Nursing 322: Fall 2007
Traumatic Brain Injury
1. Start this exercise by completing the required reading assignments found on your syllabus.
3. Review the additional material that is required for your particular role:
4. Your will be required to present on the topic and answer the questions provided.
5. Keep in mind that the focus of class is on the nursing care of these clients and conditions. Always ask yourself, “what do my classmates and I need to know to care for these patients?”
6. You have no more than 5-7 minutes to present.
Brain Injury Classification/Review
Click: http://www.biausa.org/Pages/types_of_brain_injury.html#symptoms
From a review of the content from your book and the above page, discuss what level of brain injury we should expect. How do we differentiate this from other levels of brain injury (mild vs. moderate vs. severe)?
Differentiate between an open and closed head injury. Which would we suspect here and how would we know the difference?
ER/ETU Nurse
Pick up from me the article: Traumatic and Head Injury by P.A. Bemis
Review the Rapid ABC assessment and discuss with the class in the context of this patient.
Review and summarize the “Initial Assessment and Interventions” section, particularly the “Head Injuries” information.
Summarize the assessments you would do and what you might expect to find from this information (see also NIC Neurologic Monitoring pps. 511-512).
Discuss why each of the following trauma labs might/should be drawn: CBC, UA, type and cross, ABG’s, electrolytes, clotting studies
ICU Nurse
ICP Management Group:
Access and read the article below (it is available full text) and review NIC for ICP monitoring (pp. 445).
LeJeune, G. M., & HowardFain, T. (2002). Nursing assessment and management of
patients with head injuries. DCCN: Dimensions of Critical Care Nursing, 21(6), 226-231.
Discuss intracranial pressure (ICP) including:
It might work to present this material as a concept map...
Pharmacology Group
Review your drug book and the Trauma Nursing (McQuillan) text available at Clemens library.
Review the following medications as they apply to the patient with TBI.
Mannitol, Loop Diuretics (Lasix), Glucocorticosteroids (Dexamethasone), Anticonvulsants (Dilantin/Cerebrex), Thorazine, Codeine, Lidocaine, Barbituates
Why are they being given?
What do you as the nurse need to be concerned about with each medication? Focus on the nursing aspects of each drug!
Complications Group
Review your textbook and the Trauma Nursing (McQuillan) text available at Clemens library. Focus on the following and be able to discuss what they are and how they are managed:
Aspiration
Hypo/hyperthermia
Seizures
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)
Diabetes Insipidus (DI)
Infections (which ones for this patient?)
Care of the Unconscious client
Be prepared to add to the comments of the other ICU Nurse groups, especially the complications group. Review the textbook for information on the issues below. Be prepared to talk about nursing interventions and outcomes specific to these issues from NIC. Be sure to review the following from NIC (Cerebral Edema Management pps. 234-235, Cerebral Perfusion Promotion pps. 236-237). Be able to answer, “What is this patient at risk for and how can the nurse prevent it?”:
Consider:
Discharge/Case Coordinator & Rehabilitation
Review the last portion of the Trauma Nursing (McQuillan) book available at Clemens library. Go to the link below and synthesize the materials you reviewed in the context of this patient.
Review the information from the Traumatic Brain Injury Resource Guide at:
Click onto the "Resources" tab and review the "Rating Scales" page. Use one of the scales and make up a hospital discharge evaluation score.
Skim the section on this web page under the "Treatment Tab" and select Guide for Selection page
Skim the following articles that are both available full text online. Review the rehabilitation and family sections. Apply what you find to the patient that is presented in this scenario.
Lovasik, D., Kerr, M. E., & Alexander, S. (2001). Traumatic brain injury research: A review of clinical studies. Critical Care Nursing Quarterly, 23(4), 24-41.
Marks, J.P. & Daggett, L.M. (2006). A critical pathway for meeting the needs of families of patients with severe traumatic brain injury.
Be able to answer:
Who will be involved with after care?
What will this after care entail?
Where will it occur?
What will it cost?
What are the essentials for helping families cope and stay involved?
References
Articles
LeJeune, G. M., & HowardFain, T. (2002). Nursing assessment and management of patients with head injuries. DCCN: Dimensions of Critical Care Nursing, 21(6), 226-231.
Letvak, S., & Hand, R. (2003). Postanesthesia care of the patient suffering from traumatic brain injury. Journal of PeriAnesthesia Nursing, 18(6), 380-5, 406-13.
Lovasik, D., Kerr, M. E., & Alexander, S. (2001). Traumatic brain injury research: A review of clinical studies. Critical Care Nursing Quarterly, 23(4), 24-41.
Marks, J.P. & Daggett, L.M. (2006). A critical pathway for meeting the needs of families of patients with severe traumatic brain injury.
Nolan, S. (2005). Traumatic brain injury: A review. Critical Care Nursing Quarterly, 28(2), 188-194.
Web sites
Brain Injury Association of America: http://www.biausa.org/Pages/home.html
Traumatic Brain Injury Resource Guide: http://www.neuroskills.com/
Massive MedLine Resource List covering every aspect of care: http://www.nlm.nih.gov/medlineplus/headandbraininjuries.html
Brain Mapping Pages: http://www.biausa.org/Pages/brain_maps.html and http://www.braintumor.org/pservices/brain3d/brain1.asp
Critical Care Review of TBI and Head Injury:
http://www.wildirismedicaleducation.com/courses/34/index_ccare.html
TBI Model Systems: http://www.tbindc.org/
Center for Outcome Measurement In Brain Injury: http://www.tbims.org/combi/