And hyperglycaemia and close monitoring of glycaemic control is essential ( vogelzang et al.

2006) . most importantly, Paul’s muscular strength must the restored to facilitate timely weaning
from weaning from ventilator dependence (Lettleri 2006).

A recurrent trend in management of patients with TBI is the induction of mild

hypothermia (central temperature 34 O C) to decrease ICP and CBF and stabilize cell membranes
protecting the brain from ischemia (yanko and micko 2001 ; Gunnarsson and fehlings 2003) . To
achieve hypothermia, a patient with severe TBI admitted to the emergency department should
not be-warmed, as active cooling has to occur within 90 minutes of injury (Clifton et al. 2001)
Mild hypothermia causes e left shift in the oxygen (O2) dissociation curve, so Hb affinity for O2
increased, ang since hypothermia also slows cerebral metabolism, O2 supply and demand
implications should be closely monitored (Clifton 2004). Complications of induced hypothermia
include increased incidence of bacterial infection, myocardial suppression, cardiac arrhythmias,
renal dysfunction, re-warming shock and a rebound increase in ICP (Yanko and Mitcho 2001).

Psychological care and communication with patient who is ventilated is of paramount

importance (Liao and so 2002; Geraghty 2005). Pstients with HBI can often exhibit elevations in
ICP in response to noxius stimuli include sudden touch, unfamiliar environmental noise, and
painful procedures. Paul’s general hygiene needs should be managed according to how tolerant
he is of such interventions. Clustering care is not advisable; however, a patient’s response is
ubique and the nurse should discover the best approach in accordance with paul’s clinical signs
(Elisenhart 1994). It is worth exploring what effect family presence and therapeutic touch, such
as stroking the hand or cheek, has on Paul (Liao and so 2002 ; Azoulay et al. 2003) as this may
have a beneficial effect on ICP.

CONCLUSION

TBI is associated with significant risk of long-term neurological damage and disability
(Arbour 2004). The initial 72 hours post-TBI is recognized as a crucial period in the patient’s
management. Close monitoring and skilled medical and nursing interventions are vital to the
survival and recorvery from injury. The paucity of adequate empirical studies on the
management of patients with a raised ICP means tere is currently insufficiabt evidence to provide
strong recommendations for individual medical and nursing interventions