Page 269 - Critical Care Nursing Demystified

254 CRITICAL CARE NURSING DeMYSTIFIED

Prognosis
Patients are generally admitted to the hospital for observation for a period of
24 hours with discharge instructions to seek immediate care if the post-
concussion symptoms persist or worsen.

Contusion

What Went Wrong?
The patient sustains bruising of the brain with some superficial parenchymal
bleeding mostly over the temporal area.

Hallmark Signs and Symptoms
Contusions can increase in size and severity several days after injury as further bleed-
ing and cerebral edema occur, creating a worsening of symptoms and an increase in
intracranial pressure. Extreme ecchymoses is evident at the injured site.

Interpreting Test Results
Diagnosis is made via CAT scan, presenting symptoms, and physical and neu-
rological assessments. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

Prognosis
These larger evolving areas of bleeding may require surgical intervention to
reduce the ICP and cerebral edema and to evacuate the hematoma.
Specifically, there are three types of hematomas.

Epidural Hematoma
What Went Wrong? A collection of blood between the inner skull and the out-
ermost layer of the dura, which has been pulled away from the skull. Frequently
it occurs as a result of a fall, blow to the head, or MVA that causes a skull frac-
ture and a laceration to the middle meningeal artery.

Hallmark Signs and Symptoms Classic symptoms include a brief loss of conscious-
ness followed by a lucid period that can last up to 12 hours. Deterioration in
the person’s level of consciousness begins to occur with hemiparesis seen on
the opposite side of the body from impact and a fixed, dilated pupil seen on the
same side of the body as that on which the impact occurred. These are the
characteristic qualifiers of an epidural hematoma. The patient may also complain
of a severe, localized headache.
Interpreting Test Results A CAT scan reveals a collection of epidural blood.