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Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors

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Presentation on theme: "Neurosensory: Traumatic Brain Injury (TBI) & Brain Tumors"— Presentation transcript:

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

2 Normal brain protected by:

3 Normal brain




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


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


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 Decreased cerebral perfusion (IICP)
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 http://library. med. utah

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


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>


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 Rehab- outpatient or in house
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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