Page 268 - Critical Care Nursing Demystified

Chapter 5 CARE OF THE PATIENT WITH NEUROLOGICAL NEEDS 253

at the time of impact, for example, gunshot wound, baseball bat, MVA. Second-
ary injuries are those that occur after the primary injury insult.
The more severe injuries may require surgery to remove bone fragments or
to evacuate hematomas via burr holes or a craniotomy.

NURSING ALERT
There is always a high risk of patients with penetrating head wounds developing
infections and brain abscesses as secondary injuries. The injured brain must always
be protected.

Specific Types of Head Injury
Can be open where the brain dura is torn, or closed where the brain dura
remains intact. Open skull fractures require surgery to close the dura and
remove bony fragments.

Hallmark Signs and Symptoms
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rhinorrhea and ecchymosis over the mastoid process (bruising behind the
ears—Battle’s sign) as well as raccoon eyes (ringlike ecchymosis around the
eyes).

Concussion

What Went Wrong?
A brain injury in which there is a loss of consciousness that lasts from a few
seconds to 1 hour.

Signs and Symptoms
The victim might experience confusion, irritability, disorientation, and have a
period of posttraumatic amnesia. Patients may complain of headache, fatigue,
dizziness, inability to concentrate, and impaired memory. Despite the loss of
consciousness with functional impairment, the brain remains structurally
intact.

Interpreting Test Results
Diagnosis is confirmed based upon symptoms; length of time of unconscious-
ness, if it occurred; nature of the injury; and CAT scan.