Submitted by:

Mary Shein Love D. Cubico

Submitted to:
Joan F. Akut BSN,RN

And
Jaaziel Jessa Permi

3rd Rotation
Second Semester 2020 – 2021
April 2021
 INCIDENCE AND
DEFINITION
PREVALENCE

ETIOLOGY NURSING THEORY

SIGN AND ANATOMY AND

SYMPTOMS PHYSIOLOGY
PATHOPHYSIOLOGY DRUG STUDY

LABORATORY AND NURSING CARE

DIAGNOSTIC PLAN

SURGICAL JOURNAL WITH

INTERVENTION REFLECTION
DISCHARGE PLAN DOCUMENTATION

NURSING PROCEDURE REFERENCES

LEARNING EXPERIENCE
 Traumatic brain injury (TBI) or craniocerebral trauma describes an injury that is the result of
an external force and is of sufficient magnitude to interfere with daily life and prompts the seeking
of treatment.
 A primary injury is defined as the consequence of direct contact to the head/brain during the
instant of initial injury while secondary injury evolves over the ensuring hours and days after the
initial injury and results from inadequate delivery of nutrients and oxygen to the cells.
 A traumatic brain injury, closed (blunt) occurs when the head accelerates and then rapidly
decelerates or collides with another object (e.g., a wall, a dashboard of a car) and brain tissue
is damaged but there is no opening through the skull and dura.
 A traumatic brain injury, open (penetrating) occurs when an object penetrates the skull, enters
the brain, and damages the soft brain tissue in its path or when blunt trauma to the head is so
severe that it opens the scalp, skull, and dura to expose the brain.
Hinkle, J., & Cheever, K. (2018). Chapter 68 Management of Patients with Neurologic Trauma. In Brunner & Suddarth's Textbook of Medical-Surgical Nursing (14th ed.,
Vol. 2, pp. 2034-2036)
TYPES OF BRAIN INJURY
 Contusion – the brain is bruised and damaged in a specific area because of severe acceleration
deceleration force or blunt trauma. Clinical manifestations of a contusion are dependent upon Size,
location, and the extent of surrounding cerebral edema.
 Epidural hematoma – collection of blood in the epidural space between the skull and dura Mater. This
can result from a skull fracture that causes a rupture or laceration of the middle Meningeal artery. It
accounts for approximately 2.7% to 4% of traumatic head injuries (hickey, 2014).
 Subdural hematoma – collection of blood between the dura and the brain, a space normally Occupied
by a thin cushion of fluid. The most common cause is trauma, but it can also occur as a Result of
coagulopathies or rupture of an aneurysm.
 Acute SDH – approximately 50% of brain injuries and 60% of deaths in patients with brain Injuries result from
acute SHDs and are associated with major head injury involving contusion or Laceration.

Hinkle, J., & Cheever, K. (2018). Chapter 68 Management of Patients with Neurologic Trauma. In Brunner & Suddarth's Textbook of Medical-Surgical Nursing (14th ed.,
Vol. 2, pp. 2036-2037).
Types of brain injury
 Chronic SDH – can develop from seemingly minor head injuries and is seen most frequently In
older adults who are prone to this type of head injury due to brain atrophy, which is a
Consequence of the aging process.
 Intracerebral hemorrhage and hematoma – bleeding into the parenchyma of the brain. It is
Commonly seen in head injuries when force is exerted to the head over a small area (e.g.,
Missile injuries, bullet wounds, stab injuries). It can also result from other factors as well as
Nontraumatic causes.
 Concussion – temporary loss of neurologic function with no apparent structural damage to the
Brain. It is also referred to as “mild TBI”. The mechanism of injury is usually blunt trauma from An
acceleration-deceleration force, a direct blow, or a blast injury.
 Diffuse axonal injury– results from widespread shearing and rotational forces that produce
Damage throughout the brain – to axons in the cerebral hemispheres, corpus callosum, and
Brainstem. Recovery depends on the severity of the axonal injury.
Hinkle, J., & Cheever, K. (2018). Chapter 68 Management of Patients with Neurologic Trauma. In Brunner & Suddarth's Textbook of Medical-Surgical Nursing (14th ed.,
Vol. 2, pp. 2037-2038).
Treatment consists of making openings through the skull to decrease ICP
emergently, remove the clot, and control the bleeding.
Supportive measures also includes ventilatory support, seizure prevention, fluid
and electrolyte maintenance, nutritional support, and management of pain
and anxiety.
All therapy is directed toward preserving brain homeostasis and preventing
secondary brain injury

Hinkle, J., & Cheever, K. (2018). Chapter 68 Management of Patients with Neurologic Trauma. In Brunner & Suddarth's Textbook of Medical-Surgical
Nursing (14th ed., Vol. 2, pp. 2038).
 Falls (35.2 %)
 Motor vehicle crashes (17.3%)
 Being struck by objects (16.5%)
 Assaults (10%)

Hinkle, J., & Cheever, K. (2018). Chapter 68 Management of Patients with Neurologic Trauma. In Brunner & Suddarth's Textbook of Medical-Surgical
Nursing (14th ed., Vol. 2, pp. 2034).
 Symptoms, apart from those of the local injury, depend on
the severity and the anatomic location of underlying brain injury.
Persistent, localized pain usually suggest that a fracture is present.
Fractures of the cranial vault may or may not produce swelling in the
region of the fracture. Fracture of the base of the skull tend to
traverse the paranasal sinus of the frontal bone or the middle ear
located in the temporal bone. Therefore, they frequently produce
hemorrhage from the nose, pharynx, or ears, and blood may appear
under the conjunctiva. An area of ecchymosis (bruising) may be
seen over the mastoid (Battle sign). Basal skull fractures are
suspected when CSF escapes from the ears (CSF otorrhea) and the
nose (CSF rhinorrhea). Drainage of CSF is a serious problem, because
meningeal infection can occur if organisms gain access to the
cranial contents via the nose, ear, or sinus through a tear in the dura.
 An estimated 57 million people worldwide are currently living with a tbi-related
disability (CDC, 2016a).
 An estimate of 2.5 million emergency department visits in the united states
each year, the majority of which are for a mild TBI (CDC, 2016a).
 As a result of TBI, approximately 52,000 people die (contributing to about 30%
of all injury-related deaths), 275,000 are hospitalized, and 80,000 to 90,000 will
have long-term disabilities (CDC, 2016a; hickey, 2014).

Hinkle, J., & Cheever, K. (2018). Chapter 68 Management of Patients with Neurologic Trauma. In Brunner & Suddarth's Textbook of Medical-Surgical
Nursing (14th ed., Vol. 2, pp. 2033)
“Self-care Deficit Nursing Theory” (SCDNT) by Dorothea
Orem
Dorothea Orem’s self-care deficit theory defined
nursing as “the act of assisting others in the provision and
management of self-care to maintain or improve human
functioning at home level of effectiveness.” In her theory,
one practices self-care on a daily basis independently in
maintaining life, health, and well-being. However,
patients with TBI mostly are unable to care for themselves
and thus this is where our roles as nurses come to light.
The theory of self-care deficit is specific to nurses
because we act as an extension of themselves in Dorothea Orem
providing the appropriate care while they still can’t do it Self-care Deficit Nursing Theory

for themselves.
Quiambao-Udan, J. (2011). Theoritical Foundations of Nursing. (First ed.,pp. 171-173)
 THE CENTRAL NERVOUS SYSTEM
Brain
The CNS consists of the brain and the spinal cord.
BRAIN
The basic functional unit of the brain is the neuron. Also,
Spinal
Cord neurotransmitters are present which communicates
messages from one neuron to another or from a neuron
to a target cell, such as muscle or endocrine cells. The
brain also accounts for approximately 2% of the total
body weight and it is divided into three main areas: the
cerebrum, the brain stem and the cerebellum.
CEREBRUM
The largest part of the brain and is composed of right and
left hemispheres. It performs higher functions like
interpreting touch, vision and hearing, as well as speech,
reasoning, emotions, learning, and fine control of
movement. Also divided into four lobes:
Frontal – “master” lobe; executive function
Parietal – analyzes sensory information; body position in
space, size and shape discrimination
Temporal – contains auditory receptive areas; memory of
sound and understanding of language and music.
Occipital – visual interpretation and memory
BRAIN STEM
Consists of the midbrain, pons, and medulla oblongata.
Midbrain – connects the pons and the cerebellum with
the cerebral hemispheres; it contains sensory and motor
pathways and serves as the centers for auditory and
visual reflexes. Cranial nerve III and IV originate in the
midbrain.
Pons – portions of the ponshelp regulate respiration.
Cranial nerves V through VIII originate in the pons.
Medulla oblongata – reflex centers for respiration, blood
pressure, hear rate, coughing, vomiting, swallowing and
sneezing. Cranial nerves IX through XII originate in the
medulla
CEREBELLUM
It is posterior to the midbrain and
pons, and below the occipital lobe. It
integrates sensory information to provide
smooth coordinated movement. I controls
fine movement, balance, and position
(postural) sense or proprioception.
STRUCTURES PROTECTING THE BRAIN
Dura mater – outermost layer; covers the brain and the
spinal cord. A potential space exists between the dura
and the skull, known as epidural space. Another space,
the subdural space, exists below the dura.
Arachnoid – the middle membrane; an extremely thin,
delicate membrane that closely resembles a spider web. It
has the CSF in the space below it.
Pia mater – the innermost, thin, transparent layer that hugs
the brain closely and extends into every fold of the brain’s
surface.
SPINAL CORD
It is continuous with the medulla,
extending from the cerebral hemispheres and
serving as the connection between the brain
and the periphery. It serves as the pathway for
messages sent by the brain to the body and
from the body to the brain.
 Predisposing/Non-
modifiable factors:
• Gender
• Age
Intracranial
Brain Rigid cranium Pressure on pressure
swelling or allows no room for blood vessels Cerebral continues to
bleeding expansion of within the brain hypoxia rise. Brain
Brain suffers contents so causes blood and
increases may
traumatic injury intracranial flow to the ischemia
intracranial herniate
volume pressure brain occur
increases to slow

Precipitating/Modifiable
factors: Cerebral blood
• Falls flow ceases
• Prevention
 Research suggest that not all brain damage occurs at the moment of impact. Damage to
the brain from traumatic injury takes two forms: Primary and secondary injury. Primary injury
defined as the consequence of the direct contact to the head/brain during the instant of initial
injury, causing extracranial focal injuries (e.g., contusion, lacerations, external hematomas, and
skull fractures), as well as possible focal brain injuries from sudden movement of the brain within
the cranial vault (e.g., subdural hematomas (SDHs) concussion, diffuse axonal injury (DAI). The
greatest opportunity for decreasing TBI is the implementation of prevention strategies. Secondary
injury evolves over the ensuing hours and days after initial injury and results from inadequate
delivery of nutrients and oxygen to the cells. Identification, prevention, and treatment of
secondary injury are the main foci of early management of severe TBI. Contributors to this
process include intracranial pathologic process such as intracranial hemorrhage, cerebral
edema, intracranial hypertension, seizure and vasospasm.

Hinkle, J., & Cheever, K. (2018). Chapter 68 Management of Patients with Neurologic Trauma. In Brunner & Suddarth's Textbook of Medical-Surgical
Nursing (14th ed., Vol. 2, pp. 2034)
 The Monro-Kellie hypothesis, also known as the Monro-Kellie doctrine, explains the
dynamic equilibrium of cranial contents. The cranial vault contains three main components:
brain, blood and cerebrospinal fluid (CSF). According to the Monro-Killie hypothesis, the cranial
vault is a closed system, and is one of the three components increases in volume, at least one of
the other two must decrease in volume or the pressure will increase. Any bleeding or swelling
within the skull increases the volume of the contents within the skull and therefore causes
increased intracranial pressure (ICP). If the pressure increases enough, it can cause displacement
of the brain through or against the rigid structures of the skull. This causes restriction of the blood
flow to the brain, decreasing oxygen delivery and waste removal. Cells within the brain become
anoxic and cannot metabolized properly, producing ischemia, infraction, irreversible brain
damage, and eventually brain death.

Hinkle, J., & Cheever, K. (2018). Chapter 68 Management of Patients with Neurologic Trauma. In Brunner & Suddarth's Textbook of Medical-Surgical
Nursing (14th ed., Vol. 2, pp. 2034)
 Computed tomography (CT) scan uses a
Magnetic resonance imaging
narrow x-ray beam to scan body parts in
(MRI) uses a powerful magnetic
successive layers. The images provide
field to obtain images of different
areas of the body. cross-sectional views of the brain.
A craniotomy is the surgical
removal of part of the bone from
the skull to expose the brain. In
TBI’s, it may be required to
remove a clot or control the
bleeding.
 Contraindication: hypersensitivity to any
Generic Name: Phenytoin components of the drug; pregnancy and
Brand Name: Dilantin lactation; impaired renal or liver function
Adverse effects: CNS: depression,
Classification: Anticonvulsant confusion, drowsiness, lethargy, fatigue
GI: constipation, anorexia CV: cardiac
Route: Parenteral
Dysrhythmia, changes in blood pressure
Mechanism Of Action: The hydantoins stabilize nerve others: bone marrow suppression
membranes throughout the CNS directly by Nursing responsibilities:
 Discontinue the drug at any sign of
influencing ionic channels in the cell membrane,
Hypersensitivity reaction or severe
thereby decreasing excitability and hyperexcitability Skin rash.
to stimulation. By decreasing conduction through  Monitor complete blood count
nerve pathways, they reduce the tonic-clonic, (CBC) before and periodically
muscular, and emotional responses to stimulation. During therapy.
 Discontinue the drug slowly, and
Indication: Treatment Of Seizures After Neurosurgery Never withdraw the drug quickly
Karch, A. (2017). Chapter 23 Antiseizure Agents. In Focus on Nursing Pharmacology (7th ed., pp. 392-394).
Generic Name: Diazepam
Brand Name: Valium
Classification: Benzodiazepines; Anxiolytics
Route: Parenteral
Mechanism Of Action: Acts in the limbic system
and reticular formation, potentiates the effects of
GABA, has little effect on cortical function.
Indication: Relieves tension and agitation
Contraindication: Hypersensitivity to any
components of the drug; pregnancy and
lactation; impaired renal or liver function
karch, A. (2017). Chapter 23 Antiseizure Agents. In Focus on Nursing Pharmacology (7th ed., pp. 395-396).
Adverse effects: CNS: depression, confusion,
drowsiness, lethargy, fatigue GI: constipation,
anorexia, dry mouth GU: urinary retention CV:
Cardiac dysrhythmia, changes in blood
pressure
Nursing responsibilities:
 Patients are advised not to drink alcohol
while they are taking these agents.
 Monitor for adverse effects and provide
appropriate supportive Care as needed.
 Monitor for drug-drug Interactions.
Generic Name: Propofol
Brand Name: Diprivan
Classification: Nonbarbiturate Anesthetics
Route: Parenteral
Mechanism Of Action: These drugs are thought
to act in the reticular activating system and
limbic system to potentiate the effects of
gamma-aminobutyric acid. It has A very rapid
clearance and produces much less of A
hangover effect and allows for quick recovery.
Indication: Sedation
Contraindication: Hypersensitivity to any
components of the drug; impaired renal or liver
function
Karch, A. (2017). Chapter 27 General and Local Anesthetic Agents. In Focus on Nursing Pharmacology (7th ed., pp. 465)
Adverse effects: CV: hypotension, Bradycardia
integu: local burning on Injection respi: pulmonary
edema
Nursing responsibilities:
 Monitor pulse, respiration, blood pressure,
ECG, and cardiac output continually
during administration.
 Institute safety precautions, such as side
rails, and monitor patient until the recovery
phase is complete and the patient is
conscious and able to move and
communicate.
 Provide pain relief as appropriate, along
with reassurance and support; skin care
and turning; and supportive care.
Generic name: Midazolam
Brand name: Versed
Classification: Anticonvulsants, Benzodiazepine
Route: Intravenous
Mechanism of action: May potentiate the effects
of GABA, depress the CNS, and suppress the
spread of seizure activity
Indication: Preoperative sedation
Contraindication: Contraindicated in patients
hypersensitive to drug or its components and in
those with acute angle-closure glaucoma, shock,
coma, or acute alcohol intoxication
Klower, Wolters. Nursing 2020 Drug Handbook. Vol. 2, pg.1051-1054, 2020
Adverse effects: CNS: over sedation,
drowsiness, amnesia, headache, involuntary
movement, hiccups. CV: variation in BP and
pulse rate. GI: nausea and vomiting
Nursing responsibilities:
 Teach patient about drug use and
potential adverse reaction
 Advise patient to immediately report
difficulty breathing
 Caution patient or caregivers of
patient taking opioid with
benzodiazepine, CNS depressant, or
alcohol to seek immediate medical
attention for dizziness, light-
headedness, extreme sleepiness,
slowed or difficulty breathing, or
unresponsiveness
Subjective data
 The patient complained of a severe headache

Objective data
 Heart rate: 50 bpm
 Pain scale: 8/10

Nursing diagnosis
 Acute pain related decreased cerebral blood flow secondary to physical trauma as manifested by
guarding behavior, facial grimace and pallor

Goals of intervention
Short term
 After 1 hour of nursing intervention, the patient will report pain relieved or decreased with the pain scale of
2/10

Long term
 After 2 days of nursing intervention, the patient will demonstrate use of relaxation skills and diversional
activities, as indicated, for individual situation .
Nursing interventions
Independent
 Perform pain assessment each time pain occurs. Document and investigate changes from
previous reports and evaluate results of pain intervention
Rationale: to demonstrate improvement in status or to identify worsening of underlying condition/developing
complications
 Monitor skin color and temperature and vital signs
Rationale: which are usually altered in acute pain
 Ascertain client’s knowledge of and expectations about pain management
Rationale: provides baseline for interventions and teaching, provides opportunity to allay common fears and
misconceptions

Dependent
 Administered analgesics as prescribed
Rationale: to provide relief for pain and inflammation.
Collaborative
 Identify specific sign and symptoms and changes in pain characteristics requiring medical
follow-up.
Rationale: provides opportunity to modify pain management regimen and allows for timely intervention for
developing complications

Evaluation
 Goal was fully met as evidenced by the patient will report pain relieved or decreased with
the pain scale of 2/10
 Goal was fully met as evidenced by the patient will demonstrate use of relaxation skills and
diversional activities, as indicated, for individual situation
Subjective data
 Changes in level of consciousness
 Reacting only to painful stimuli
Objective data
 Blood pressure: 180/50 mmHg
 Heart rate: 50 bpm
Nursing diagnosis
 Ineffective cerebral tissue perfusion related to increased intracranial pressure secondary to traumatic brain
injury
Goals of intervention
Short term
 Within the 8-hour shift, patient will have improvement in cerebral perfusion.
 After the nurse-patient interaction, patient will display signs of improvement in intracranial pressure which is
evidenced by stable vital signs and having normal readings on the ICP monitor.
Long term
 Within the 3 days of nursing intervention, patient will display improved status.
Nursing Interventions
Independent
 Frequent assessment and monitoring of neurologic status and compared with baseline data.
Rationale: Assessment of LOC is the most sensitive neurologic indication of deterioration of the patient’s condition

 Close monitored patient’s vital signs

Rationale: To asses the intracranial status

 Evaluated pupils, noting size, shape, equality, light reactivity.

Rationale: Pupil reactions are regulated by the oculomotor (III) cranial nerve and are useful in determining whether the
brain stem is intact. Pupil size and equality is determined by balance between parasympathetic and sympathetic
innervation. Response to light reflects combined function of the optic (II) and oculomotor (III) cranial nerves.

 Positioned with head slightly elevated and in neutral position.

Rationale: Reduces arterial pressure by promoting venous drainage and may improve cerebral perfusion

 Arterial blood gases and pulse oximetry are monitored

Rationale: To ensure that systemic oxygenation remains optimal
Nursing Intervention
Dependent
 Administered supplemental oxygen as indicated.
Rationale: Reduces hypoxemia. Hypoxemia can cause cerebral vasodilation and increase pressure or edema formation

 Assisted with attachment of ventilatory support as indicated.

Rationale: Maintaining optimal oxygenation to preserve cerebral function.

 Established effective suctioning procedures as indicated.

Rationale: Secretions that are obstructing the airway must be suctioned with care, because transient elevations of ICP
occur with suctioning

Collaborative
 Prepared for surgery, as appropriate: craniotomy.
Rationale: To relieve elevated ICP, control hemorrhage or evacuate a blood clot.

 Attachment of an ICP monitor

Rationale: To identify increased pressure early in its course (before cerebral damage occurs)
Evaluation
 Within the 8-hour shift, goals were met. Patient had improvement of cerebral perfusion and
improvement in the intracranial pressure which is evidenced by stable vital signs and having
normal readings on the ICP monitor.
 Within 3 days of nursing intervention, patient displayed improved status.
Subjective data
 Alteration in the level of consciousness

Objective data
 Heart rate: 50 bpm
 Temperature: 100° F

Nursing diagnosis
 Risk for injury related to altered level of consciousness Secondary to traumatic brain injury

Goals of intervention
Short term
 Within the 8-hour shift, patient will remain free from Injury.

Long term
 Within the 5 days of nursing intervention, patient or Significant others will modify environment as
indicated to Enhance safety.
Nursing interventions
Independent
 Assessed risk factors for injury – lack of side rails, invasive lines equipment
Rationale: To help obtain data for plan of care.

 Keep side rails up and in lowest position whenever the client Is not receiving direct care.
Rationale: It helps to prevent fall and injury.

 Gave adequate support to the limbs and head when moving or turning the patient.
Rationale: Limbs without tone may dislocate if They are allowed to fall unsupported.

 Turned the client toward the nurse.

Rationale: To prevent falls.

 Keep bed and bedding free of moisture, dust, and debris.

Rationale: It Prevents skin excoriation.

 Using padded side rails or wrapping the patient’s hands in Mitts

Rationale: To protect the patient from self-injury and dislodging of Tubes.
Nursing interventions
Dependent
 Administered antiseizure drugs as prescribed.
Rationale: For Prophylactic treatment of seizures during early post-injury Phase.

 Administered benzodiazepines as prescribed

Rationale: For agitation.

Collaborative
 Refer to physical or occupational therapist, as appropriate.
Rationale: To identify high risk tasks, conduct site visits; select, create, and modify equipment or assistive devices.

 Encourage participation in self-help programs, such as assertiveness training, positive self-

image.
Rationale: To enhance self-esteem and sense of self-worth.
Evaluation
 Within the 8-hour shift, goal was met as evidenced by patient is free from any injury.
 Within 5 days of nursing intervention, goal was met. Environment was modified as indicated to
enhance safety.
Source: American Academy of Pediatrics
Date Published: November 2, 2018
Source: https://www.sciencedaily.com/releases/2018/11/181102083501.htm

“Traumatic brain injuries can lead to long-term neurological And psychiatric disorders”

Traumatic brain injury is a leading cause of morbidity and mortality in children, and rates
of injury have increased over the past decade. According to a study being presented at the
2018 American Academy of Pediatrics National Conference & Exhibition, these injuries have long-
term consequences; researchers found children who experience traumatic brain injury are at
higher risk of developing headache, depression, and mental or intellectual disorders up to five
years after the event.
 As I read the article that I chose I learned that any head injury depending on its severity
can be life-threatening and thus needs immediate care. I realized that a child who experienced
a traumatic brain injury could possibly have long-term neurological and psychiatric disorders
which can greatly affect the overall growth and well-being of that child.

As I read further I learned that with the incidence of concussion and traumatic brain injury
rising in this nation’s children, it is vital that we continue to evaluate mechanisms for prevention
and treatment. With cases like TBI, prevention is better than cure and it is one of our primary roles
as nurses to be educators thus providing our patients health teaching and prevention measures
against any head injury
MEDICATION
 Informed the client about some common side effects of the medication such as drowsiness,
fatigue, lethargy, and constipation.
 Emphasized the importance of adherence to the drug as prescribed.
EXERCISE
 Instructed to avoid strenuous activities. No lifting or straining.
 Encouraged not to drive or operate machinery.
TREATMENT
 Encouraged to continue with the rehabilitation program at home or with a support group.
 Patient should not be left alone. Have a relative or friend stay with the patient for some
time.
 Instructed the family to aid in the coping of functional changes of the patient.
 Highly recommended to join a support group as well also for the family.
HEALH TEACHING
 Limit activities and give more time for relaxation and have adequate rest.
 Encouraged to return to usual activities gradually.
 Keep distractions and noise down. If possible, maintain a quiet environment.
 Improvement takes place at their own pace. Some skills, such as movement or speech, may
go back and forth between getting better and then worse but there is improvement.
OPD CONSULTATION
 Instructed to have follow up visitation to the physician.
 Prompt consultation should be made when there is pain that is becoming worse, fever or
any other complications that the patient is experiencing.
DIET
 Protein-rich, low-sugar fruits, vegetables and whole grain type of foods can be beneficial for
the patient.
 Adequate hydration is encouraged.
 ASSESSMENT OF THE RESPIRATORY SYSTEM

There is a reciprocal relationship between lung function and brain function: the brain
needs sufficient oxygen supply in order to operate, and the respiratory system needs instructions
from the brain in order to function. In cases of Traumatic Brain Injury, respiratory dysfunction is the
most common medical complication which occurs, up to one-third of patients with severe
traumatic brain injury develop Acute Respiratory Distress Syndrome (ARDS). Frequent respiratory
assessment is made in patients with traumatic brain injury to make sure that an established and
patent airway is available which is a critical part in the patient’s overall improvement of the
condition. Respiratory irregularities could also indicate an increased intracranial pressure and can
also lead for further intervention which is possibly respiratory support.
 This case analysis entitled Traumatic Brain Injury (TBI) brought new body of knowledge that
is surely beneficial in my part as a student nurse. It provided me more in-depth understanding of
the disease process and how it can affect a person’s daily routine. Upon making this requirement
for our 3rd rotation, it is a bit challenging because this topic is new to me. Knowing more
thorough concept of traumatic brain injury, it aided me in how to manage emergency cases like
this and to manage further complications brought about by the injury. I learned how to manage
this kind of condition when symptoms occur and through the knowledge imparted on me I can
now provide the appropriate care I could possibly render to my patient and be competent
enough to address their needs in regards with complex life-threatening injury.
BOOK
 Karch, A. M. (2017). Focus on Nursing Pharmacology (Seventh Edition.). Wolters Kluwer.
 Hinkle, J., & Cheever, K. (2018). Chapter 68 Management of patients with Neurologic trauma. In
Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (14th ed., Vol. 2, pp. 2033-2048).
 Smeltzer, S. C., & Bare, B. G. (1992). Brunner&Suddarth’s Textbook of Medical-Surgical Nursing (7th ed).
Philadelphia, United States of America: Lippincot Company
 Quiambao-Udan, J. (2011). Theoretical Foundations of Nursing. (First ed.,Pp169-183)
 Vanputte, C., Regan, J., & Russo,A. Seeley’s Essentials of Anatomy & Physiology (Ninth Edition).
McGraw-Hill Education International Edition
 Klower, Wolters. Nursing 2020 Drug Handbook. Vol. 1, pg.67-71, 2020
WEBSITE
 Https://www.Drugs.Com/cg/head-injury-discharge-care.Html
 Https://www.Sciencedaily.Com/releases/2018/11/181102083501.Htm