Neurosensory: Traumatic Brain Injury (TBI) Marnie Quick, RN, MSN, CNRN.
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Transcript of Neurosensory: Traumatic Brain Injury (TBI) Marnie Quick, RN, MSN, CNRN.
Neurosensory: Traumatic Brain Injury (TBI)
Marnie Quick, RN, MSN, CNRN
Traumatic Brain Injury (TBI): Etiology/Pathophysiology Risk factors- MVA; elevated blood alcohol;
contact sports; acts of violence- gun, knife Mechanism of craniocerebral trauma
Acceleration (movement)-deceleration (stationary) Coup (impact)-contrecoup (opposite) phenomenon Blunt penetrating injury Closed head injury
Skull fracture Linear; comminuted; depressed; basilar
Coup-contracoup injury
Gunshot to brain
Knife in brain
Battle sign- ecchymosis behind the ear Basilar skull is fractured toward the posterior
Raccoon eyes- periorbital ecchymosis Basilar skull fracture is more anterior
Raccoon eyes
Traumatic Brain Injury (TBI): Patho: Primary brain Injury- Focal Contusion Epidural hematoma Subdural hematoma Intracerebral hematoma
Epidural hematoma
Subdural hematoma
Intracerebral hematoma
Traumatic Brain Injury (TBI): Patho: Primary Brain Injury- Diffuse
Concussion Temporary injury- graded mild-severe Post Concussion Syndrome last wks-months
Diffuse axonal injury Widespread disruption of axons Poor prognosis
Traumatic Brain Injury (TBI): Common Manifestations/Complications
Different bleeds (p.1376) Increased intracranial pressure (Module10) Restlessness- R/O respiratory Post concussion syndrome (p.1377) Systemic effects of acute brain injury (p. 1375) CSF leak- rhinorrhea/otorrhea- basal skull Fx Brainstorming- hypothalamic stimulation-ANS Associated cervical spinal cord injury
Traumatic Brain Injury (TBI): Therapeutic interventions Diagnostic tests- Skull/spinal; CT/MRI; EEG; ABG’s; CBC, glucose,
electrolytes Treatment of IICP- airway; fluid resuscitation; positioning;
temperature reg; meds- osmotic diuretics Prevention of complications-
Medications- IICP; stress ulcers; straining; ‘brainstorming’ Diet/calories CSF leak with possible menigitis Other (p. 1375); SIADH
Surgery On bone; evacuation clot; craniotomy/ectomy; cranioplasty; monitors
Burr holes
Crainectomy- bone flap out to allow for brain expansion post op
Post crani
Intraventricular and subarachnoid monitoring devices for IICP
Traumatic Brain Injury (TBI): Nursing assessment specific to TBI
Health history Description of accident; past medical history
Physical exam NVS Glasgow Coma Scale (p.1299) Brainstem reflexes VS- Late sign is Cushing reflex Skull/face; SCI
Traumatic Brain Injury (TBI): Pertinent Nursing Problems
Decreased intracranial adaptive capacity Ineffective airway clearance/breathing pattern Home care
Home evaluation/rehab/nursing home Teach about post concussion syndrome Coummunity agencies/support groups