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

5. Gunshot to brain

6. Knife in brain

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

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

9. Raccoon eyes

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

14. Epidural hematoma

15. Subdural hematoma

16. Intracerebral hematoma

17. 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

18. 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

19. 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

20. Burr holes

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

22. Post crani

25. Intraventricular and subarachnoid monitoring devices for IICP

26. 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

27. 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