1. Management of Patients with Traumatic Brain Injury
Antoinette McNeil, BSN, RN, CCRN
Program Synthesis Practicum I
Trudy Thompson, MSN, RN
September 24, 2013

2. Objectives
The nurse will define intracranial pressure and cerebral perfusion pressure
The nurse will stat the sign and symptoms of increase intracranial pressure
The nurse will know the different types of monitoring systems
The nurse will state what their role is in caring for the patient
The nurse will demonstrate how to level the ventriculostomy

3. Introduction Traumatic brain injury accounts for 1.4 millions injuries
There are approximately 52,000 death annually in the United States
80,000 to 90,000 survivors suffer long- term neurologic impairments

4. Intracranial Pressure and Cerebral Perfusion Pressure
Monroe-Kellie doctrine hypothesis
Intracranial pressure
ICP 0 to 10mm Hg
Increase intracranial pressure/intracranial hypertension
ICP 15mm Hg or greater
Cerebral perfusion pressure
Measure of force to deliver blood to the brain
CPP calculation: mean arterial pressure(MAP)- ICP=CPP

7. Signs and Symptoms Early Signs Vomiting Irritability Headache Seizures
Lethargy
Photophobia

8. Late Signs Depressed consciousness Pupil enlargement
Papillary reaction to light sluggish
Tone and reflexes of limbs are altered
Crushing’s triad

9. Monitoring Systems Camino ICP monitor Intraventricular catheter
Cannot drain CSF
Zeroed prior to insertion
Intraventricular catheter
Leveled at the tragus
Drain CSF
Gold Standard

11. Nurses Role Cluster Care Suction when necessary
Keep patient in alignment
Decrease noise level
Decrease lights
Keep patient sedated
Record vital signs, ICP, CPP hourly
Zero ventriculostomy transducer at Foramen of Monroe

17. Summary
Goal to prevent secondary injury in patients with complex brain injuries

18. Evaluation
Observation of return demonstration of leveling transducer of ventriculostomy
Question and Answer regarding sign and symptoms for increase ICP

19. Reference
Cecil, S., Chen, P. M., Callaway, S. E., Rowland, S. M., Adler, D. E., & Chen, J. W. (2011, April). Truamatic Brain Injury Advance Multimodal Neuromonitoring From Theory to Clinical Practice. Critical Care Nurse, 31(2),
Milkova, S. (n.d.). Stategies for Effective Lesson Planning. Retrieved from
Moreda, M. V., Wyatt, A. H., & Olson, D. M. (2009, ). November. Nursing 2009 Critical Care, 4(6),
Schimpf, M. M. (2012, Juy-September). Diagnosing Increased Intracranial Pressure. Journal of Trauma Nursing, 19(3),
The Royal Children’s Hospital Melbourne. (n.d.).
Vreeland, D. G., Rea, R. E., & Montgomery, L. L. (2011, July- September). A Review of the Literature on Heart Failure and Discharge Education. Critical Care Nursing Quarterly, 34(3),