1. 1 Nursing Care & Priorities for Those with Traumatic Brain Injury & Brain Tumors Keith Rischer, RN, MA, CEN

2. 2 Todays Objectives  Differentiate the causes of traumatic brain injury.  Review pathophysiology and clinical manifestations of TBI & brain tumors.  Identify nursing priorities and client education with TBI & brain tumors.  Identify manifestations of ICP and purpose of ICP monitoring.  Prioritize nursing care with craniotomy-postop.

3. Traumatic Brain Injury 3  Patho Open head injury Halo sign C-spine precautions Closed head injury Concussion Mild-mod-severe  Glasgow coma scale

4. 4 Traumatic Brain Injury  Types of force Acceleration Deceleration Coup-contrecoup  Hemorrhage Intracerebral Epidural Subdural  Diagnosis CT MRI

5. 5 Increased Intracranial Pressure  Normal pressure  Patho  Clinical Manifestations (chart 48-5 p.1037) Decreased LOC Restlessness/irritability Headache N&V Slurred speech Pupillary changes Seizures  Brain herniation Pupil changes LOC Cheyne-stokes resp VS changes…Cushings triad

6. 6 Nursing Interventions: I-ICP  Maintain airway and optimal ventilation  HOB elevated 15 – 30 degrees  All ADL’s increase ICP – spacing  Limit suctioning  Calm environment  Prevent hyperthermia

7. 7 Nursing Priorities with TBI  Establish baseline  Early detection of subtle changes  Airway/breathing ABG’s  Vital signs Maintain adequate cerebral perfusion pressure (CPP) Cushings triad  Positioning  Neuro Assessment Glascow Coma Scale LOC Eye/pupils Motor Decerebrate/decorticate posturing Response to pain

8. 8 Medical-Nursing Priorities w/Critical TBI  Drug therapy Steroids Mannitol Filter needle/tubing Furosemide Nursing priorities…  Neuromuscular blocking agents Nursing considerations…  Anti-convulsant agents  Respiratory management Managing CO2 w/vent

9. 9 Medical-Nursing Priorities w/Critical TBI  Fluid & lyte management Diabetes Insipidus SIADH  Nutritional management Enteral tube feedings if LT  Surgical management Craniotomy ICP monitoring Intraventricular catheter

10. 10 Brain Tumors  Patho  Complications Cerebral edema-inflammation I-ICP Focal neuro deficits Obstruction of CSF Pituatary dysfunction SIADH DI

11. 11 Brain Tumors  Types Gliomas astrocytomas Metastatic  Clinical Manifestations Headaches N&V Visual changes Seizures Change in mentation/personality  Diagnosis  Interventions

12. 12 Craniotomy:Post-op Priorities (p.1059-1062)  Nursing priorities… Detect early changes in status Prevent/minimize complications ICP  Neuro assessment  I&O  Pain control  Cardiac monitoring VS  Position  Dressing assessment  Monitoring lab values Sodium CBC ABG’s

13. 13 Craniotomy Post-op Complications (p.1064-5)  ICP Hydrocephalus  Hematomas  Hypovolemic shock  Respiratory Atelectasis Pnuemonia  Wound infection  Meningitis  Seizures  CSF leak  Fluid/lyte imbalances DI-SIADH