Page 270 - Critical Care Nursing Demystified

Chapter 5 CARE OF THE PATIENT WITH NEUROLOGICAL NEEDS 255

Prognosis Surgery is required to evacuate the hematoma and cauterize the bleed-
ing vessels. Postoperative recovery depends on how well the patient’s level of
consciousness returns and to what degree. Mortality rates vary and can increase
according to how well the patient responds to the surgical intervention.

Subdural Hematoma
What Went Wrong? Bleeding occurs between the dura and arachnoid membranes
probably caused by a rupture of the veins between the brain and the dura mater.

Hallmark Signs and Symptoms Based on the time frame from injury to the onset of
symptoms, subdural hematomas can range from acute (symptoms materializing
within 48 hours) to subacute (symptoms occurring within 2 days to 2 weeks)
to chronic (symptoms occurring within 2 weeks to 2 months). Symptoms
appear more gradually with each classification of subdural hematoma, but sur-
gical intervention is still a must!

Intracerebral Hematoma
What Went Wrong? Occurs when there is actual bleeding within the brain tissue caused
by depressed skull fractures and penetrating wound injuries. The rate of bleeding
expands significantly and surgical intervention is necessary to control the bleeding. 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.

Missile Head Injuries

Caused by objects such as a bullet that penetrates the skull but does not exit
the brain. A missile injury can also be classified as perforating in that it enters
and also exits the brain.
Head trauma is also classified according to degrees of injury as follows:

Mild There is a loss of consciousness for up to 15 minutes with a
Glasgow Coma Scale of 13–15. The patient is often released after
being evaluated in the hospital Emergency Room.
Moderate The Glasgow Coma Scale is 9–12 with a loss of consciousness for
as long as 6 hours. Patients are hospitalized and treatment is
initiated to prevent an increase in ICP and cerebral edema and to
curb a deterioration in the patientʼs condition.
Severe These patients are in critical care settings often requiring venti-
latory support. Their condition deteriorates within 48 hours after
admission and their Glasgow Coma Scale is often 8 or less even
after resuscitation efforts.

Mechanisms of Head Injury

The ways in which head trauma occurs provide useful information in dealing
with the challenges of neurological deficits. See Figure 5–7.