Neurosensory: Traumatic Brain Injury (TBI)

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Neurosensory Traumatic Brain Injury (TBI)

• Marnie Quick, RN, MSN, CNRN

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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

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Coup-contracoup injury
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Gunshot to brain
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Knife in brain
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Battle sign- ecchymosis behind the ear Basilar
skull is fractured toward the posterior
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Raccoon eyes- periorbital ecchymosis
Basilar skull fracture is more anterior
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Raccoon eyes
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Traumatic Brain Injury (TBI)
Patho Primary brain Injury- Focal

• Contusion
• Epidural hematoma
• Subdural hematoma
• Intracerebral hematoma

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Epidural hematoma
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Subdural hematoma
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Intracerebral hematoma
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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

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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

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Traumatic Brain Injury (TBI)
Therapeutic interventions

• Diagnostic tests- Skull/spinal CT/MRI EEG
  ABGs 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

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Burr holes
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Crainectomy- bone flap out to allow for brain
expansion post op
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Post crani
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Intraventricular and subarachnoid monitoring
devices for IICP
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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

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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