Concussion & Mild TBI

A concussion is a functional brain injury caused by rotational or acceleration-deceleration forces. Glasgow Coma Scale (GCS) is 13–15, and standard CT is typically normal because the damage is metabolic, not structural. Loss of consciousness is NOT required for diagnosis — brief confusion, amnesia around the event, or feeling 'foggy' qualifies. The hallmark concern is post-concussive deterioration: worsening headache, repeated vomiting, increasing confusion, unequal pupils, or declining GCS. These red flags suggest evolving intracranial pathology and require urgent re-imaging. For uncomplicated concussion, nursing management centers on serial neurological assessments (neuro checks every 1–2 hours initially), maintaining a low-stimulation environment (dim lights, limit screens, reduce noise), and educating the patient and family about return precautions. Physical and cognitive rest is the cornerstone of recovery — no return to sports or strenuous activity until symptom-free for at least 24 hours at each step of a graded stepwise return-to-activity protocol. Acetaminophen is preferred for headache; NSAIDs and aspirin are avoided initially due to bleeding risk. Discharge teaching must include explicit warning signs that require immediate return: worsening headache, seizures, slurred speech, weakness on one side, repeated vomiting, or inability to be awakened.