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