NUR 211- TBI
Describe the two types of TBIs and give examples/subtypes of each. - ANS 1. Open trauma-
(penetrating) damage to soft tissue of the brain by penetrating objects.
2. Closed trauma- (blunt)
a. Acceleration- caused by head in motion.
Sitting still and all of sudden the body is jolted
quickly and the brain slams into the BACK OF
THE SKULL.
b. Deceleration- the head stops suddenly when
moving really fast and the brain continues
forward and slams into the FRONT OF THE
SKULL.
c. Rotational forces- affects the brain but also
cuts off 02 to the brain- think neck injury.
Describe the pathophysiology of a TBI if left untreated. - ANS 1. Brain suffers traumatic injury
2. the brain starts to swell or bleed = increased cranial volume.
3. Rigid cranium allows no room for expansion = increased ICP
4. Pressure on blood vessels within the brain = decreased blood flow to the brain.
5. cerebral hypoxia and ischemia
6. ICP continues to rise = brain may herniate
7. Cerebral blood flow stops.
What is a primary injury? give examples. - ANS Initial injury resulting from the traumatic event.
Occurs at the moment of impact. Can be mild to severe.
Ex. contusion, laceration, shearing injuries, hemorrhage.
What is a secondary injury? Give an example. - ANS Insult to the brain subsequent to the
original primary event. This is the swelling that if not prevented or is left untreated leads to
ISCHEMIA.
Ex. Cerebral Edema
How do you know if someone has increased ICP? List two things you would look for. - ANS 1.
They will have a change in LOC!- this is the first thing we assess with TBI.
2. Pupil response- blown pupil.
How is ICP measured? What are some important things to remember while using this
measuring device? - ANS Ventriculostomy- ventricular drain
*Can be put in bedside in ICU
, *MUST BE LEVEL WITH THE TEMPLE
*Has 3 way stop-cock to release CSF= decrease ICP.
*Monitor these patients for infection - Temperature.
What do you expect a patient's BP to look like initially after TBI and what do we need to do
about it and why? What do you need to consider if their BP is not what you expected, and why
is it significant? - ANS Initially- Hypertension is common with severe TBI because the brain is
trying to compensate due to swelling. WE MUST CONTROL HTN TO PREVENT SECONDARY
INJURY CAUSED BY ICP.
If they have hypotension- we need to rule out other injuries such as internal bleeding.
This is significant because we need to know if they have other injuries, but also because
hypotension causes inadequate perfusion to neural tissue.
**IT IS NOT TYPICAL TO HAVE HYPOTENSION WITH TBI B/C BODY IS TRYING TO SHUNT
BLOOD TO THE BRAIN.
What is the normal ICP range? - ANS 5-15 mmHg.
What is the goal of treatment for TBI? - ANS The goal is to decrease ICP to prevent secondary
injury.
What is hypercapnia treatment? give an example of how it would be used. - ANS This is an
older treatment that is used less often now. The theory is that excess CO2 promotes
vasodilation which would increase blood flow/02/glucose to the brain, which (in theory) helps
prevent ischemia.
*The reason it's not used as much now is because someone realized that vasodilation leads to
more swelling in the brain.
*This is used on a case by case basis, but it's not the standard.
EX. Pt. on a vent with normal ABGs. Dr orders hypercapnia tx=we would HYPERVENTILATE
THEM by decreasing the rate &/or volume.
What is a craniectomy, what is the goal of this treatment? - ANS Removing a piece of skull (a
bone flap) and storing it in the SQ tissue of the abdominal cavity.
*Removing the bone flap allows the brain to swell, which DECREASES the ICP= the goal.
After swelling goes down the bone flap will be put back.
What is Burr Hole Evacuation? - ANS Holes are made in the skull with a perforator, which has
an auto-stop mechanism to prevent damage to the dura.
The procedure alleviates pressure by letting out fluid- decreasing the ICP.
If someone has a TBI what do you need to consider when positioning them? What if they also
have SCI? - ANS HOB 35-45 degrees *guideline!* We look at the ICP to determine how far to
raise the HOB.
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