Traumatic Brain Injury Nursing Management

Definition

• Also known as head injury.
• Is the disruption of normal brain function due to trauma-related injury resulting in compromised neurologic function resulting in focal or diffuse symptoms.
• Motor vehicle accidents are the most common etiology of injury.

Etiology And Pathophysiology

Types of Traumatic Brain Injury

1. Concussion – transient interruption in brain activity; no constructural injury noted on radiographics.
2. Cerebral contusion – bruising of brain with associated swelling.
3. Intracerebral hematoma – bleeding into the brain tissue commonly associated with edema.
4. Epidural hematoma – blood between the inner table of the skull and dura.
5. Subdural hematoma – blood between the dura and arachnoid caused by bleeding commonly associated with additional brain injury.
6. Diffuse axonal injury – axonal tears within the white matter of the brain.

Assessment

1. Disturbance in level of consciousness from slightly drowsy to unconscious.
2. Headache, vertigo, agitation, and restlessness.
3. Cerebrospinal fluid leakage at ears and nose, which may indicate skull fracture.
4. Contusions about eyes and ears indicating skull fractures.
5. Irregular respirations
6. Cognitive deficit
7. Pupillary abnormality
8. Sudden onset of neurologic deficits
9. Otorrhea indicating posterior fossa skull fracture
10. Rhinorrhea indicating anterior fossa skul fracture.

Nursing Diagnosis

• Risk for injury related to complications of head injury.
• Acute pain related to altered brain or skull tissue.

Diagnostic Evaluation

1. CT identifies and localizes lesions, cerebral edema, and bleeding.
2. Skull and cervical spine X-ray identify fracture and displacement.
3. Complete blood count, coagulation profile, electrolyte levels, serum osmolarity, arterial blood gases, and other laboratory tests monitor for complications.
4. Neuropsychological test during rehabilitation phase determine cognitive deficits.

Nursing Interventions

1. Maintain ICP monitoring, as indicated, and report abnormalities.
2. Maintain patent airway; assist with intubation and ventilatory assistance is needed.
3. Turn the patient every 2 hours and encourage coughing and deep breathing.
4. Apply firm pressure over puncture site for subdural trap, and observe for drainage and dressing.
5. Suction the patient as needed.
6. Institute measures to prevent increased ICP or other neurovascular compromise.
7. Feed the patient as soon as possible after a head injury and administer histamine-2 blockers to prevent gastric ulceration and hemorrhage from gastric acid hypersecretion.
8. If the patient is unable to swallow, provide enteral feedings after bowel sounds have returned.
9. Elevate the head of the bed after feedings, and check residuals to prevent aspiration.
10. Monitor respiratory rate, depth, and pattern of respirations.

Complications

• Infections
• Increased intracranial pressure
• Posttraumatic seizure disorder
• Permanent neurologic deficits
• Persistent sympathetic storming
• SIADH
• Death

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