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Nursing Care & Priorities for Those with Traumatic Brain Injury & Brain Tumors

Nursing Care & Priorities for Those with Traumatic Brain Injury & Brain Tumors. Keith Rischer, RN, MA, CEN. Todays Objectives. Differentiate the causes of traumatic brain injury. Review pathophysiology and clinical manifestations of TBI & brain tumors.

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Nursing Care & Priorities for Those with Traumatic Brain Injury & Brain Tumors

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  1. Nursing Care & Priorities for Those with Traumatic Brain Injury & Brain Tumors Keith Rischer, RN, MA, CEN

  2. Todays Objectives • Differentiate the causes of traumatic brain injury. • Review pathophysiology and clinical manifestations of TBI & brain tumors. • Identify nursing priorities and client education with TBI & brain tumors. • Identify manifestations of ICP and purpose of ICP monitoring. • Prioritize nursing care with craniotomy-postop.

  3. Traumatic Brain Injury • Patho • Open head injury • Halo sign • C-spine precautions • Closed head injury • Concussion • Mild-mod-severe • Glasgow coma scale

  4. Traumatic Brain Injury • Types of force • Acceleration • Deceleration • Coup-contrecoup • Hemorrhage • Intracerebral • Epidural • Subdural • Diagnosis • CT • MRI

  5. Increased Intracranial Pressure • Normal pressure • Patho • Clinical Manifestations (chart 48-5 p.1037) • Decreased LOC • Restlessness/irritability • Headache • N&V • Slurred speech • Pupillary changes • Seizures • Brain herniation • Pupil changes • LOC • Cheyne-stokes resp • VS changes…Cushings triad

  6. Nursing Interventions: I-ICP • Maintain airway and optimal ventilation • HOB elevated 15 – 30 degrees • All ADL’s increase ICP – spacing • Limit suctioning • Calm environment • Prevent hyperthermia

  7. Nursing Priorities with TBI • Establish baseline • Early detection of subtle changes • Airway/breathing • ABG’s • Vital signs • Maintain adequate cerebral perfusion pressure (CPP) • Cushings triad • Positioning • Neuro Assessment • Glascow Coma Scale • LOC • Eye/pupils • Motor • Decerebrate/decorticate posturing • Response to pain

  8. Medical-Nursing Priorities w/Critical TBI • Drug therapy • Steroids • Mannitol • Filter needle/tubing • Furosemide • Nursing priorities… • Neuromuscular blocking agents • Nursing considerations… • Anti-convulsant agents • Respiratory management • Managing CO2 w/vent

  9. Medical-Nursing Priorities w/Critical TBI • Fluid & lyte management • Diabetes Insipidus • SIADH • Nutritional management • Enteral tube feedings if LT • Surgical management • Craniotomy • ICP monitoring • Intraventricular catheter

  10. Brain Tumors • Patho • Complications • Cerebral edema-inflammation • I-ICP • Focal neuro deficits • Obstruction of CSF • Pituatary dysfunction • SIADH • DI

  11. Brain Tumors • Types • Gliomas • astrocytomas • Metastatic • Clinical Manifestations • Headaches • N&V • Visual changes • Seizures • Change in mentation/personality • Diagnosis • Interventions

  12. Craniotomy:Post-op Priorities (p.1059-1062) • Nursing priorities… • Detect early changes in status • Prevent/minimize complications • ICP • Neuro assessment • I&O • Pain control • Cardiac monitoring • VS • Position • Dressing assessment • Monitoring lab values • Sodium • CBC • ABG’s

  13. Craniotomy Post-op Complications (p.1064-5) • ICP • Hydrocephalus • Hematomas • Hypovolemic shock • Respiratory • Atelectasis • Pnuemonia • Wound infection • Meningitis • Seizures • CSF leak • Fluid/lyte imbalances • DI-SIADH

  14. Neuro Case Study • 72 yr. male w/PMH AAA • Slipped and fell in BR 2 weeks ago w/no LOC • Chief c/o • headache that has continued all day and gotten worse • While in ED dramatic change in LOC • Lethargic…obtunded • Decerebrate posturing • Intubated and paralyzed • CT • rt. Occipital SDH w/midline shift

  15. Neuro Case Study • To OR for immediate evacuation • CT: shows small residual hematomas • POD 1 • Extubated-Is alert, MAE, follows commands • lt. facial weakness, lt. hemiplegia, speech garbled • ICP 14-20…BP 176/67 • Mannitol q3h for ICP >10 • CPP??? • Labs • Na: 131/was 144 preop • u/o 200cc last 8 hours. Was averaging 400cc/hr last 24 hours • Creatinine 0.9

  16. Neuro Case Study: POD 2 • Nursing priorities… • Developed focal seizures eyes deviate to right and twitch for <1” • Cerebryx IV load & Ativan IV prn • MRI No change in SDH • Labs • Na: 138 • Creatinine: 1.3 • Meds • Ancef IV • Labetolol IV prn to keep CPP 50-60

  17. Neuro Case Study: POD 7 • Transferred to neuro floor • Continues to have significant lt. hemiplegia w/garbled speech • PEG placed • Plan for NHP

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