6- NEUROLOGICAL TRAUMA: HEAD AND SPINAL CORD INJURY b Flashcards
Intracerebral Haemorrhage
Haemorrhage occurs into the substance of the brain
• May be due to trauma or a non traumatic cause:
Intracerebral Haemorrhage treatment
Supportive care
• Control of ICP
• Administration of fluids, electrolytes, and antihypertensive
medications
• Craniotomy or craniectomy to remove clot and control
hemorrhage
May not be possible due to the location or lack of circumscribed area of
hemorrhage
Management of the Patient with Head
Injury
Assume cervical spine injury until this is ruled out
• Therapy to preserve brain homeostasis and prevent
secondary damage
Therapy to preserve brain homeostasis and prevent
secondary damage
• Treat cerebral oedema
• Maintain cerebral perfusion; treat hypotension, hypovolemia, and
bleeding; monitor and manage ICP
• Maintain oxygenation as well as cardiovascular and respiratory
function
• Manage fluid and electrolytes
Supportive Measures Intracerebral Haemorrhage
• Respiratory support; intubation and mechanical ventilation • Seizure precautions and prevention • NG to manage reduced gastric motility and prevent aspiration • Fluid and electrolyte maintenance • Pain and anxiety management • Nutrition
Nursing Process – Assessment of the
Patient with Brain Injury
• Health history with focus upon the immediate
injury, time, cause and the direction and force of
the blow
• Baseline assessment
• LOC: Use Glasgow Coma Scale
• Frequent and ongoing neurologic assessment
• Multisystem assessment
Interventions Intracerebral Haemorrhage
• Provide ongoing assessment and monitoring is vital
• Maintain airway
• Positioning to facilitate drainage of oral secretions with
HOB usually elevated 30° to decrease venous
pressure
• Suctioning with caution
• Prevention of aspiration and respiratory insufficiency
• Monitor ABGs, ventilation, and mechanical ventilation
• Monitor for pulmonary complications
• Monitor I&O and daily weights
• Monitor blood and urine electrolytes, osmolality and blood
glucose
• Implement measures to promote adequate nutrition
• Implement strategies to prevent injury
• Assess oxygenation
• Assess bladder and urinary output
• Assess for constriction due to dressings and casts
• Pad side rails
• Use mittens to prevent self-injury; avoid restraints
Strategies to prevent brain injury
• Reduce environmental stimuli
• Use adequate lighting to reduce visual hallucinations
• Implement measures to minimize disruption of sleep–wake
cycles
• Provide skin care
• Implement measures to prevent infection
Strategies to Maintain body temperature brain injury
- Maintain appropriate environmental temperature
- Use coverings: sheets, blankets as per patient needs
- Administer antipyretics for fever (paracetamol)
- Use cooling blankets or cool baths; avoid shivering
Spinal Cord Injury
Pathophysiology
SCI’s often occur as a result of injury to
mobile areas in the vertebrae
The result of concussion, contusion, laceration, or
compression of the spinal cord
types of spinal cord injury
Primary injury
Secondary injuries
Primary injury spinal cord injury
is the result of the initial trauma
Secondary injuries spinal cord injury
usually the result of ischemia,
hypoxia, and haemorrhage which destroys the nerve
tissues
are thought to be reversible/
preventable during the first 4 to 6 hours after injury
Clinical Manifestations spinal cord injury
Depends on type and level of injury • If conscious patient usually complains of back and neck pain • Impaired respiratory function is apparent in injuries above T6
•Complete spincal cord complete
Paraplegia
•Tetraplegia (quadriplegia)
Incomplete spincal cord
Some movement or feeling below the
level of the injury
Spinal shock
(lasts up to 3 months)
– A sudden depression of reflex activity below
the level of spinal injury
– Muscular flaccidity and lack of sensation and
reflexes
Acute Management Spinal shock
Skeletal fracture reduction and traction • Oxygen therapy • IV corticosteroids (Methylprednisone) to reduce oedema • Indwelling catheter • Administration of IV fluids • Surgery?
Promotion of adequate breathing and airway
clearance spinal shock
Monitor carefully to detect potential respiratory failure – Pulse oximetry and ABGs – Lung sounds • Early and vigorous pulmonary care to prevent and remove secretions • Suctioning with caution • Breathing exercises • Assisted coughing • Humidification and hydration
Improving mobility spinal shock
• Maintain proper body alignment • Turn only if spine is stable and as indicated by physician • Monitor blood pressure with position changes • PROM at least 4 times a day • Use neck brace or collar, as prescribed, when patient is mobilized • Move gradually to erect position
Maintaining skin integrity spinal shock
Inspect all skin areas, particularly bony prominences • Turn patient every 2 hours • Ensure adequate nutrition • Wash and dry patients skin thoroughly • Educate patient and family on pressure ulcer prevention
Maintaining home and community based
care for TBI and SCI
Support of family • Provide and reinforce information • Measures to promote effective coping • Setting of realistic, well-defined, shortterm goals • Referral for counselling • Support groups- • NSW Brain Injury Association • Spinal Cord Injuries Australia
