List, prioritize, discuss care for patients suffering an acute critical neuro emergency.

 Pick a condition from this chapter. and create a

quick concept map

Primary Brain Injury – injury caused by physical
stress by blunt or penetrating force.
Open Head Integrity of skull is compromised;
Injury caused by either a blunt force
trauma or penetrating object.
High risk for infection
Closed From blunt trauma, causes
Head Injury acceleration then deceleration of
head or hits a stationary object.
Secondary Brain Injury – process that Types of Brain Injury
occur after brain injury. Result from vascular,
physiologic, and biochemical events. Concussion Head trauma that result in neurological
or mild TBI function change but no brain damage. Usually
Most common causes: resolves within 72 hrs.
 Hypotension and hypoxia Contusion Brain is bruised with period of
 Intracranial hypertension / ↑ ICP unconsciousness with stupor or confusion.
 Cerebral edema Diffuse Widespread injury to brain; results in coma;
 Hydrocephalus axonal injury seen in severe head trauma
 Brain herniation Intracranial Can occur in epidural, subdural, or
hemorrhage intracerebral space.

Risk Factors:
 Motor vehicle or
motorcycle accidents Dx Procedures:
 Drug or alcohol use
 Sports • Cervical spine films
 Assault • CT and/or MRI
 Gunshot wounds • Calculation of cerebral
 Falls perfusion using ICP
monitor
Expected Findings:
 Use of alcohol or drugs
 Amnesia before or after injury
 Loss of consciousness.
 CSF leakage (nose and ears) –
indicate basilar skull fracture.
 ↑ ICP
• Severe headache, N/V
• LOC deterioration,
restlessness, irritability
• Dilated or pinpointed
nonreactive pupils
• Cranial nerve dysfunction
• Alteration of breathing
pattern
• Motor function deterioration;
abnormal posturing
• Cushing’s triad (severe
HTN, wide PP, bradycardia)
• Seizures
HEAD INJURY Nursing Care:
• Damage to brain from  Assess respiratory status (priority) – untreated
external mechanical force hypoxia leads to brain damage, use GCS
• Not caused by congenital or  Asses cranial nerve function – eye blink
neurodegeneration. response, gag reflex, tongue, and shoulder
movement
 Assess PERRLA
 Bilateral sensory and motor response
 Assess ICP (expected range 10-15 mm Hg)
ICP can be ↑ by:
 Hypercarbia
 Endotracheal or oral tracheal suctioning
 Extreme neck or hip flexion or extension
Complications:  Maintain HOB at <30 degree
Drug therapy: • Brain herniation  Increased intra-abdominal pressure
• Hematoma and intracranial  ↓ ICP by:
 Mannitol – osmotic diuretic  Elevated HOB
hemorrhage
 Barbiturates – for client to  Avoid extreme flexion, extension of head;
• Pulmonary edema
be placed in coma; reduce maintain body at midline neutral position
• DI or SIADH
metabolic demand  Maintain patent airway
 Phenytoin – prevent/treat
• Cerebral salt wasting
 Administer oxygen therapy
seizure Lab Test:  Hyperventilate on mechanical ventilation.
 Morphine - analgesic Use stool softeners
• ABG’s  Maintain cervical stability until cleared by
Therapeutic procedure: • CBC with diff x ray
• Blood glucose  Report CSF leakage
• Craniotomy • Electrolytes  Provide calm, restful environment
Interprofessional care: • Serum and urine osmolality  Prevent immobility complications
• Toxicology screen with  Monitor F&E and osmolality
• PT, OT, SLP ECG  Provide fluids
• Social services or case
• Monitor anti-seizure med  Maintain safety, initiate seizure
managers blood levels precautions
• Rehab facilities
Real life scenario

I had a 39-year-old male patient who was admitted to hospital due to a TBI from a vehicular accident. The patient was in a coma in the ICU then
transferred to med surg floor when after he woke up. A surgery was performed to relieve pressure and fluid building inside the brain. Patient was going to be
discharged the next day during my date of care. Neuro and respiratory assessments were one of the most important things we need to monitor during my shift
as well as maintaining ICP in normal ranges and airway patency. Upon discharge, patient would need extensive rehabilitation for speech and occupational
therapy to help him recover.