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