Care of Child With Head Injury

Download as ppt, pdf, or txt
Download as ppt, pdf, or txt
You are on page 1of 34

Care of Child with Head Injury

Presented By
Hidayatullah
Objectives
By the end of the presentation students will be
able to:
 Define Head Injury
 Discuss types of Head Injury
 Describe causes, treatment and prognosis of
child with head injury
 Discuss Nursing Management of child with
head injury
Definition
• The head injury is a pathologic process that
involves the scalp skull, meninges or brain as a
result of mechanical force.

• Head injury is the most common cause of


death and disability in childhood
• The main concern after any blow to baby’s head
is injury to the underlying brain, which occurs in
two forms: bleeding and concussion.
• When small blood vessels have been broken
between the skull and the brain or within the
brain. Bleeding occurs within this space and
compresses the brain.
• A blow to the head may also cause a concussion,
meaning the brain has been “shaken up” by the
fall
• Pressure on the brain from bleeding or from the
swelling associated with concussion produces the
outward signs of brain injury
Causes
The most common cause of head injury in
children includes:
1.Falls
2.Motor vehicle accidents
3.Pedestrain
4.Bicycle accidents
5.Child abuse
Risk factors of head injury in children
Many factors make children more at risk to head
injury:
1.Larger head size in relation to body
2.Bicycle accidents and falls
3.Psychological factors (children high level of
activity, curiosity, incomplete motor
development, and lack of knowledge and
judgment skills)
• Children younger than 3 years of age have a very
mobile spine especially in cervical region along
with immature neck muscles. This place them at
higher risk of injury from acceleration.
(speeding up) and deceleration injuries. These occur
when head receive a blow or is shaken the
sudden acceleration causes deformation of skull
and movement of brain
• Bruising of brain may occur when brain collide
(crash) with skull
• Another result of brain movement is
hemorrhages in the brain, which are caused by
the shearing forces that may tear small arteries
Path physiology
Exposed nature of head (External violence)

Force of impact- intracranial content are


damaged

Severe scalp laceration – bleed to death


Primary Head Injury
• Skull fracture
• Contusion
• Intracranial trauma and difficult injuries
Secondary Head Injury
• Hypoxic brain damage
• Increased ICP
• Infection
• Cerebral edema
Seriousness of Head Injury
• Head Injury in children is serious
Because it can cause an immediate threat to child’s life
as well as number of complications that can lead to
life long impairment of an individual’s physical,
cognitive and psychological functioning
Prognosis for the child who has suffered with head
injury depends on extent and severity of the injury as
well as complications
Types
The common head injuries seen in children are:
1.Skull fracture
2.Linear skull fracture
3.Depressed skull fracture
4.Compound skull fracture
5.Concussion
6.Contusion
7.Subdural hematoma
8.Epidural hematoma
Nursing Management
• Health History
1.Take a detailed history including past medical
history with details of events surrounding the
injury such as:
- Any loss of consciousness, irritability , lethargy,
abnormal behavior, vomiting (if so, how many
times) any seizures activity and any
complaints of headache, visual changes or
neck pain
Physical Examination
• ABC’s (Airway, Breathing and Circulation)
• All children who experienced head trauma need an
assessment of their neurological function as soon as
they are seen this include:
1. LOC (level of consciousness GCS)
2. Pupilary response and any seizures
NOTE: fixed and dilated pupils, fixed and constricted
pupils, or sluggish pupillary reaction to light will
require immediate intervention and are considered
serious
Physical Examination
NOTE: a child’s spine must remain stabilized
after a head injury until spinal cord injury is
ruled out.

• IF CLEAR LIQUID is noted drainage from


ears or nose notification of the physician
should be done. If the fluid test positive for
glucose this indicates leaking of CSF
(cerebrospinal fluid)
Care of child with Mild Head Injury
• Mild to moderate or close head injury refers to
brain injury without any penetrating injury to
brain
• No loss of consciousness, no other injury to head
or body
• Children acting normally after the injury
• Provide parents with clear instructions regarding
care of child at home
• Explain they must seek medical attention if
child’s condition gets worsen at any time during
1st several days after injury
Mild Head Injury: Symptoms
• Children may show cognitive and behavioral
symptom like:
1. Difficulty paying attention
2. Problems making sense of what has been seen or
heard
3. Forgetting things, in early days after injury
• The majority make a full recovery, but some may
experience ongoing cognitive and behavioral
difficulties such as slow information process and
attention problems
Care of a child with Severe Head Injury
• Children with more severe head injury require
intensive care initially until stabilized
• Focus on maintaining ABG’s
• Maintain airway, monitor breathing,
circulation and neurological status closely
• Preventing from seizures and treating any
other injuries that may have occurred as a
result of trauma. (fracture to other body part)
Nursing Management
• Focus on evaluation of neurological status
(checking GCS every hourly, Pupilary
response)
• Assessing for change in LOC and signs and
symptoms of increased ICP
• Initiate seizures precaution
Individualized Nursing Care
• Maintain a quite environment to help reduce
restlessness and irritability
• Manage pain and administer sedatives as ordered by
physician
• Observe the level of sedation closely to ensure LOC
will not become altered, which would hinder the
ability to assess neurological changes
• Monitor for the development of complications such
as hemorrhage, infection, cerebral edema and
herniation of brain.
Providing Support and Education
• Provide support and education to family of a child
who has suffered a head trauma
• Encourage them to involve in child’s care
• Encourage them to verbalize their feelings and
concern related to child and his or her care
• Rehabilitation of child with permanent brain damage
is an essential component of child care. It may
continue for months and years. This can place strain
on family and its finance.
• Family need to be involve in rehabilitation of child.
Preventing from further injuries
• Nurse play a key role in education the
public on topics such as helmet use with
certain sports, bicycles and motorcycles,
safety, using seat belts and providing
adequate supervision of children to help
prevent injuries and accidents and
resultant head trauma from occurring.
Birth Trauma
1. Caput succedaneum
2. Cephalohematoma
Care of Child with
Hydrocephalus
Objectives
By the end of the presentation students will be
able to:
1.Define hydrocephalus
2.Describe path physiology, sign and symptoms
3.Discuss diagnostic evaluation
4.Discuss therapeutic evaluation and
management of child with hydrocephalus
Definition
• Hydrocephalus is a condition caused by an imbalance in the
production and absorption of CSF in the ventricular system.

• Hydrocephalus, also known as “water in the brain”, is a


medical condition in which there is an abnormal
accumulation of CSF in the ventricles, or cavities of the
brain

• This may cause increased intracranial pressure inside the


skull and progressive enlargement of the head, convulsion,
and mental disability

• Hydrocephalus can also cause death.


Types
Communicating
excessive abnormal production or impaired
reabsorption of CSF
Non Communicating (obstructive)
Flow of CSF is blocked after it exist from
ventricle.
Path physiology
Imbalance of secretion and absorption of CSF

Accumulation of CSF in the ventricles

Ventricles become dilated

Enlargement of skull
Etiology
• Development malformations
• Aqueductal stenosis
• Neoplasm
• Infection
• Trauma
Diagnostic Test
• Head circumference
• CT scan
• MRI
Sign and Symptoms
Infancy:
1. Rapid increase in head size
2. Vomiting, sleepiness, irritability, downward
deviation of eyes and seizures
Other Children:
Headache followed by nausea, pupilary edema
(swelling of optic disc) blurred vision, diplopia,
sun setting of eyes, problems with balance , poor
coordination, gait disturbance or other changes in
personality and cognition.
Hydrocephalus: Management
Therapeutic Management:
 Surgery
removal of obstruction i.e. tumor, cyst etc
 Shunt procedure and medication
 Shunts: VP shunt (Ventricular-peritoneal
shunt)
Complications of VP shunt
• Infection
• Malfunction
• Mechanical problems: plugging, separation of
tube
• Subdural hematoma
• Over draining or under draining
Ventricular peritoneal shunt (vp)
Definition
A VP shunt is a long, plastic tube that allows
fluid to drain from the brain to another part of
the body
This drainage prevents the Increase in pressure
on the brain caused by hydrocephalus
Extra Ventricular Drain (EVD)
Definition
• External ventricular drainage (EVD) is a
treatment that allows the temporary drainage
of cerebrospinal fluid (CSF) from the ventricles
of the brain, relieving raised intracranial
pressure.
(Woodward,2002)
• Thank You
• Acknowledgement
• Ms Aruna Kareem

You might also like