MEDICAL SURGERY NUR 265 TBI

TBI ● One of the biggest things we see in TBI or anyone that has a head injury even if they have a tumor or something they are going to have a late sign of ICP called Cushing’s Triad ● What do we see when we see Cushing’s Triad? Severe hypertension, widened pulse pressure, bradycardia or decrease or alteration in respiratory rate or pattern(late sign) ● Early signs: alterations in neuro status, lethargic, restlessness or irritability, pupil changes (oval, become sluggish or bigger than the other) those are earlier signs you can catch on a patient ● The other thing we need to be worried about is when we are taking of somebody and we want to prevent ICP (neurological emergencies and best practices for preventing or managing ICP in the book) ● Talks about: maintaining the head midline so that we don’t have to go back one side or the other because that will cut off and increased ICP ● Avoiding sudden hip or neck flexion during positioning and at the knees as well ● No cluster care because we don’t want to give them all of this stuff at one time and then be like oh alright and now we’ve agitated them enough. So give them their bath and maybe an hour later change the sheets if we need to ● Anytime we suction somebody whether they are neuro or not: we should always hyper oxygenate with them 100% FiO2 before and after because hyperoxygenation with 100% O2 even when we see the ICP going up will actually decrease their intracranial pressure ● We only suction when we want, we want a quiet environment, keep the lights low and make sure we limit visitors- seizure precautions but no rail padding. Also we want to log roll them because we don’t want them twisting at the hips or twisting at the neck or waist because it can increase ICP (do not hold your breath while being log rolled and do not cough because it increases ICP) ● Doesn’t matter where the brain injury, tumor or bleed in the brain we always want to be aware that the first sign is going to be: restlessness or decreased LOC or ICP - assessing neuro status is first indicating icp change ● Basilar skull fracture: racoon eyes and battle signs (normal findings) ● Mild TBI like a concussion: most important variable to assess in a brain injury is LOC ( pg917) ● What are some things you see in a person with a concussion? Lose consciousness for less than 30 minutes, sleep disturbances (sleep more or less), nervous, irritable, complaining of headaches, difficulty concentrating, amnesia around time of event (all have in common) ● Shouldn’t see: signs of increased ICP like Cushing’s Triad (severe hypertension or widened pulse pressure) ● So what do we want to tell our patient? (Patient and Family Education in book) Give Tylenol for headache q4h, but we don’t want to give sedatives, sleeping pills or alcohol… why do you think that is? It’ll sedate them and mask everything we want to see. No strenuous activities for at least 48 hours ● Should not have: persistent nausea and vomiting because that means something else is going wrong ● We know that they will have sleep disturbances and become irritable This study source was downloaded by from CourseH on :17:46 GMT -05:00 MEDICAL SURGERY NUR 265 TBI ● Seizures, worsening headaches, persistent nausea or vomiting, blurred vision then call 911 or return to the emergency room ● Who do think is at greatest risk for brain injuries? Sport players, elderly (due to falls - walker / through rigs) ● Anyone who has a head injury whether it’s a craniotomy, whether it’s a brain tumor, they had surgery for something else, subarachnoid hemorrhage, epidural, subdural or anything like that. Everyone that has that is at risk for something because we have those hormones from the hypothalamus to the pituitary ● The biggest one is the one that helps with the kidneys. Do you know which one that is? ADH ● Anyone that has anything to do with the brain you’ll see DI or SIADH- complications ● So, what do we do for DI? We give them fluids, right? (Yes) And watch their sodium because it’ll be really high, their serum osmo will be high but their specific gravity will be low because of the dilute urine. (Treat with Fluids) ● Whereas, SIADH I constantly have the ADH thrown out there saying hold on hold on, so I’m going to be fluid volume overloaded (hyponatremia) give 3% sodium and fluid restriction but not desmopressin to help their urine not urinate because their urine osmo is going to be low and the specific gravity will be high (high is dry but low is wet) ● If I had someone that came in with a mild TBI with difficulty sleeping, is that a priority for me? No because that’s expected ● If I had someone that came in that maybe fell, hit their head and now feels dizzy or a little problem with their eyesight, would that be a priority for me? No because I’m expecting something like that ● If they come in and they are like they hit their head and their irritable, then I expect that but if they start having a decreased LOC then I’m going to get worried and notify the PHCP Meningitis ● Which ones worse… bacterial or viral? Bacterial because viral we are just treating the signs and symptoms. So we don’t have to much worry with that one. People in closed quarter - college dorms, prisons, military. ● Worry about - SEIZURES and ICP - s/s ICP - headache, n/v ams, irritability PUPIL CHANGES( early)shape can change ex. ovoid, sluggish, eye movement back/forthx: all day 4 and 3 hrs later a 7 ; shouldn’t be big change.Also PHOTOPHOBIA- not worry about vitals NORMAL UNTIL TRIAD- ● What do we do with a patient that has bacterial meningitis? ANTIBIOTICS and can do LUMBAR PUNCTURE to know what’s exactly causing it and give the right antibiotic. DROPLET PRECAUTIONS. Monitor for seizures but not put on seizure precaution at first. ● If someone has a spinal cord injury- worried that … RESPIRTORY Bc can go onSPINAL SHOCK- which happens in first 24hours s. CORD SWELLS AND GET TEMPORARY PARALYSIS. Will have complete loss of autonomic and sensory and motor fx. Autonomic helps with Temperature- worry Bc can drop BP and HR. NEUROGENIC SHOCK-will see hypotension , bradycardia but won’t not see paralysis. If see hypotension and bradycardia and we’re not oxygenating as well we might see DECRESE PERFUSSION = DECRESE LOC.