13.1.1 Traumatic Brain Injury
Traumatic Brain Injury
From Medical-Surgical Nursing- Ch 17
Learning Objectives
By the end of this section, you will be able to:
- Discuss the pathophysiology, risk factors, and clinical manifestations for traumatic brain injuries
- Describe the diagnostics and laboratory values in traumatic brain injuries
- Describe the medical therapies that apply to the care of traumatic brain injuries
- Apply nursing concepts and plan associated nursing care for the patient with traumatic brain injuries
- Evaluate the efficacy of nursing care for the patient with traumatic brain injuries
Traumatic brain and spinal cord injuries occur when the brain and/or spinal cord are damaged by trauma. Such trauma may include a forceful blow to the head and/or body that happens when an individual falls, or trauma may result when an object slams into the head and/or body. Although some patients may be able to recover from brain or spinal cord injuries, in some cases, these injuries cause permanent disability and even death.
Traumatic Brain Injury
Damage that results when the brain experiences a sudden assault from an external source is called traumatic brain injury (TBI). The external source can be a variety of things, including a powerful blow to the head from falling, as well as something like a bullet that shatters the skull and pierces the brain. Incidents that may lead to traumatic brain injuries include automobile accidents, blunt force trauma, and being struck by a flying object.
Pathophysiology
TBI may cause temporary or long-term problems, depending on the nature and severity of the injury. TBIs may be penetrating, which occurs when the skull is pieced by a sharp object that enters brain tissue. Other TBIs are nonpenetrating, which occurs when the assault is strong enough to move the brain around inside the skull, but the skull is not broken.
The problems caused by TBIs may include cognitive difficulties, such as the inability to think, communication issues, and/or struggling to move body parts. A primary injury occurs immediately, whereas a secondary injury occurs gradually in response to reactive processes in the brain that are caused by the trauma. Secondary injuries may take days, or even weeks, to appear.
Link to Learning
Read this article for more information about TBI from Mayfield Brain & Spine.
Clinical Manifestations
TBIs have symptoms in three areas: physical, cognitive and behavioral, and perception and sensation. Physical symptoms may include headaches, double or blurred vision, seizures, convulsions, tremors, nausea and vomiting, slurred speech and/or difficulty swallowing, muscle weakness, paralysis, balance and coordination issues, drainage in the ears or nose, and bowel and/or bladder control issues. Cognitive and behavioral symptoms may include lack of consciousness, coma, disorientation and confusion, concentration issues, loss of memory, difficulty thinking, short attention span, mood changes, irritability, frustration, loss of inhibitions, and sleep disorders. Perception and sensation symptoms may include ringing in the ears, sensitivity to sound and/or light, vertigo and dizziness, fatigue and lack of energy, anxiety, depression, foul tastes in the mouth, and decreased understanding of time and/or space. Typically, symptoms, such as headache and confusion, tend to occur immediately following a TBI, whereas symptoms that involve moods and emotions may take longer to develop.
Assessment and Diagnostics
To assess and diagnose a TBI, patients should undergo a physical examination that gathers information about the type of injury the patient has, including whether the injury is penetrating or nonpenetrating. The examination should also review the patient’s symptoms, which may include physical, cognitive and behavioral, and/or perception and sensation symptoms. If a TBI diagnosis cannot be confirmed through a physical examination, patients should undergo MRIs, CTs, and/or other neuropsychological tests.
Diagnostics and Laboratory Values
To confirm a TBI diagnosis, patients may need to be tested. Options for testing include MRIs, CTs, and neuropsychological tests. The Glasgow Coma Scale (GCS) can be used to assess the patient’s consciousness level. MRIs and CTs will show evidence of injury, such as skull fractures and swelling, bruising, and/or bleeding on the brain. Neuropsychological tests will reveal problems the patient may be having with concentration, memory, problem-solving, and other cognitive skills. As noted previously, a GCS score lower than eight indicates problems with a patient’s consciousness level. The highest possible score on the GCS is 15. Patients with higher scores have less severe injuries.
Nursing Care of the Patient with Traumatic Brain Injury
Nursing care for a patient with TBI should focus on helping the patient recover if possible. If the patient has permanent health issues as a result of the injury, nursing care should focus on helping the patient adjust and learn to manage the new health issues, which may include problems such as nerve damage and seizures. Patients may also experience issues such as memory loss, a decline in cognitive thinking abilities, double vision, and headaches. If needed, the patient and their family should be provided with mental health support.
Recognizing Cues and Analyzing Cues
The cues of TBI will be found in the patient’s physical examination and test results. The findings should reveal whether the patient has TBI, and if so, the nature and severity of the injury.
Prioritizing Hypotheses, Generating Solutions, and Taking Action
TBI treatment should be prioritized based on the severity of the symptoms. The nursing interventions appropriate for patients with TBI may include those in Table 17.23.
| Nursing Care | Rationale |
|---|---|
| Complete focused neurological assessments. | The patient’s pain levels, cognitive abilities, and other symptoms may indicate TBI. |
| Monitor vital signs. | Changes in the patient’s vital signs such as heart rate and blood pressure may indicate health issues. Patient may also show signs of infection. |
| Provide care before and after surgery. | Some patients with TBI may need surgery. Nurses should help patients prepare for surgery and provide care after surgery, such as dressing patients’ wound(s), maintaining oxygenation, positioning the patient, monitoring ICP, and assessing with GCS. |
| Administer medications. | Patients may need medication to help with pain relief. Other medications that can help limit additional damage to the brain following an injury include antiseizure and coma-inducing drugs. Some patients may need diuretics to help with fluid retention. |
| Help prevent seizures and provide seizure care. | In some patients, traumatic brain injuries can cause seizures. Nurses should take actions to help prevent seizures, such as low lighting, and provide care to help patients during a seizure, such as safe bedding and pillows. |
| Coordinate with therapists. | As they recover, some patients need therapy to regain skills and overcome problems incurred by traumatic brain injury. This may include speech, physical, and/or occupational therapists. |
Evaluation of Nursing Care for the Patient with Traumatic Brain Injury
The desired outcome for patients with TBI is recovery from the injury and relief of their symptoms. If their symptoms cannot be relieved, the desired outcome is to help them control and manage their symptoms, overcoming any losses in skills and functioning.
Medical Therapies and Related Care
The medical therapies used to help patients with TBI may include surgery, medications, and therapy. Depending on the severity of their injury and symptoms, some patients may need rehabilitation and long-term care to recover.
Next- 13.2.1 Intercranial Emergencies and Intercranial Emergency Drugs
