Nursing Care Of Traumatic Brain Injury

Definition- When an external force damages the head resulting in temporary or permanent brain dysfunction we can call it TBI.

Types- There are two major types of TBI. 

1. Extra Axial TBI                                             

• Injury within the skull                                 
• that does not involve parenchyma. 

    2. Intra Axial TBI-

• It involves axonal parenchyma, e.g.- Diffuse axonal injury, Cortical contusion.

sometimes it involves a series of molecular events that can persist for hours of days, it is secondary brain injury & brain herniation.

1. Extra Axial injury- There are 3 types of extra-axial TBI, which are 

• Subdural hematoma- Collecting of blood between the outermost layer of meninges ( dura mater) and subarachnoid space.  A person has a risk of developing it after a small blow to the head. This small blow can rupture the blood capillaries.
• Epidural hematoma- It occurs very rarely, it occurs between the dura mater( outermost layer) & the inner surface of the skull bone.
•  As we have known it is a very rare chance of occurring epidural hematoma, but if it occurs then it can rapidly be developed because of involvement of the middle meningeal artery.

This condition is a medical emergency it rapidly increases ICP which can lead to the death of the patient.

• Subarachnoid hemorrhage- In this condition bleeding occurs between the arachnoid space and pia matter ( innermost layer of meninges) 

    2. Intra Axial TBI-  There are 2 types of intra axial TBI which are following

• Diffuse Axonal Injury (DAI)- In this type of injury axon of the neuron is affected or we can say that they lose their elasticity and become bottle due to stretching, straining, and rapid acceleration of head or neurons. Because we all know that axons can be 100 cm long so this type of injury may be affect a large part of the brain or body parts as well as cranial nerves.
• Cortical contusion- It is the bruises on the brain tissue which can involve the local capillaries as well as nearest nerves.

 Causes- 

• Car accidents 
• Falls
• Gunshots
• Abuse
• Shaken baby syndrome
• During seizures
• The sudden acceleration of the head 

 Sign & Symptoms-

• Loss of consciousness
• Increased ICP
• Headache
• seizures
• Tremors
• Vertigo 
• Rookuns eyes
• Bettle sign
• Tinnitus 
• vomiting
• confusional state
• weakness
• Numbness
• Vision  and Auditory problems

Complications-

• Brain herniation
• Coma 
• Death
•  memory loss etc

Management-  Surgical management is the only treatment of TBI and its only useful in extra-axial TBI. To prevent further injuries the neurologist may prescribe some drugs like

• Anticonvulsants
• Antihypertensive
• Diuretics
• Musscles Relaxants

Nursing management-

• Assess the GCS of the client every hour.
• Assess patient protective reflexes signs( Coughing, Gaging)
• Regular monitor ICP of the client.
• If seizures occur then prevent injury.
• Keep the patient at total bed rest & elevate the bed at a 20-30 degree angle.
• Watch closely for signs of CSF leakage from the nose or ear.
• Provide the patient a quiet environment.
• Use an aseptic technique while dressing or caring for the patient.
• Educate the client to do not to blow the nose because blowing can increase the ICP.

• Nursing Diagnosis:- 
• Decreased intracranial adaptive capacity R/T intracranial hemorrhage.
• Risk of electrolyte imbalance R/T increases ADH due to regular mechanism compromising.
• Risk of seizures R/T intracranial bleeding.
• Risk for airway clearance R/T neuromuscular impairment.