding speech/ writing, Inability to
organize thoughts and ideas, and following)
Behavioral Changes
* Difficulty in self control
* Lack of awareness of abilities
* Risky behavior
* Difficulty in social situations
Emotional Changes
* Anxiety
* Depression
* Mood swings
* Irritability
* Lack of empathy for others
* Anger
* Insomnia
Sensory Problems
* Persistent ringing in ears
* Difficulty recognizing objects
* Blind spots or double vision
* Skin tingling, pain or itching
* Trouble with balance or dizziness
Degenerative Brain Diseases
* Alzheimer’s Disease
* Parkinson’s Disease
* Dementia Pugilistica;

Diagnostic Test: Medical/ Surgical Management:

* Magnetic Resonance Imaging (MRI) * Plasma Exchange (Plasmapheresis)
* Computerized Tomography (CT) Scan * Immunoglobulin Therapy
* Intracranial Pressure Monitor * Removing clotted blood
(hematomas)
* Glasgow Scale Coma * Repairing skull fractures
* Opening a window in skull
* Rehabilitation

Nursing Diagnosis:
* Risk for injury r/t complications of head injury
* Acute pain r/t altered brain or skull tissue
Nursing Interventions:
1) Turn the patient every 2 hours and encourage cough and deep breathing exercises.
2) Maintain ICP monitoring, as indicated and report abnormalities.
3) Suction the patient as needed.
4) Institute measures to prevent increased ICP or other neurovascular compromise.
5) If the patient is unable to swallow, provide enteral feeding after bowel sounds have
return.
6) Monitor respiratory rate, depth, and pattern of respirations.
7) Elevate the head of the bed after feedings and check residuals to prevent aspiration.

PATHOPHYSIOLOGY

Head Injury

Systemic Insults Transient Neuronal Depolarization Intracranial lesions

Cerebral Ischemia Neurotransmitter Release Impaired Auto regulation

Neuronal Excitation Altered CBF

Metabolic Failure
Cell energy failure
Membrane Disruption

Cerebral Edema
Brain Swelling