A nurse is caring for an older adult patient in the emergency department who sustained a head injury due to a fall. Which of the following are common causes of head injuries in older adults?

Choice A rationale
A contrecoup injury is indeed a “true” injury. It occurs on the side of the brain opposite to the point of impact and can have severe consequences, including brain damage. Therefore, this statement is incorrect.
Choice B rationale
The severity and healing time of contrecoup injuries can vary greatly depending on the force and location of the impact, as well as individual health factors. It’s not accurate to say that contrecoup injuries are generally less severe and heal more quickly over time.
Choice C rationale
This statement is correct. A coup injury refers to the brain damage that occurs directly under the point of impact, while a contrecoup injury occurs on the opposite side of the brain from

where the head is struck. These injuries can occur separately or together, but if the blow is strong enough, they usually appear together.
Choice D rationale
The sequence of coup and contrecoup injuries is not as this choice describes. The coup injury happens at the point of impact, and the contrecoup injury happens when the brain rebounds and hits the opposite side of the skull. Both types of injuries can impact the brain’s blood supply.

Choice A rationale
Penetrating traumatic brain injuries can cause significant damage to the brain. The extent of this damage is often related to the size, route, and speed of the object entering the brain. A larger, faster object or one that follows a path through vital areas of the brain can cause more severe injury. This is because the object can disrupt normal brain tissue and function, leading to a range of potential effects, from temporary changes in brain function to long-term complications or even death.
Choice B rationale
While it is true that a penetrating injury can cause leakage of cerebrospinal fluid (CSF), this is not the primary source of damage in such injuries. CSF leakage can lead to complications such as meningitis, an infection of the protective membranes covering the brain and spinal cord.
However, the primary damage in penetrating brain injuries comes from the direct physical disruption of brain tissue by the object.
Choice C rationale
Coup and contrecoup injuries are terms used to describe injuries that occur at the site of impact (coup) and on the opposite side of the brain (contrecoup). These injuries are typically associated with blunt force trauma, not penetrating injuries. In a penetrating injury, the damage is localized to the path that the object has taken through the brain, rather than at the point of impact and its opposite side.

Choice D rationale
While a penetrating object can indeed shatter the skull and potentially cause an infection, the primary damage in penetrating brain injuries is caused by the direct injury to the brain tissue itself. Infections are a secondary complication that can occur if bacteria enter the brain through the wound.