Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors
-
Upload
brandon-sargent -
Category
Documents
-
view
40 -
download
0
description
Transcript of Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors
![Page 1: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/1.jpg)
Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors
Marnie Quick, RN, MSN, CNRN
![Page 2: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/2.jpg)
Normal brain protected by:
![Page 3: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/3.jpg)
Normal brain
![Page 4: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/4.jpg)
![Page 5: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/5.jpg)
![Page 6: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/6.jpg)
![Page 7: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/7.jpg)
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 or penetrating injury Closed head injury Scalp lacerations Skull fractures- Linear; comminuted; depressed;
basilar; open/closed
![Page 8: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/8.jpg)
Coup-contracoup injury
![Page 9: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/9.jpg)
![Page 10: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/10.jpg)
Penetrating injury- Gunshot to brain
![Page 11: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/11.jpg)
Penetrating injury: Knife in brain
![Page 12: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/12.jpg)
Basilar skull fracture- Base of skull fractured
![Page 13: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/13.jpg)
Basilar skull fracture is base of skull if posterior> Battle sign- ecchymosis behind the ear
![Page 14: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/14.jpg)
Basilar skull fracture is more anterior Raccoon eyes- periorbital ecchymosis
![Page 15: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/15.jpg)
Basilar Skull fractures can cause leakage of CSF from meninges
![Page 16: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/16.jpg)
Minor Brain Injury
Concussion- sudden transient disruption of neural activity in the brain with change in LOC
Post Concussion Syndrome- may occur after other brain injuries- severity of symptoms are not related to severity of brain injury. Sym may persist wks-months
![Page 17: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/17.jpg)
Major Brain Injury- Focal injury
Brain contusion- bruising; coup-contracoup Brain laceration- tearing brain tissue, ICH DAI- diffuse axonal injruy
Widespread disruption of axons Poor prognosis
Brain bleeds- Note meninges in relation to bleeds on following slides
![Page 18: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/18.jpg)
![Page 19: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/19.jpg)
Epidural hematoma
![Page 20: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/20.jpg)
Subdural hematoma (SDH)
![Page 21: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/21.jpg)
Intracerebral hematoma
![Page 22: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/22.jpg)
Secondary brain injury
Cerebral edema Localized or diffuse Peaks 24-72 hrs Occurs with CHI; open head injury; anoxia May in itself cause death by pressure> herniation
Increased ICP Herniation Syndromes
![Page 23: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/23.jpg)
Traumatic Brain Injury (TBI): Common Manifestations/Complications
Increased ICP symptoms general and specific Restlessness- R/O respiratory; waking up Systemic effects of acute brain injury-
hypermetabolism, brainstorming, SIADH Brainstorming- hypothalamic stimulation-ANS CSF leak- rhinorrhea/otorrhea- basal skull Fx Post concussion Syndrome Associated cervical spinal cord injury
![Page 24: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/24.jpg)
Collaborative Care: Traumatic Brain Injury (TBI):
Diagnostic studies (similar to ICP) Emergency management: assessment and interventions
(Lewis 1484 Table 57-9) Treat IICP- airway; fluid; positioning; temp reg; meds Prevention of complications
Medications: IICP; seizures; stress ulcer;straining;brainstorming Diet/calories: hypermetabolic state; ileus; swallow/gag CSF leak: glucose; halo; HOB 30; no nasal suction Other: SIADH> hyponatremia
Surgery: bone repair; evacuation clot; craniotomy/ectomy; burr hole; cranioplasty; monitor placement
![Page 25: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/25.jpg)
Burr holescraniotomy
![Page 26: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/26.jpg)
Place monitors/intraventricular drain:
![Page 27: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/27.jpg)
Crainectomy- bone flap out to allow for brain expansion post op
![Page 28: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/28.jpg)
Post crani
![Page 29: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/29.jpg)
Traumatic Brain Injury (TBI): Nursing assessment specific to TBI
Health history Description of accident; past medical history
NVS and Glasgow Coma
http://www.trauma.org/scores/gcs.html Brainstem reflexes VS- Late sign is Cushing reflex Skull/face; CSF leak; SCI Consider older adult finding
![Page 30: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/30.jpg)
Pertinent Nursing Problems Specific to Traumatic Brain Injury (TBI):
Health promotion Ineffective tissue perfusion, cerebral (decreased
intracranial adaptive capacity) Ineffective airway clearance/breathing pattern Hypothermia Pain Impaired physical mobility
![Page 31: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/31.jpg)
Anxiety Decreased cerebral perfusion (IICP) Brain death (ethical dilemmas p.1485) Home care
Home evaluation/rehab/nursing home Teach about post concussion syndrome; B&B;
spasticity; dysphagia; nutrition; seizure disorder; personality changes; family role changes
6 months typical plateau period Community agencies/support groups
![Page 32: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/32.jpg)
http://library.med.utah.edu/kw/animations/hyperbrain/oculo_reflex/oculocephalic2.html
http://cim.ucdavis.edu/eyes/version15/eyesim.html
http://www.softwarefornurses.com/access/index.asp
![Page 33: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/33.jpg)
Primarybrain tumors Arise from support
cells, neurogilia cells; the meninges; or blood vessels
Do not metastasize outside cranium
Cause unknown
![Page 34: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/34.jpg)
Grade I and II gilomas (astrocytoma) made up of astrocytes; are benign, slow-growing tumors
Grade II and IV gliomas (glioblastoma Multiforme are invasive and fast-growing
Meningiomas arise from the meninges; slow-growing; benign, encapsulated and compress the brain
Brain tumors may be lethal due to their location
![Page 35: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/35.jpg)
Gioblastoma Meningioma
![Page 36: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/36.jpg)
![Page 37: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/37.jpg)
Metastatic (secondary) brain tumors Originate from outside
the brain- lung and breast most common sites
Single or multiple Becoming more common
as individual with cancer in other parts of the body are living longer
![Page 38: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/38.jpg)
Clinical Manifestations/complications of Brain tumors General ICP symptoms Common early symptoms: headache; vomiting;
papilledema (visual changes) Seizures- partial classification in type Brain tumor symptoms occur due to their ability
to compress or destroy brain tissue; edema that forms around the tumor; hemorrhage; & obstruction of CSF flow
Specific symptoms as to the lobe affected>
![Page 39: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/39.jpg)
![Page 40: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/40.jpg)
Frontal lobe: personality changes; inappropriate behavior; inability to concentrate; impaired judgment; headache; expressive aphasia if dominant hemisphere; motor weakness or paralysis from motor strip
Parietal lobe: sensory deficits- paresthesia, visual field deficits; contralateral sensory disturbances from sensory strip; loss of interpretation and discrimination for sensing input; perceptual problems
![Page 41: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/41.jpg)
Occipital lobe: visual disturbances; visual agnosia Temporal lobe: complex partial (psychomotor)
seizures; auditory hallucinations; memory problems; Wernicke aphasia if dominant hemisphere
Cerebellum: gait distrubances; balance and coordination problems
Brain stem: cranial nerve dysfunction; vital signs
![Page 42: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/42.jpg)
Complications of Brain Tumors Hydrocephalus Infection Death is usually caused by IICP/hermiation
![Page 43: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/43.jpg)
Collaborative Care for Brain Tumors Diagnostic tests CT/MRI EEG PET Angiogram Tissue biopsy
![Page 44: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/44.jpg)
Collaborative Care for brain tumors Surgery
To remove or debulk Supratentorial- above
tentorium Infratentorial-below Stereotaxic-localized
![Page 45: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/45.jpg)
Radiation Used alone or with other therapies Gamma or Cyber-knife Complication- increased cerebral edema
Medications Chemotherapy: IV; intraventricular (ommaya
Reservoir) or by wafer implanted Corticosteroids to treat brain edema Anticonvulsants to prevent seizures
Rehab- outpatient or in house
![Page 46: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/46.jpg)
Health history: progression of symptoms; other cancers, disease
Physical exam Neuro vital signs Specific signs of the local functions of different parts
of the brain Similar neuro deficits as the individual with a stroke Signs of increased intracranial pressure/herniation
![Page 47: Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors](https://reader036.fdocuments.in/reader036/viewer/2022062308/56812a85550346895d8e2030/html5/thumbnails/47.jpg)
Pertinent Nursing Problems for Brain Tumor
Impaired tissue perfusion, cerebral Self-care deficits Anxiety Risk for infection-post crani Acute pain Disturbed self-esteem Nutrition Home care- rehab; home eval; support groups