Questions and Answers
What defines a traumatic brain injury (TBI)?
Under which category would a scalp laceration fall regarding head trauma?
What type of injury is characterized by the brain being exposed due to skull compromise?
Which factor contributes to secondary injury in acute head trauma?
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Which of the following describes an acceleration-deceleration injury?
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What is typically true about linear fractures of the skull?
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Which symptom is associated with a basilar skull fracture?
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What is a key sign of elevated intracranial pressure (ICP) related to cerebral edema?
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Which type of hematoma is typically associated with venous bleeding?
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What is a common misconception about the management of traumatic head injury?
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Study Notes
Acute Head Injury Overview
- Acute head injury encompasses injuries to the head and its structures, defined by specific terms.
- Traumatic Brain Injury (TBI) arises from traumatic events, including blunt or penetrating injuries.
- Closed head injuries involve blunt trauma without skull fractures; penetrating injuries breach the skull.
Types of Head Trauma
- Open trauma compromises the skull and exposes the brain.
- Closed trauma leaves the skull intact and the brain protected.
Etiology and Pathophysiology
- Primary injury results from kinetic forces impacting the skull; secondary injury leads to biochemical changes and neuronal death.
- Kinetic forces include:
- Acceleration: moving object hits stationary head.
- Deceleration: moving head strikes stationary object.
- Acceleration-deceleration: observed in high-speed crashes.
- Coup-contrecoup injuries involve movement of brain contents.
- Rotational injuries involve twisting that can damage neurons.
Severity of Head Injury
- Severity assessed by Glasgow Coma Scale (GCS):
- Mild: GCS 13-15
- Moderate: GCS 9-12
- Severe: GCS less than 8
Primary Injury Types
- Focal injuries:
- Scalp lacerations: can bleed extensively; require sterile dressing.
- Skull fractures: may be linear (crack, non-surgical), depressed (surgical elevation), or basilar (can cause leakage from nose/ears, raccoon eyes).
- Diffuse injuries:
- Cerebral concussion: mental status changes without structural damage.
- Diffuse Axonal Injury (DAI): damage to brain axons, varying severity based on coma duration.
Hematomas
- Epidural hematoma: occurs outside dura; high mortality from arterial bleeding; typically requires surgical intervention.
- Subdural hematoma: blood accumulation below dura; venous bleeding; common in the elderly; monitored closely for symptoms.
- Intracerebral hematoma: bleeding within brain tissue; treatment often required for large clots.
Secondary Injury
- Secondary injuries occur after initial trauma, linked to compromised cerebral perfusion.
- Cerebral edema can lead to herniation syndromes and occurs 24-48 hours post-injury.
Symptoms and Diagnosis
- Signs of traumatic head injury include altered consciousness, pupillary response, and cognitive/function assessments.
- Diagnostic tools include skull x-ray, CT scans for lesions, and MRI for unexplained findings.
Nursing Diagnoses
- Focus on altered cerebral perfusion, ineffective airway clearance, impaired mobility, and communication.
Collaborative Management
- Airway management: maintain adequate oxygen levels, monitor cerebral perfusion pressure (CPP).
- Prevention and treatment of seizures within the first week post-injury.
- Monitor fluid/electrolyte status, particularly for hyponatremia; avoid hypotonic solutions.
- Ensure optimal nutrition; enteral or parenteral feeding should begin within 7 days post-injury.
Surgical Management
- Craniectomy for depressed fractures; debridement may be necessary to reduce neurological damage.
- Focus on maintaining head position, physiotherapy, and splinting to prevent complications.
Brain Death Criteria
- Confirmed by a deep coma, absence of brainstem reflexes, and apnea test indicating non-respiratory function.
- EEG results are used to support diagnosis.
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Description
This quiz explores key concepts related to acute head injuries, including etiology, pathophysiology, systemic impacts, and assessment techniques. It also focuses on nursing diagnoses and collaborative management strategies in handling traumatic brain injuries. Prepare to deepen your understanding of this critical subject in nursing care.
