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Nursing Care & Priorities for Those with Traumatic Brain Injury

& Brain Tumors

Keith Rischer, RN, MA, CEN

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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.

Traumatic Brain Injury

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Patho• Open head injury• Halo sign

C-spine precautions

• Closed head injury Concussion Mild-mod-severe

Glasgow coma scale

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Traumatic Brain Injury

Types of force• Acceleration• Deceleration • Coup-contrecoup

Hemorrhage• Intracerebral• Epidural• Subdural

Diagnosis• CT• MRI

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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

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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

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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

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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

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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

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Brain Tumors

Patho Complications

• Cerebral edema-inflammation• I-ICP• Focal neuro deficits• Obstruction of CSF• Pituatary dysfunction

SIADHDI

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Brain Tumors

Types• Gliomas

astrocytomas• Metastatic

Clinical Manifestations• Headaches• N&V• Visual changes• Seizures• Change in mentation/personality

Diagnosis

Interventions

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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

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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