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Neurosensory: Traumatic Brain Injury (TBI)

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

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Neurosensory: Traumatic Brain Injury (TBI)

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  1. Neurosensory: Traumatic Brain Injury (TBI) Marnie Quick, RN, MSN, CNRN

  2. 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

  3. Coup-contracoup injury

  4. Gunshot to brain

  5. Knife in brain

  6. Battle sign- ecchymosis behind the ear Basilar skull is fractured toward the posterior

  7. Raccoon eyes- periorbital ecchymosis Basilar skull fracture is more anterior

  8. Raccoon eyes

  9. Traumatic Brain Injury (TBI): Patho: Primary brain Injury- Focal • Contusion • Epidural hematoma • Subdural hematoma • Intracerebral hematoma

  10. Epidural hematoma

  11. Subdural hematoma

  12. Intracerebral hematoma

  13. 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

  14. 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

  15. 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

  16. Burr holes

  17. Crainectomy- bone flap out to allow for brain expansion post op

  18. Post crani

  19. Intraventricular and subarachnoid monitoring devices for IICP

  20. 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

  21. 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

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