Concussion Nursing Guide

This content is intended as a Quick Reference for Concussion and will cover an overview and nursing considerations utilizing the nursing process.

Concussion Etiology and Epidemiology

A concussion is a physiologic disruption in brain function that is induced by trauma. It causes consciousness or memory loss, mental state or personality alteration, or focal neurologic deficits. Concussions occur in contact sports and during acceleration-deceleration injuries. (McCrory et al., 2017). They cause diffuse soft tissue damage, inflammation, and minimal structural damage in the brain, leading to temporary neural dysfunction (under 48 hours) (McCrory et al., 2017).

Complications from concussions include:

• Post-traumatic headaches
• Post-traumatic vertigo
• Post-concussion syndrome
• Second impact syndrome
• Intracranial hemorrhage
• Seizures
• Subarachnoid bleeding
• Subdural hematoma

The risk factors for concussions include:

• Genetic predisposition
• Participating in high-risk sports
• Not wearing protective athletic gear
• Previous concussion
• Falling
• Motor vehicle collision
• Soldier involved in combat
• Victim of physical abuse

Concussion Diagnosis

• CT or MRI to rule out fractures and/or other serious injuries (Puffenbarger et al., 2019)
• Neuropsychological testing

Concussion Management

• Residual effects (dizziness, headaches, memory loss, etc.) may persist for up to 3 to 4 months after injury (Echemendia et al., 2017).
• There is no medication to reverse a concussion.
• Observe and monitor for improvement.
• Utilize non-opioid analgesics for pain, such as acetaminophen (Tylenol®) or ibuprofen (Motrin®).
• Bed rest is recommended, with gradual increase to normal activity.

Concussion Nursing Care Plan & Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnosis, interventions, expected outcomes, and education for individuals with concussions are listed below

Concussion Assessment

• History
  • Temporary loss of consciousness
  • Nonspecific change in consciousness
  • Disorientation, confusion, or feeling as if in a fog
  • Dizziness
  • Severe headache or pressure in the head
  • Persistent vomiting and nausea
  • Amnesia surrounding the traumatic event
  • Dizziness or “seeing stars”
  • Ringing in the ears
  • Slurred speech
  • Delayed response to questions
  • Appearing dazed
  • Fatigue
  • Memory or concentration issues
  • Irritability and other personality changes
  • Light and noise sensitivity
  • Sleep disturbances
  • Psychological adjustment problems and depression
  • Taste and smell disorders
• Physical Examination
  • Change in upper and lower extremity sensation and strength
  • Decreased coordination and balance exhibited by the finger-nose-finger test and/or using slow, purposeful movements to complete a task
  • Hematoma
  • Hyperacusis
  • Neurological changes such as visual field changes, extraocular movements, and pupillary reflexes
  • Persistent rhinorrhea or otorrhea
  • Positive Romberg test
  • Tenderness or pain on or in the head

General physical and neurological examinations are usually normal. Note that the Glasgow Coma Scale is not sensitive for detection of mild brain injuries.

Concussion Nursing Diagnosis/Risk For

• Acute pain
• Anxiety
• Ineffective coping
• Fluid volume deficit
• Injury

Concussion Interventions

• Administer medications, as ordered, as well as pain medications and non-pharmacological pain relief measures
• Insert and maintain IV, per order and hospital policy
• Encourage individual to express feelings and communicate
• Reorient individual to time and place as needed
• Maintain the following:
  • Adequate hydration
  • Calm environment
  • Safety precautions
• Monitor the following:
  • Adverse reaction or complications
  • Input and output
  • Neurological status
  • Pain assessment
  • Treatment response
  • Vital signs

Expected Outcomes

• Adequate fluid volume
• Adequate pain relief
• Decreased anxiety
• Effective coping
• Remaining free of injury
• Stable neurological status

Individual/Caregiver Education

• Avoid aspirin.
• Avoid contact sports until full recovery.
• Discuss diagnosis and further treatment.
• Discuss medications and potential side effects.
• Call if loss of consciousness, projectile and/or persistent vomiting, or signs and symptoms of increased intracranial pressure occur.
• Wear protective equipment while engaging in contact sports.

Content Release Date 

4/1/2022

Content Expiration

12/31/2024

Content Contributor

The content was created by Relias external nursing content writer and editor Rakesh Tripathi MBA, MPH, BSN, RN-CEN. He is a Certified Emergency Nurse (CEN) with extensive experience, primarily in acute care settings. Mr. Tripathi has considerable experience in travel nursing, as well as more than a decade of general nursing experience. He has conducted nursing research for the European governments and worked as a nursing lecturer for Glasgow Caledonian University (GCU) Scotland, affiliated colleges, and has practiced nursing in Asia, the UK, and the U.S.

Resources

• Concussion https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Concussion
• Traumatic Brain Injury & Concussion https://www.cdc.gov/traumaticbraininjury/index.html

References

• Echemendia, R. J., Meeuwisse, W., McCrory, P., Davis, G. A., Putukian, M., Leddy, J., ... & Herring, S. (2017). The sport concussion assessment tool 5th edition (SCAT5): background and rationale. British journal of sports medicine, 51(11), 848-850. http://doi.org/10.1136/bjsports-2017-097506
• McCrory, P., Meeuwisse, W. H., Dvořák, J., Echemendia, R. J., Engebretsen, L., Feddermann-Demont, N., ... & Sills, A. K. (2017). 5th international conference on concussion in sport (Berlin). Br J Sports Med, 51(11), 837. http://dx.doi.org/10.1136/bjsports-2017-097878
• Peterson, A. B., Xu, L., Daugherty, J., & Breiding, M. J. (2019). Surveillance report of traumatic brain injury-related emergency department visits, hospitalizations, and deaths, United States, 2014. https://stacks.cdc.gov/view/cdc/78062
• Puffenbarger, M. S., Ahmad, F. A., Argent, M., Gu, H., Samson, C., Quayle, K. S., & Saito, J. M. (2019). Reduction of computed tomography use for pediatric closed head injury evaluation at a nonpediatric community emergency department. Academic Emergency Medicine, 26(7), 784-795. https://doi.org/10.1111/acem.13666