I.

Introduction
II. Head Injury
a. Definition and explanation
b. Mechanisms of injury
i. Acceleration
ii. Deceleration
iii. Acceleration deceleration
iv. Deformation
v. Rotation
c. Types of Head Injury
Reminders: Differentiate Primary from Secondary
i. Primary
1. Concussion
2. Contusion
3. Laceration
4. Skull fractures
ii. Secondary (Mention only the three, explanation on Patho)
1. Cerebral edema
2. Increased ICP
3. Hematoma formation
III. Expanding Lesions
a. Hematoma
i. Subdural
ii. Epidural
iii. Intracerebral
b. Tumor
c. Abscess
d. Granuloma
IV. Hydrocephalus
a. Definition and explanation
b. Labeling (active, occult, and arrested) - explain
c. Types
i. Communicating
ii. Non communicating
iii. Normal Pressure
iv. Hydrocephalus ex vacuo
v. Congenital
vi. Acquired
V. Cerebral Edema
a. Definition
b. Types
i. Interstitial
ii. Vasogenic
iii. Cytotoxic
VI. Pathophysiology of Increased ICP
VII. Clinical Manifestations
VIII. Complications
a. Herniation
i. Tentorial
ii. Uncal
iii. Cingulate
IX. Diagnostic Test
X. Medical Management
a. Drug Therapy
b. Hyperventilation
c. Nutritional
XI. Nursing Management
a. Assessment
i. LOC
ii. Glasgowcoma
iii. Neurologic
b. Implementation
i. Respiratory Function
ii. Monitoring ICP
iii. Body Position
iv. Protection from Injury
v. Psychological Consideration
http://www.tbirecoverycenter.org/patho.htm
http://www.frca.co.uk/article.aspx?articleid=100915
http://www.neurocriticalcare.org/files/public/1015LeRoux.pdf
http://www.thecorrect.com/medical-emergency/head-trauma.html
http://emedicine.medscape.com/article/326510-overview#aw2aab6b4
http://www.merckmanuals.com/professional/injuries_poisoning/traumatic_brain_injury_tbi/traumatic_
brain_injury.html

WHY?
INCREASED INTRACRANIAL
PRESSURE

Frequent neuro checks. Why?
Condition quickly changes and establish a
baseline. Looking for improvements
First sign is change in LOC

Drug Induced Comas. Why?
Decreases metabolic demand on brain
Shut down

Avoidance of Valsava Maneuver. Why?
Increased ICP

Administer Lasix. Why?
Decreases ICP (unload intravascular spaces)

Hyperventilation. Why?
Respiratory alkalosis Cerebral
vasoconstriction Decreased cerebral
blood volume, decreased ICP
5O2 and 6 CO2 levels

Seizure Precautions. Why?
Cerebral changes cause seizures

Elevate HOB. Why?
20-30
o
will increase venous
return/drainage.

Careful regulation of IV fluids. Why?
Prevent Increased ICP. DO NOT want to
overload with fluids

Neck in Neutral, Midline Position. Why?
Promote venous drainage

Administer Oxygen. Why?
Increase cerebral perfusion

Administer osmotic diuretics. Why?
Dehydrate brain, Decreases cerebral edema

Passive Range of Motion. Why?
Prevent Contractures, no active so as to not
put stress on their body

Turn and deep breathe. Why?
Prevent pneumonia, increase gastric
motility, position sense in the bed, no
coughing

Administer corticosteroids. Why?
Decreases cerebral edema

Treat elevated temperatures. Why?
Increases cerebral metabolism rate and
cerebral edema

Restrict fluids. Why?
Dehydration, decrease circulating fluid
volume

Check stools for occult blood. Why?
Corticosteroids can cause bleeding

Administer Anticonvulsants. Why?
Prevent convulsions, and seizures, because
it increases ICP

Monitor intake and output. Why?
Dehydration, diabetes insipidus

No trendelengerg. Why?
Decreased venous return and increases
cerebral edema

Monitor electrolytes. Why?
Evaluate seizures

Keep blood pressure normotensive. Why?
Increase BP Increased ICP

Monitor BUN/Creat Levels. Why?
Renal Function

Monitor Blood Gas Values. Why?
Respiratory Status (CO
2
) increased CO2
leads to vasodilation increased ICP

Continuous intracranial pressure monitoring. Why?
Condition of client in early stages, and see if
treatment is effective

Administer stool softeners. Why?
Prevent straining

Ventriculostomy. Why?
Drain, and administration of drugs, must
keep sterile, must keep gravity drain at
certain level do not move bed up or down.

Intracranial surgery. Why?
Remove tumor, correct bleed, correct
underlying cause

Nothing snug around neck. Why?
Decreases venous drainage, and increased
ICP

Avoid Extreme hip flexion and prone position.
Why?
Increased intraabdominal/intrathoracic
pressure increases ICP

Assist client to move in bed. Why?
Movement increases ICP

No Restraints. Why?
Resistance Increases ICP

Decrease anxiety level and avoid emotional upsets.
Why?
Decreases ICP

Suction as needed to maintain clear airway. Why?
Coughing Increases ICP

No Narcotics or sedatives. Why?
Effects LOC