ReACH National Demonstration Collaborative Reducing Acute Care Hospitalization
Understanding Brain Injury – Acute Hospitalization
Transcript of Understanding Brain Injury – Acute Hospitalization
a n e d u c a t i o n a l g u i d e f o r f a m i l y & f r i e n d s
Vo l u m e O n e - T h i r d E d i t i o n
www.finr.net800-697-5390
a n e d u c a t i o n a l g u i d e f o r f a m i l y & f r i e n d s
Acute HospitalizationAcute Hospitalization
njurynjuryIIrainrainBBnderstandingnderstandingUU
UNDERSTANDING
BRAIN INJURY
UNDERSTANDING
BRAIN INJURY
Acute Hospitalization
An Educational Guidefor Family & Friends
ACKNOWLEDGMENTS
The third edition of this booklet was made possible with the help and dedication of the following health care professionals:
Medical Illustrator
Chief Editor
Contributing Editors
This first edition of this booklet was made possible with the help and dedication of the following health care professionals:
Authors
Senior Editor
Contributing Editors
Medical Illustrator
TABLE OF CONTENTS
23 ASSESSMENT AND TREATMENT
28 INTENSIVE CARE
34 ACUTE HOSPITALIZATION
39 SYMPTOMS AFTER BRAIN INJURY
41 FAMILY ADJUSTMENT
45 ISOLATION
46 EXPECTATIONS
47 HOW TO HELP
49 MANAGING STRESS
51 MEMBERS OF THE TEAM
53 QUESTIONS & ANSWERS
55 GLOSSARY
60 APPENDIX OF MEDICAL ILLUSTRATIONS
61 SUGGESTED READINGS
62 NOTES
1 INTRODUCTION
2 THE HEAD AND BRAIN
10 BRAIN INJURIES
Understanding Brain Injury, Neurologic Rehabilitation
1
INTRODUCTION
2
THE HEAD AND BRAIN
Structures and Functions
This section will cover the structures and functions of the following areas:
The Skull
ILLUSTRATION 1.1
CORONAL VIEW OF THE HEAD
PIA MATER
DURA MATER
SUBDURAL SPACE
EPIDURAL SPACE
SKULL
CEREBELLUMBRAIN STEM
SPINAL CORDVERTEBRAE
CORTEX
LATERAL VENTRICLE
3
IILLLUSSTTRRAATTIIOONN 1.2
INSET VIEW OF THE HEAD WITH BRAIN
DURA MATERSUBDURAL
SPACE
SUBARACHNOID SPACE
ARACHNOID MEMBRANE
PIA MATER
EPIDURAL SPACE
SKULL SKIN
CORTEX
Frontal Lobes
4
LATERAL VIEW OF THE HEAD WITH FULL BRAIN
DURA MATER
SKULL
CORTEXPARIETAL LOBE
PFRONTAL LOBE
OCCIPITAL LOBE
TALE
CEREBELLUM
OCCIPITLOBE
UM
O
CEREBELLLU
TEMPORAL LOBE
BRAIN STEM
VERTEBRAE
SPINAL CORD
ILLUSTRATION 1.3
Damage to the Frontal Lobes
Parietal Lobes
5
Damage to the Parietal Lobes
Temporal Lobes
6
Damage to the Temporal Lobes
Occipital Lobes
Damage to the Occipital Lobes
7
The Cerebellum
The Brain Stem and Cranial Nerves
8
BRAIN STEM AND CRANIAL NERVES
ILLUSTRATION 1.4
BRAIN STEM AND CRANIAL NERVES
ILLUSTRATION 1 4CRANIAL NERVES(DENOTED IN YELLOW)
BRAIN STEM
9
THE 12 CRANIAL NERVES
ILLUSTRATION 1.5
I. OLFACTORY II. OPTIC
III. OCULOMOTOR IV. TROCHLEAR
V. TRIGEMINAL
VIII. VESTIBULOCOCHLEARVII. FACIAL
VI. ABDUCENS
IX. GLOSSOPHARYNGEAL
XI. SPINAL ACCESSORY
X. VAGUS
XII. HYPOGLOSSAL
Cranial nerve Sensory and motor func onI Olfactory SmellII Op c SightIII Oculomotor Moves eye upward, downward and inward; raises eyelids; controls pupils IV Trochlear Moves eye downward and inward (towards nose)V Trigeminal Sensa on in eyes, teeth and face, lower jaw; jaw movement; chewing VI Abducens Turns eye outward (away from nose)VII Facial Taste ( p and middle of tongue), facial expression, tear and saliva produc onVIII Ves bulocochlear Hearing and balanceIX Glossopharyngeal Taste (back of tongue), touch, temperature sensa on from tongue and
throat; tongue and throat movement, swallowing, gag re exX Vagus Swallowing, breathing, heart rate, stomach acid produc onXI Spinal accessory Moves head, neck and shoulders, larynx and throat (swallowing)XII Hypoglossal Moves tongue
This section will discuss:
10
BRAIN INJURIES
Concussions
Skull Fractures
Penetrating Head Wound
11
PENETRATING HEAD WOUND
ILLUSTRATION 2.1
BONE FRAGMENTS
DAMAGE TO BRAIN TISSUE
DURA LAYER
SKULL
PENETRATING OBJECT
Arterial Dissections
12
ILLUSTRATION 2.2
DIFFUSE AXONAL INJURY
DAMAGED AXON
MYELIN SHEATH
13
ILLUSTRATION 2.3
CEREBRAL INFARCTION/STROKE
FATTY PLAQUE
MIDDLE CEREBRAL ARTERY
BLOOD CLOT
DEAD BRAIN TISSUE
MIDDLE CEREBRAL ARTERY
14
ANOXIA / HYPOXIAANOXIA / HYPOXIA
ILLUSTRATION 2.4
BLOOD SUPPLY TO BRAIN
HIPPOCAMPUS
BASAL GANGLIA
DAMAGE DUE TO LACK OF
OXYGEN
Increased Intracranial Pressure
15
Hydrocephalus
Contusions
16
CONTUSIONCONTUSION
ILLUSTRATION 2.5
Hemorrhages & Hematomas
Epidural Hematoma
17
EPIDURAL HEMATOMA
ILLUSTRATION 2.6
EPIDURAL HEMATOMA
DURA LAYER
SKULL
BLOOD IN EPIDURAL
SPACE
SUBARACHNOID SPACE
Intraparenchymal Hematoma
Subdural Hematoma
Acute:
Subacute:
Chronic:
18
INTRACEREBRAL HEMATOMA
ILLUSTRATION 2.7
DURA LAYER
SKULL
SUBARACHNOID LAYER
BLOOD WITHIN THE BRAIN TISSUE
S H
ILLUSTRATION 2.8
S HSUBDURAL HEMATOMA
DURA LAYER
SKULL
ARACHNOID LAYER
BLOOD IN THE SUBDURAL SPACE
Subarachnoid Hemorrhage
19
SUBARACHNOID HEMORRHAGE
ILLUSTRATION 2.9
SKULL
BLOOD IN THE SUBARACHNOID
SPACE
DURA LAYER
Intraventricular Hemorrhage
20
INTRAVENTRICULAR HEMORRHAGE
ILLUSTRATION 2.10
INTRAVENTRICULAR HEMORRHAGE
PROFILE OFNORMAL VENTRICLES
BLOODIN LEFT VENTRICLE
BLOODIN LEFT VENTRICLE
Aneurysm
21
ILLLUSTRATION 2.11
PRESSURE ON SURROUNDING TISSUE
ANEURYSM
ARTERY
AANEURYSM
Seizures
Coma
22
23
ASSESSMENT AND TREATMENT
Early Assessment
This section will discuss:
Diagnostic Tests
X-ray / Evaluation of the Cervical Spine
CT Scan
MRI
24
Catheter Angiography / CTA / MRA
EEG / QEEG
PET / SPECT Scan
Other Tests
25
Glasgow Coma Scale
Eye opening
Best verbal response
Best motor response
26
Early Treatment
27
injuries.
Intravenous Line
Arterial Line
28
INTENSIVE CARE
IIIIIIIIIIII AAVVEENNOUUUSSSAAAAAAAAAANNNNTTTRRRRRRRRRRRAAAAAA LINNEE
IILLLLLLLLUUUUSSSTTRRAATTIIOOONNN 4.1
FLUID BAG
Monitoring Equipment
Foley Catheter
29
IILLLUSTRAATTIIOO
CARDDIIOVASCULLAAR MONITOR, FOOLLLLEYYY CCCATHHEETTEERR, AND CCHEST TUBE
CARDIOVASCULAR MONITOR
FOLEY CATHETER
ELECTRODES
OONNN 444.222
URINE DRAINAGE
BAG
RINEINAGEAG CHEST
DRAINAGE SYSTEM
CHEST TUBE
Chest Drainage System
Nasogastric Tube
Cooling (Hypothermia) Therapies
30
NNAASSOOGGAASTRIICC TTUBE
IIILLLLLLUUUSSSTTTRRRAAATTTIIIOOONNN 4444.3333
TO STOMACH
LUNGS STOMACH
ESOPHAGUS
31
Endotracheal and Tracheal Tubes
Ventilator (Respirator)
TRACCHHEOSTOMY TUBE
ILLUSTRATION 4.5
TO VENTILATOR LUNGS STOMACH
ESOPHAGUS
ENDOTRACHEAL TUBE
ILLUSTRATION 4.4
TO VENTILATOR
LUNGS STOMACH
ESOPHAGUS
Suction Catheter
ICP Monitor
/ Ventriculostomy
32
VVEEN RICULOSTOOMMYYNTTTTTTTTTRRRRRRRR
IILLLLLUUSSSTTTTRRRRAAATTION 4.66
PRESSURE MONITOR
BRAINVENTRICLES
CSF DRAINAGE
33
ILLUSTRATTTIOIONN 44..777
EPIDURAL
SUBDURAL
SUBARACHNOID
INTRAPARENCHYMAL
INTRACRANIAL PRESSURE MONITORING LOCATIONS
INTRAVENTRICULAR
This section will discuss the acute rehabilitation phase of care, including:
Cognitive Functioning Elimination Patterns
Fluid Balance
34
ACUTE HOSPITALIZATION
35
Rancho Los Amigos Scale of Cognitive Functioning
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
Level 7
Level 8
Physical Care
Airway Management
36
37
M a i n t a i n i n g Nutrition and Fluid Balance
Promoting Normal Elimination Patterns
GASTROSTOMY TUBE
IILLUUSSTTTRRAAATTTIIOOONN 55.1
GASTROSTOMY TUBE
LUNGS STOMACH
ESOPHAGUS
Preventing Eye Irritations
Skin Care
38
39
SYMPTOMS AFTER BRAIN INJURY
Brain injury results in three main types of impairments. This section will discuss:
Physical Problems
Cognitive Impairments
Behavioral Disorders
40
41
FAMILY ADJUSTMENT
suffered a brain injury.
Feelings of Panic
Denial
42
43
Anger
Fatigue
Guilt
44
45
ISOLATION
46
EXPECTATIONS
47
HOW TO HELP
The following guidelines will help during the acute rehabilitation phase:
Avoid overstimulation.
Use the familiar.
Be consistent.
Stay calm.
Give step-by-step directions.
Do not remind the patient of past abilities.
Do not talk down to the patient.
Avoid arguments and stressful situations.
Allow response time.
Maintain a sense of humor.
Remember to praise.
48
49
MANAGING STRESS
This section offers simple tips on dealing with stress.
Some tips for managing and preventing stress are listed below:
Eat properly.
Try to get enough rest.
Avoid excessive use of alcohol and sedative medications.
Express feelings.
Seek out professional help.
Be kind to yourself.
Let others help.
Ask questions.
50
51
MEMBERS OF THE TEAM
The following list includes many
treatment team members and briefly describes their responsibilities.
Anesthesiologist:
Attending Physician:
Clinical Psychologist:
Consulting Physician:
Intern:
Internist:
Neurologist:
Neuropsychologist:
Neurosurgeon:
Nurse:
Nutritionist:
Occupational Therapist (OT):
Physical Therapist (PT):
Speech Language Pathologist (SLP):
Psychiatrist:
Psychologist:
Physiatrist:
Resident:
Respiratory Therapist (RT):
Social Worker (SW):
Unit Secretary/Clerk:
52
53
QUESTIONS & ANSWERS
HOW LONG DOES IT TAKE FOR PATIENTS TO COME OUT OF A COMA?
HOW DO PATIENTS ACT AS THEY COME OUT OF A COMA?
WHAT DOES IT MEAN WHEN THE PATIENT MOVES WHILE IN A COMA?
IS THERE ANYTHING I CAN DO TO BRING THE PATIENT OUT OF A COMA?
WHAT CAN I TELL MY CHILDREN ABOUT A COMA AND BRAIN INJURY?
54
55
GLOSSARY
ANOSMIA
ANOXIA
CATHETER
CEREBROSPINAL FLUID
CLOSED HEAD INJURY
COGNITION
COMA
SCAN
DECUBITUS ULCER
DEFICIT
DIPLOPIA
ELECTROENCEPHALOGRAM
ELECTROCARDIOGRAM
EYE TAPE
FEEDING TUBE
HALO
ORTHOSIS
PERSISTENT VEGETATIVE STATE
PLATEAU
RESPIRATOR
56
57
SCANNING
SEIZURE
SENSORY INTEGRATION
SENSORY STIMULATION
VENTILATOR
Classes of Medications
ANTIBIOTICS
ANTICOAGULANTS
ANTICONVULSANTS
ANTIDEPRESSANTS
ANTIPSYCHOTICS
BLOOD PRESSURE MEDICATIONS
DIURETICS
LAXATIVES
MUSCLE RELAXANTS
SEDATING AGENTS
Specific Medications
58
59
MANNITOL
The Head and BrainIllustration Title Page
Brain InjuriesIllustration Title Page
Intensive CareIllustration Title Page
Acute HospitalizationIllustration Title Page
60
APPENDIX OF MEDICALILLUSTRATIONS
61
SUGGESTED READINGS
An Introduction to Head Injuries
Physical Medicine and Rehabilitation: State of the Art Reviews
Austin American Statesman
Journal of Neurosurgical Nursing
Physical Medicine and Rehabilitation: State of the Art
Reviews
Reference Tools
FINR Brain Atlas
Handbook of Neurosurgery: Trauma, Infection, Seizures, Vascular, Critical Care, Hydrocephalus,
Differential Diagnosis, 4th Edition, Vol. 2.
HDI Coping Series on Head Injury
Treatments
Principles of Neurorehabilitation
Catalogue of Educational Materials
Neuroanatomy and Neuropathology, a Clinical Guide for the Neuropsychologist, 2nd
Edition
62
NOTES
NOTES
63
64
NOTES
NOTES
65
Neurologic RehabilitationUnderstanding Brain Injury
Neur
ADDITIONALEDUCATIONAL MATERIALS
FINR Brain Atlas App
finr.net
finr.netfi
UNDERSTANDING BRAIN INJURYis provided as an educational service.
To request additional copies,please contact: