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Management of Patients with Traumatic Brain Injury

Management of Patients with Traumatic Brain Injury. Antoinette McNeil, BSN, RN, CCRN Program Synthesis Practicum I Trudy Thompson, MSN, RN September 24, 2013. Objectives. The nurse will define intracranial pressure and cerebral perfusion pressure

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Management of Patients with Traumatic Brain Injury

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  1. Management of Patients with Traumatic Brain Injury Antoinette McNeil, BSN, RN, CCRN Program Synthesis Practicum I Trudy Thompson, MSN, RN September 24, 2013

  2. Objectives • The nurse will define intracranial pressure and cerebral perfusion pressure • The nurse will stat the sign and symptoms of increase intracranial pressure • The nurse will know the different types of monitoring systems • The nurse will state what their role is in caring for the patient • The nurse will demonstrate how to level the ventriculostomy

  3. Introduction • Traumatic brain injury accounts for 1.4 millions injuries • There are approximately 52,000 death annually in the United States • 80,000 to 90,000 survivors suffer long-term neurologic impairments

  4. Intracranial Pressure and Cerebral Perfusion Pressure • Monroe-Kellie doctrine hypothesis • Intracranial pressure • ICP 0 to 10mm Hg • Increase intracranial pressure/intracranial hypertension • ICP 15mm Hg or greater • Cerebral perfusion pressure • Measure of force to deliver blood to the brain • CPP calculation: mean arterial pressure(MAP)-ICP=CPP

  5. Signs and Symptoms • Early Signs • Vomiting • Irritability • Headache • Seizures • Lethargy • Photophobia

  6. Late Signs • Depressed consciousness • Pupil enlargement • Papillary reaction to light sluggish • Tone and reflexes of limbs are altered • Crushing’s triad

  7. Monitoring Systems • Camino ICP monitor • Cannot drain CSF • Zeroed prior to insertion • Intraventricular catheter • Leveled at the tragus • Drain CSF • Gold Standard

  8. Nurses Role • Cluster Care • Suction when necessary • Keep patient in alignment • Decrease noise level • Decrease lights • Keep patient sedated • Record vital signs, ICP, CPP hourly • Zero ventriculostomy transducer at Foramen of Monroe

  9. Summary • Goal to prevent secondary injury in patients with complex brain injuries

  10. Evaluation • Observation of return demonstration of leveling transducer of ventriculostomy • Question and Answer regarding sign and symptoms for increase ICP

  11. Reference • Cecil, S., Chen, P. M., Callaway, S. E., Rowland, S. M., Adler, D. E., & Chen, J. W. (2011, April). Truamatic Brain Injury Advance Multimodal Neuromonitoring From Theory to Clinical Practice. Critical Care Nurse, 31(2), 25-36. • Milkova, S. (n.d.). Stategies for Effective Lesson Planning. Retrieved from http://www.crlt.umich.edu/gsis/p2_5 • Moreda, M. V., Wyatt, A. H., & Olson, D. M. (2009, ). November. Nursing 2009 Critical Care, 4(6), 42-47. • Schimpf, M. M. (2012, Juy-September). Diagnosing Increased Intracranial Pressure. Journal of Trauma Nursing, 19(3), 160-167. • The Royal Children’s Hospital Melbourne. (n.d.). http://www.rch.org.au • Vreeland, D. G., Rea, R. E., & Montgomery, L. L. (2011, July-September). A Review of the Literature on Heart Failure and Discharge Education. Critical Care Nursing Quarterly, 34(3), 235-245

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