Traumatic Brain Injury & Hematomas Nursing Care

Traumatic brain injury ranges from concussion (mild TBI) to severe injury. The primary injury is the immediate mechanical damage; the secondary injury evolves over hours-to-days from cerebral edema, hematoma expansion, hypoxia, hypotension, and rising intracranial pressure. Because the skull is a fixed box (Monro-Kellie doctrine), expanding blood or swelling raises ICP and can cause herniation. The whole point of nursing care is to prevent and limit secondary injury.

Track serial neuro checks: LOC and GCS (a drop is the key warning), pupil size/reactivity (a fixed, dilated “blown” pupil suggests herniation), motor function, and vital signs for Cushing’s triad. Look for signs of a basilar skull fracture — raccoon eyes, Battle’s sign, CSF rhinorrhea/otorrhea (halo sign). Note the injury mechanism and any lucid interval. Monitor oxygenation and blood pressure closely — hypoxia and hypotension worsen outcomes.

TBI outcomes are uncertain and families are often in crisis. Explain the neuro checks and why you wake the patient, keep families updated through a fast-changing course, and prepare them for possible personality or cognitive changes. For concussion, counsel on the importance of rest and not returning to sports/activity too soon. Involve case management and rehabilitation early for moderate-to-severe injury.

For concussion/mild TBI discharge: teach physical and cognitive rest, graded return to activity, and the warning signs to return immediately — worsening or persistent headache, repeated vomiting, increasing drowsiness or confusion, unequal pupils, slurred speech, weakness, or seizures. Stress injury prevention (helmets, seatbelts, fall prevention) and, for anticoagulated/elderly patients, the heightened risk of subdural bleeding after even minor head trauma.