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Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors Marnie Quick, RN, MSN, CNRN.

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Presentation on theme: "Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors Marnie Quick, RN, MSN, CNRN."— Presentation transcript:

1 Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors Marnie Quick, RN, MSN, CNRN

2 Normal brain protected by:

3 Normal brain

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7 Traumatic Brain Injury (TBI): Etiology/Pathophysiology Risk factors- MVA; elevated blood alcohol; contact sports; acts of violence- gun, knife Mechanism of craniocerebral trauma Acceleration (movement)-deceleration (stationary) Coup (impact)-contrecoup (opposite) phenomenon Blunt or penetrating injury Closed head injury Scalp lacerations Skull fractures- Linear; comminuted; depressed; basilar; open/closed

8 Coup-contracoup injury

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10 Penetrating injury- Gunshot to brain

11 Penetrating injury: Knife in brain

12 Basilar skull fracture- Base of skull fractured

13 Basilar skull fracture is base of skull if posterior> Battle sign- ecchymosis behind the ear

14 Basilar skull fracture is more anterior Raccoon eyes- periorbital ecchymosis

15 Basilar Skull fractures can cause leakage of CSF from meninges

16 Minor Brain Injury Concussion- sudden transient disruption of neural activity in the brain with change in LOC Post Concussion Syndrome- may occur after other brain injuries- severity of symptoms are not related to severity of brain injury. Sym may persist wks-months

17 Major Brain Injury- Focal injury Brain contusion- bruising; coup-contracoup Brain laceration- tearing brain tissue, ICH DAI- diffuse axonal injruy Widespread disruption of axons Poor prognosis Brain bleeds- Note meninges in relation to bleeds on following slides

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19 Epidural hematoma

20 Subdural hematoma (SDH)

21 Intracerebral hematoma

22 Secondary brain injury Cerebral edema Localized or diffuse Peaks hrs Occurs with CHI; open head injury; anoxia May in itself cause death by pressure> herniation Increased ICP Herniation Syndromes

23 Traumatic Brain Injury (TBI): Common Manifestations/Complications Increased ICP symptoms general and specific Restlessness- R/O respiratory; waking up Systemic effects of acute brain injury- hypermetabolism, brainstorming, SIADH Brainstorming- hypothalamic stimulation-ANS CSF leak- rhinorrhea/otorrhea- basal skull Fx Post concussion Syndrome Associated cervical spinal cord injury

24 Collaborative Care: Traumatic Brain Injury (TBI): Diagnostic studies (similar to ICP) Emergency management: assessment and interventions (Lewis 1484 Table 57-9) Treat IICP- airway; fluid; positioning; temp reg; meds Prevention of complications Medications: IICP; seizures; stress ulcer;straining;brainstorming Diet/calories: hypermetabolic state; ileus; swallow/gag CSF leak: glucose; halo; HOB 30; no nasal suction Other: SIADH> hyponatremia Surgery: bone repair; evacuation clot; craniotomy/ectomy; burr hole; cranioplasty; monitor placement

25 Burr holes craniotomy

26 Place monitors/intraventricular drain:

27 Crainectomy- bone flap out to allow for brain expansion post op

28 Post crani

29 Traumatic Brain Injury (TBI): Nursing assessment specific to TBI Health history Description of accident; past medical history NVS and Glasgow Coma Brainstem reflexes VS- Late sign is Cushing reflex Skull/face; CSF leak; SCI Consider older adult finding

30 Pertinent Nursing Problems Specific to Traumatic Brain Injury (TBI): Health promotion Ineffective tissue perfusion, cerebral (decreased intracranial adaptive capacity) Ineffective airway clearance/breathing pattern Hypothermia Pain Impaired physical mobility

31 Anxiety Decreased cerebral perfusion (IICP) Brain death (ethical dilemmas p.1485) Home care Home evaluation/rehab/nursing home Teach about post concussion syndrome; B&B; spasticity; dysphagia; nutrition; seizure disorder; personality changes; family role changes 6 months typical plateau period Community agencies/support groups

32 eflex/oculocephalic2.html

33 Primary brain tumors Arise from support cells, neurogilia cells; the meninges; or blood vessels Do not metastasize outside cranium Cause unknown

34 Grade I and II gilomas (astrocytoma) made up of astrocytes; are benign, slow-growing tumors Grade III and IV gliomas (glioblastoma Multiforme are invasive and fast-growing Meningiomas arise from the meninges; slow- growing; benign, encapsulated and compress the brain Brain tumors may be lethal due to their location

35 Gioblastoma Meningioma

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37 Metastatic (secondary) brain tumors Originate from outside the brain- lung and breast most common sites Single or multiple Becoming more common as individual with cancer in other parts of the body are living longer

38 Clinical Manifestations/complications of Brain tumors General ICP symptoms Common early symptoms: headache; vomiting; papilledema (visual changes) Seizures- partial classification in type Brain tumor symptoms occur due to their ability to compress or destroy brain tissue; edema that forms around the tumor; hemorrhage; & obstruction of CSF flow Specific symptoms as to the lobe affected>

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40 Frontal lobe: personality changes; inappropriate behavior; inability to concentrate; impaired judgment; headache; expressive aphasia if dominant hemisphere; motor weakness or paralysis from motor strip Parietal lobe: sensory deficits- paresthesia, visual field deficits; contralateral sensory disturbances from sensory strip; loss of interpretation and discrimination for sensing input; perceptual problems

41 Occipital lobe: visual disturbances; visual agnosia Temporal lobe: complex partial (psychomotor) seizures; auditory hallucinations; memory problems; Wernicke aphasia if dominant hemisphere Cerebellum: gait distrubances; balance and coordination problems Brain stem: cranial nerve dysfunction; vital signs

42 Complications of Brain Tumors Hydrocephalus Infection Death is usually caused by IICP/hermiation

43 Collaborative Care for Brain Tumors Diagnostic tests CT/MRI EEG PET Angiogram Tissue biopsy

44 Collaborative Care for brain tumors Surgery To remove or debulk Supratentorial- above tentorium Infratentorial-below Stereotaxic-localized

45 Radiation Used alone or with other therapies Gamma or Cyber-knife Complication- increased cerebral edema Medications Chemotherapy: IV; intraventricular (ommaya Reservoir) or by wafer implanted Corticosteroids to treat brain edema Anticonvulsants to prevent seizures Rehab- outpatient or in house

46 Health history: progression of symptoms; other cancers, disease Physical exam Neuro vital signs Specific signs of the local functions of different parts of the brain Similar neuro deficits as the individual with a stroke Signs of increased intracranial pressure/herniation

47 Pertinent Nursing Problems for Brain Tumor Impaired tissue perfusion, cerebral Self-care deficits Anxiety Risk for infection-post crani Acute pain Disturbed self-esteem Nutrition Home care- rehab; home eval; support groups


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