V. Medical Management
• Nondepressed skull fractures generally do not require surgical treatment but require close observation of patient.
• Depressed skull fractures may be managed conservatively; contaminated or deforming fracture require surgery.
• Antibiotic treatment is instituted with blood component therapy, if indicated.
• In Epidural hemorrhage, this is an extreme emergency because marked neurologic deficit or respiratory arrest may occur within minutes. Burr holes are made to remove the clots, and the bleeding point is controlled (craniotomy, drain insertion)
• Management involves supportive care, control of ICP, maintenance of fluid and electrolyte balance, administration of antihypertensive medications or craniotomy.
• Increased ICP is managed by adequate oxygenation, mannitol administration, ventilator support, maintenance of fluid and electrolyte balance, nutritional support, pain and anxiety management or neurosurgery
VI. Nursing Diagnosis
• Ineffective airway clearance and ventilation related to hypoxia
• Ineffective tissue perfusion: cerebral related to increased ICP and decreased cerebral perfusion pressure.
• Fluid volume deficit related to disturbances of consciousness and hormonal dysfunction.
• Altered nutrition: less than body requirements related to metabolic changes, fluid restrictions, and inadequate intake.
• Risk for injury (self-directed and directed to others) related to disorientation, restlessness, and brain damage.
• Risk for impaired body temperature: increased related to damage to temperature-regulating mechanism
• Potential for impaired skin integrity related to bed rest, hemiparesis, hemiplagia and immobility.
• Impaired thought processes (deficits in intellectual function, communication, memory, information processing) related to results of brain injury.
• Potential for disturbed sleep pattern related to head injury and frequent neurologic checks.
• Potential for ineffective family coping related to unresponsiveness of patient, unpredictability of outcome, prolonged recovery period and patient’s residual physical and emotional deficits.
• Deficient knowledge about rehabilitation process.
VII. Nursing Management
• Provide nursing management for ICP. Assess all drainage from the nose and ears for CSF.
• Watch for the halo sign or test drainage with a dextrose stick for glucose.
• Establish and maintain a patent airway by keeping the head of the bed elevated 30 degrees, instituting effective suctioning and procedure, and monitoring arterial blood gases.
• Provide ongoing assessment. Assess blood and urine electrolytes and osmolarity.
• Provide adequate nutrition and possible nasogastric tube feedings if cerebrospinal fluid rhinorrhea is not present.
• Promote coping. Collaborate with rehabilitation members to identify activities directed at redeveloping the client’s ability to devise new problem-solving strategies.