Brain Injury Concept Map PDF

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Summary

ReferencesPotential Complications-Intracerebral Hemorrhage -Epidural Hematoma= bleeding b/t dura and inner surface of skull compression of dura mater brain. Arterial epidural hematoma = neurological emergency -Subdural Hematoma: acute, subacute, chronic -Intraparenchymal Hematoma -Traumatic Subara...

Description

Risk Factors -Sex: males are three times more likely to suffer a TBI -Age:65+, 14 yrs. and under -athletes -abusive relationships -military member during war

Potential Complications

Etiology TBI– one of the leading causes of death and leading cause of disability after trauma. Most common causes of TBI in Canada: motor vehicle accidents & falls Blunt head injury: assault, fall, pedestrian event, sports injury Penetrating: high-velocity projectile (e.g., gunshot wound) Low-velocity projectile (e.g., bone fragments from skull fracture, knife) Diffuse (generalized) damage can’t be localized to one are (e.g., concussion, diffuse axonal injury) Focal (localized)damage localized to particular area of brain (e.g., contusion, hematoma)

Diagnosis Signs & Symptoms -headache, confusion, disorientation, drowsiness -loss of consciousness -memory issues, posttraumatic amnesia -emotional distress -battle sign (bruising behind ears), raccoon eyes, scalp lacerations, fractures/depressions in skull, rhinorrhea, otorrhea Medical Management (Pharmacological/Surgical) Emergency Management: -timely diagnosis and surgery if necessary -prevent secondary injury treat cerebral edema, manage ↑ ICP. Maintain cerebral oxygenation & perfusion. Prevent secondary ischemia. Concussion, contusion: observe, manage ↑ ICP ICP Management: -Cerebral oxygenation monitoring (PbtO2, SjvO2) -Drug therapy: ICU: propofol (Diprivan) rapid onset, short half-life, O2 saving propertiesDepress cerebral metabolism + O2 consumption (used for sedation/elevated ICP) Anticonvulsant drugs (e.g., phenytoin [Dilantin]) for seizures; antipyretics to maintain normothermia (damage to hypothalamus); h2-blockers, proton-pump inhibitors & sucralfate for stress ulcer prophylaxis -Hypertonic saline (decrease ICP) -Nutritional support (Body/brain requires more energy after trauma) -Osmotic diuretics (mannitol) (decrease ICP) -Elevation of head of bed to 30 degrees with head in a neutral position -ICP monitoring - Intubation and mechanical ventilation -Maintenance of CPP >60 mm Hg -Maintenance of fluid balance and assessment of osmolality -Maintenance of PaO2 at ≥100 mm Hg -Maintenance of systolic arterial pressure between 100 and 160 mm Hg -Reduction of cerebral metabolism (e.g., high-dose barbiturates) Skull fracture craniotomy Subdural/epidural hematoma craniotomy or burr-hole approach to remove blood (evacuation & decompression)

Traumatic Brain Injury (TBI)

-Intracerebral Hemorrhage -Epidural Hematoma= bleeding b/t dura and inner surface of skull compression of dura mater brain. Arterial epidural hematoma = neurological emergency -Subdural Hematoma: acute, subacute, chronic -Intraparenchymal Hematoma -Traumatic Subarachnoid Hemorrhage -Seizures, coma, post-traumatic seizure disorder -Increased intracranial pressure -Infection, SIADH, meningitis Death: -Immediately after the injury (massive hemorrhage & shock), -Within 2 hours after the injury (progressive worsening of head injury/internal bleeding) -Approximately 3 weeks after injury (multisystem failure).

Labs/Diagnostic Tests CT scan (cranio-cerebral trauma), MRI scan (detects small DAI lesions), magnetic resonance angiography (MRA), computed tomographic angiography (CTA), skull & facial radiographic studies, transcranial doppler studies (measurement of CBF velocity) ECG, Infrascanner (intracranial bleeding), electroencephalogram (EEG) Cerebral oxygenation monitoring (Licox catheter, SjvO2) ICP measurements, CSF test (rhinorrhea, otorrhea) yellow hallow around blood stain GCS: mild (GCS 13–15), moderate (9–12), severe (3–8) Labs: CBC, coagulation profile, electrolytes, creatinine, BUN, ABGs (prevent hypoxia and hypercapnia), ammonia level, drug and toxicology, CSF analysis for protein, cells, glucose

Assessment Findings

Teaching

Surface: Bruises or contusions on face, battle sign (bruising behind ears), fracture or depressions in skull, raccoon eyes (dependent bruising around eyes), scalp lacerations Respiratory: Abnormal respiratory patterns (e.g., Cheyne– Stokes respirations), central neurogenic, hyperventilation, ↓ O2 saturation, pulmonary edema CNS: Asymmetrical facial movements; bowel and bladder Incontinence; combativeness; confusion; CSF leaking from ears or Nose; decerebrate or decorticate posturing; ↓ LOC; depressed/ hyperactive reflexes; flaccidity; Glasgow Coma Scale score 20 mm Hg, bradycardia, elevated systolic blood pressure, widened pulse pressure -Risk for disuse syndrome AEB decreased level of consciousness and paralysis -Anxiety related to threat to current status, threat of death (abrupt change in health status) Goals: Patient will: -maintain normal cerebral perfusion pressure (CPP) - achieve maximal cognitive, motor, and sensory function. - experience no complications of immobility -have reduced or no anxiety Interventions: -Administer fluids cautiously to prevent fluid overload and increasing ICP. - Anticipate need for intubation for ineffective breathing patterns or absent gag reflex -Assume cervical spine injury until proven otherwise. - Monitor frequently for signs and symptoms of increased ICP or decreased cerebral perfusion. - Monitor vital signs, level of consciousness, O2 saturation, cardiac rhythm, Glasgow Coma Scale score, pupil size and reactivity -Assess pt’s risk for skin breakdown/pressure ulcers with risk assessment tool (e.g., Braden scale) -Reposition, as appropriate, every 1-2 hours -Position pt. to maximize ventilation potential and prevent tongue from blocking airway/aspiration -Remove secretions encourage coughing/suctioning -Perform passive or assisted ROM to maintain muscle strength and joint ROM -Decrease stimuli in patient’s environment. Give sedation to decrease agitation. Use a calm approach when providing care. Emergency Care: -Ensure patent airway. Stabilize cervical spine. Administer O2 via nasal cannula or nonrebreather mask. Establish IV access with two large-bore catheters to infuse normal saline or lactated Ringer's solution. Control external bleeding with sterile pressure dressing. Assess for rhinorrhea, otorrhea, scalp d R ti t' l thi

References Gardner, A. J., & Zafonte, R. (2016). Neuroepidemiology of traumatic brain injury. Handbook of clinical neurology, 138, 207-223. Lewis, S. M., Goldsworthy, S., Barry, M. A., Tyerman, J., & Lok, J. (2019). Medical-surgical nursing in Canada: Assessment and management of clinical problems (Fourth Canadian edition.). Elsevier Mosby. Varghese, R. (2017). Nursing Management of Adults with Severe Traumatic Brain Injury: A Narrative Review. Indian Journal of Critical Care Medicine., 21(10), 684–697....