Traumatic Brain

Injury
CASE STUDY
GROUP C
BSN-2A
GENERAL OBJECTIVE
At the end of the study, the student nurse will be able to
obtain knowledge about the TBI Traumatic Brain Injury which
also known as head injury. This course aims to provide a basic
theoretical understanding of the management of traumatic
brain injury in order to equipped physiotherapists with
sufficient knowledge to manage a person following a
traumatic brain injury. This includes assessing impairments,
activity limitations and participation restrictions, setting
appropriate goals of treatment, formulating an evidence-based
treatment plan, implementing treatment and evaluating its
SPECIFIC OBJECTIVES
At the end of effective reading and comprehension of the study, the student nurse
will be able to:
 Discuss the current burden of traumatic brain injury
 Understand the risk factors and complex causes for traumatic brain injury
 Understand and recognize the various clinical presentations of traumatic brain
injury
 Select appropriate assessment techniques and outcomes measures for traumatic
brain injury
 Evaluate the information gathered from the assessment of an individual with a
traumatic brain injury in order to formulate a treatment plan
 Demonstrate clinical reasoning when presented with impairments related to
traumatic brain injury
 Demonstrate an understanding of the range of therapeutic interventions for the
management of traumatic brain injury
 Critically analyze the literature related to traumatic brain injury assessment,
OVERVIEW
Traumatic brain injury (TBI) is sudden damage to the
brain caused by a blow or jolt to the head. Common causes
include car or motorcycle crashes, falls, sports injuries,
and assaults. Injuries can range from mild concussions to
severe permanent brain damage. While treatment for mild
TBI may include rest and medication, severe TBI may require
intensive care and life-saving surgery. Those who survive a
brain injury can face lasting effects in their physical and
mental abilities as well as emotions and personality. Most
people who suffer moderate to severe TBI will need
rehabilitation to recover and relearn skills.
Introduction of Modifiable &
Non-modifiabl Etiology of the Patient’s Pro
the case disease file
e

Background of
the case General Signs Incidence Demographic
& symptoms
Definition of
the case
Chief Complai Past & Present
History of Illne Laboratory Exa Nursing Care
nt ms Plan
ss

Anatomy and P
hysiology
Physical Exami Drug Study Discharge Planni
nation ng
Pathophysiology
 Traumatic Brain Injury (TBI) is defined as a non-
progressive injury to the brain, which occurred as a result of
trauma. It occurs when an external force impacts the brain and is
most often caused by a blow, bump, jolt or penetrating wound to
the head. It has been estimated that traumatic brain injury affects
over 54 to 60 million people annually leading to either
hospitalization or mortality with low and medium-income
countries experiencing nearly three times more cases of
traumatic brain injury than high income countries. It is a leading
cause of death and disability worldwide, with enormous
economic consequences.
 The presentation depends on the areas of the brain which have been
damaged. Signs and symptoms may include loss of consciousness
and issues with motor, cognitive, speech and language, vision and
hearing function plus emotional and social issues. It is a complex
pathology with many different clinical presentations and functional
impairments, and best practice requires skills in assessment, treatment
and rehabilitation. It is also associated with a risk of developing
secondary conditions that can be debilitating and even life-threatening
including deep vein thrombosis, urinary tract infections, osteoporosis,
pressure ulcers, chronic pain, and respiratory complications. Acute
care, rehabilitation services and ongoing health maintenance are
essential for prevention and management of these conditions.
 This course will provide an overview of physiotherapy
practice relating to traumatic brain injury to develop a
foundation of knowledge that will enable you to assess and
treat individuals with acute and chronic impairment as a
result of traumatic brain injury. The course will give you an
understanding of the anatomy, structure, clinical
presentation, assessment and management of traumatic brain
injury based on the latest evidence available. Traumatic brain
injury is a large topic area, and can be studied as an area of
clinical specialism within physiotherapy, therefore this
course is by no means exhaustive. Back
Back
Background of the
Case
 Traumatic brain injury (TBI) continues to be an
enormous public health problem, even with modern
medicine in the 21st century. Most patients with TBI (75-
80%) have mild head injuries; the remaining injuries are
divided equally between moderate and severe categories.
The cost to society of TBI is staggering, from both an
economic and an emotional standpoint. Almost 100% of
persons with severe head injury and as many as two thirds of
those with moderate head injury will be permanently
disabled in some fashion and will not return to their
premorbid level of function.
 BACKGROUND AND EPIDEMIOLOGY OF TRAUMATIC
BRAIN INJURY
Traumatic brain injury (TBI) constitutes a major health and
socioeconomic problem throughout the world. Globally, TBI is a
leading cause of death and disability in children and young
adults. More than 1.9 million people are estimated to sustain TBI
each year in the USA, of whom 50,000 will die as a result of their
injuries. Although most TBI is classed as mild, more than 2% of the
US population are thought to have a disability caused by a TBI.
However, TBI is often described as a `silent epidemic, since
awareness among the public and even clinicians remain low, and no
new treatment for TBI has been approved in the past 30 years. Back
Definition of the
Case
 Traumatic brain injury (TBI) is a non-
degenerative, non-congenitally insult to the
brain from an external mechanical force,
possibly leading to permanent or temporary
impairment of cognitive, physical, and
psychosocial functions, with an associated
diminished or altered state of consciousness.
 Traumatic brain injury (TBI), a form of acquired
brain injury, occurs when a sudden trauma causes
damage to the brain. TBI can result when the head
suddenly and violently hits an object or when an object
pierces the skull and enters brain tissue. The definition
of TBI has not been consistent and tends to vary
according to specialties and circumstances. Often, the
term brain injury is used synonymously with head
injury, which may not be associated with neurologic
Back
 Modifiable
and
Non- Modifiable
 Traumatic Brain Injury
MODIFIABLE NON-MODIFIABLE
 Young people  Physiological response
 Psychological response
 Low-income individuals  Physical and mental comorbidity
 Member of ethnic minority SOCIAL FACTORS
groups  Roles and Responsibilities
 Privileged and oppression
 Residents of the inner cities  Social and cultural expectation
 Men  Attitudes, traits, style and expression
 Prior history of substance OUTCOMES
 Clinical presentation, Treatment and
abuse response
 Unmarried individual  Functioning with family and society
Back  Quality of life awareness and self-regulation
o Physiological response
- Refers to body’s automatic reaction to stimulus known as
“Fight or flight”.
o Psychological response
- Refers to reaction include Changes in behavior, Physical well
being, Psychological health, thinking patterns, Spiritual
beliefs and Social interaction.
o Physical & Medical Comorbidity
- Defined as the occurrence of mental & physical disorder
within the same person, regardless of the chronological order
which they occurred or the causal pathway linking them.
Back
General Signs and
Symptoms
Signs and Symptoms
Traumatic brain injury can have wide-ranging
physical, cognitive, psychological and
physiological effects occurring immediately or
after a period of time has elapsed. The symptoms
might differ depending on the severity of the
traumatic brain injury, but some are not specific to
the type of injury.
 Symptoms of Mild Traumatic Brain Injury
Physical Symptoms Sensory Symptoms Cognitive Symptoms
With or without loss of consciousness. If loss of consciousness: a few seconds to a few
minutes
Headache Blurred Vision State of being dazed, confused
or disoriented
Nausea or Vomiting Ringing in the Ears Memory or concentration
deficits
Fatigue or Drowsiness Bad taste in the mouth or Mood changes or mood swings
changes in the ability to smell
Problems with speech Sensitivity to light or sound Irritability

Difficulty sleeping or Feeling depressed or anxious

sleeping more than usually
Dizziness or loss of balance Fatigability
 Symptoms of Moderate to Severe Traumatic Brain Injury
Physical Symptoms Sensory Symptoms Cognitive Symptoms
Loss of consciousness from several minutes to hours or days
Persistent headache or headache that Blurred vision Coma and other disorders of
worsens consciousness
Repeated vomiting or nausea Double vision Profound confusion
Convulsions or seizures Ringing in the ears Irritability
Dilation of one or both pupils of the eyes Bad taste in the mouth or changes Agitation, combativeness or
in the ability to smell other unusual behavior
Clear fluid or blood draining from the nose Sensitivity to light or sound Sad or depressed mood
or ears
Sudden swelling or bruises behind the ears Fatigability
or around eyes
Inability to awaken from sleep
Weakness or numbness
Loss of coordination or balance
Back
Etiology
 Traumatic brain injury is usually caused by a blow or other traumatic
injury to the head or body. The degree of damage can depend on several
factors, including the nature of the injury and the force of impact.
Common events causing traumatic brain injury include the following:
1. Falls- from bed or ladder, down stairs, in the bath, tree
2. Vehicle-related collisions- collisions involving cars, motorcycle or bicycles
and pedestrians involved in such accidents
3. Violence- gunshot wounds, domestic violence, child abuse and other
assaults. Shaken baby syndrome is a traumatic brain injury in infants caused
by violent shaking.
4. Sport Injuries- injuries from a number of sports, including soccer, boxing,
football, baseball, lacrosse, skateboarding, hockey and other high-impact or
extreme sports. Back
Incidence
 DOD Number for Traumatic Brain Injury worldwide – total

 Sixty-nine million individuals worldwide are estimated to sustain a TBI each

year. The proportion of TBIs resulting from road traffic collisions was greatest in
Africa and South Asia (both 56%) and lowest in North America (25%).
Back
Patient’s
Profile
Patient Name: MJM
Age: 5-year –old
Gender: Female
Date of Birth: March 12, 2016
Religion: Roman Catholic
Diagnosis: BFC TBI, Covid-19 suspect
Attending Physician: Dr. Elsa Cruz Dufourt
Back
Demographi
c
 In this table the median age of the patients was 67.0 years (IQR 50.0–77.0 years). The ratio
of men to women was 1.96. There was a unimodal age distribution, with a peak in those aged
70–79 years, which was also the peak incidence of falls (Figures 1 and 2). The TBI admissions
were mostly mild in severity 82.5%.
Who is at risk for traumatic brain injury
(TBI)?
Certain groups are at higher risk of TBI:
 Men are more likely to get a TBI than women.
They are also more likely to have serious TBI.
 Adults aged 65 and older are at the greatest
risk for being hospitalized and dying from a
Back
TBI
Chief Complaint
CHIEF COMPLAINT
Seizure upon admission
 
DIAGNOSIS
Benign Febrile Convulsion, Traumatic
Brain Injury, Covid 19 suspect
Back
Physical Examination
HEENT
 Initial physical exam upon admission reveals dyspnea, fever at 37°C,
episode of seizure, heart rate 155, respiratory rate 27bpm and oxygen
saturation 96% on room air, watched out for decreased sensorium, awake and
alert.
HEENT
 Head Essentially normal
 Eyes Essentially normal
 Ears Essentially normal
 Nose Essentially normal
 Neck Essentially normal
 Throat Essentially normal
 Cardiovascular exam Essentially normal
 Neuro exam Essentially normal
 GU Essentially normal
 Chest + lungs Essentially normal
• Watch out for decreased
sensorium

Diet: Soft diet then diet as

tolerated (DAT) when patient is
stable Back
Past and Present History
of the Illness
HISTORY OF PAST ILLNESS
According to the child's mother, her child did not have
any serious illness before, apart from the fever and cough
that are natural to the children, even if she got sick, the child
take the medicine that is given to the center and its done.
 
HISTORY OF PRESENT ILLNES
According to the mother of the patient 1 day prior to
admission her daughter falls from a tree, no LOC, no
vomiting and the mother stated that her daughter is coherent
in 3 spheres.
Few Hours Prior to Admission:

(+) Undocumented fever (+) seizure

episode, 6TC) A) ̴ 10 seconds , No level of
consciousness (No LOC) (+) shortness of
breath (SOB)
Back
Anatomy and Physiology
- (front of brain) is composed of the right and left
hemispheres.
Functions:
 initiation of movement
 coordination of movement
 temperature, touch, vision, hearing, speech and
language
 Judgment
 Reasoning
 problem solving emotions and learning.
- (back of brain) is located at the back
- (middle of brain) includes the midbrain, the pons, and the
medulla. of the head.
Functions: Functions:
 movement of the eyes and mouth
 relaying sensory messages (such as, hot, pain, or loud)  to coordinate voluntary muscle
 Hunger, Respirations
 consciousness, cardiac function, body temperature, movements
involuntary muscle movements, sneezing, coughing,  to maintain posture, balance, and
vomiting, and swallowing.
equilibrium.
 The middle part of the brain, the parietal lobe helps a person to identify  The largest section of the
objects and understand spatial relationships (where one's body is brain located in the front
compared to objects around the person). The parietal lobe is also involved of the head, the frontal
in interpreting pain and touch in the body. lobe is involved in
judgment, decision-
making, some language
functions, personality
 The occipital lobe is the characteristics, and
back part of the brain that
movement.
is involved with vision.
• The sides of the brain, these
temporal lobes are involved in
memory, speech, and sense of
smell.

 A large bundle of nerve fibers located in the back that extends from the base of the brain to the lower back, the
spinal cord carries messages to and from the brain and the rest of the body.

 A deep part of the brain, located in the brainstem,  The lowest part of the brainstem, the medulla is the most
the pons contains many of the control areas for vital part of the entire brain and contains important control
eye and face movements. centers for the heart and lungs. Back
 PATHOPHYSIOLOGY OF TRAUMATIC BRAIN
INJURY
Brain suffers traumatic
Laboratory exam injury
results Primary injury & Secondary Injury

Brain swelling or bleeding increase intracranial volume.

History of Present
Illness: Rigid cranium allows no room for expansion of
contents so intracranial pressure increases
No level of
consciousness Pressure on blood vessels within the brain causes blood flow to the
brain to show
No vomiting
Cerebral hypoxia and ischemia occur
Coherent
Risk Factor: Intracranial pressure continues to rise
Fall from Tree
SEIZURE
 Research suggests that not all brain damage occurs at the
moment of impact. Damage to the brain from traumatic injury takes
two forms:
PRIMARY INJURY and SECONDARY INJURY. Primary
injury is the initial damage to the brain that results from the
traumatic event. This may include contusions, lacerations, and torn
blood vessels from impact, acceleration/deceleration, or foreign
object penetration. Secondary injury evolves over the ensuing
hours and days after the initial injury and is due primarily to brain
swelling or ongoing bleeding. An injured brain is different from
other injured body areas due to its unique characteristics
 It resides within the skull, which is a rigid closed compartment.
Unlike an injured ankle, in which the covering skin expands with
swelling, the confines of the skull do not allow for the expansion of
cranial contents. Thus, any bleeding or swelling within the skull
increases the volume of contents within a container of fixed size and
so can cause increased intracranial pressure (ICP). If the
increased pressure is high enough, it can cause a downward or
lateral displacement of the brain through or against the rigid
structures of the skull. This causes restriction of blood flow to the
brain, decreasing oxygen delivery and waste removal. Cells within
the brain become anoxic and cannot metabolize properly, producing
ischemia, infarction, irreversible brain damage, and eventually brain
death  Back
Laboratory Exams
X-RAY for leg and right shoulder - Skull and cervical spine X-ray
identify fracture and displacement.
X-RAY of right ankle APL bilateral
hips AP

Plain Cranial CT scan with bone - CT identifies and localizes lesions,

window cerebral edema, and bleeding.

Plain Cranial CT scan with contrast

For blood culture and sensitivity - Complete blood count, coagulation

profile, electrolyte levels, serum
osmolarity, arterial blood gases, and
other laboratory tests monitor for
complications.
 X-RAY for leg and right shoulder
X-RAY of right ankle APL bilateral hips AP
 Plain Cranial CT scan with bone
window
Plain Cranial CT scan with contrast
For blood culture and sensitivity
Back
Drug Study
 DRUG NAME CLASSIFICATION INDICATION MECHANISIM OF SIDE EFFECT DOSAGE AND
ACTION FREWUENCY

CEFUROXIME ANTIBACTERIAL Infections Cephalosporins Nausea, vomiting, 300 mg

exert bactericidal diarrhea, strange IVP q8
activity by taste in the mouth,
interfering with or stomach pain
bacterial cell wall may occur.
synthesis and Dizziness and
inhibiting cross- drowsiness may
linking of the occur less
peptidoglycan. The frequently,
cephalosporins are especially with
also thought to play higher doses.
a role in the
activation of
bacterial cell
autolysins which
may contribute to
bacterial cell lysis
PHENYTOIN ANTICONVULSANTS Generalized often described as a headaches. 30 mg
tonic-clonic non-specific sodium feeling drowsy, SIVP q12
(grand mal) and channel blocker and sleepy or dizzy.
complex partial targets almost all feeling nervous,
(psychomotor, voltage-gated unsteady or shaky.
temporal lobe) sodium channel feeling or being sick
seizures subtypes. More (nausea or vomiting)
specifically, constipation.
phenytoin prevents sore or swollen gums.
seizures by mild skin rash.
inhibiting the
positive feedback
loop that results in
neuronal
propagation of high
frequency action
potentials
DIAZEPAM ANTIDEPRESSANT management of a benzodiazepine most commonly 4mg
(BENZODIAZEPINES) anxiety that exerts reported were IV PRN
disorders or for anxiolytic, sedative, drowsiness, fatigue,
the short-term muscle relaxant, muscle weakness, and
relief of the anticonvulsant and ataxia
symptoms of amnestic effects.
anxiety. In Most of these
acute alcohol effects are thought
withdrawal, to result from a
Valium may be facilitation of the
useful in the action of gamma
symptomatic aminobutyric acid
relief of acute (GABA), an
agitation, inhibitory
tremor, neurotransmitter in
impending or the central nervous
acute delirium system
tremens and
hallucinosis.
PARACETAMOL ANALGESIC, Treats mild to has a central drowsiness and 250/50
ANTIPYRETIC moderate pain analgesic effect that fatigue 2.5 ml
reduce fever is mediated through rashes and itching. Q6 RTC
activation of Children may
descending occasionally
serotonergic experience low blood
pathways. Debate sugar and tremors,
exists about its and feeling hungry,
primary site of faint and confused
action, which may after taking
be inhibition of paracetamol
prostaglandin (PG)
synthesis or through
an active metabolite
influencing
cannabinoid
receptors.
METRONIDAZOLE ANTIBACTERIAL Treatment Metronidazole headache 68 mg
of anaerobic diffuses into the loss of appetite Iv q6
bacterial organism, vomiting
infections, inhibits protein diarrhea
protozoal synthesis by heartburn
infections, interacting with cramps in your
and DNA and abdomen
microaeroph causing a loss of constipation
ilic bacterial helical DNA metallic taste in
infections structure and your mouth
strand breakage. yeast infection
Therefore, it vaginal discharge
causes cell death
in susceptible
organisms
CEFTRIAXONE ANTIBACTERIAL Susceptible works by inhibiting rash, diarrhea, 50 mg
bacterial the mucopeptide nausea, vomiting, TIV
infections of the synthesis in the upset stomach, blood q12
lower respiratory bacterial cell wall. clots, dizziness,
tract, skin and The beta-lactam headache, pain or
skin structure, moiety of ceftriaxone swelling in your
bone and joint, binds to tongue, a lump where
acute otitis media, carboxypeptidases, the medicine was
UTIs, septicemia, endopeptidases, and injected, sweating,
pelvic trans peptidases in vaginal itching or
inflammatory the bacterial discharge,
disease (PID), cytoplasmic vaginal yeast
intra abdominal membrane. These infection, anemia,
infections, enzymes are changes in taste, or
meningitis, involved in cell-wall flushing
uncomplicated synthesis and cell
gonorrhea. division.
OMEPRAZOLE PROTON- Gastric ulcers It inhibits the Headache, 10 mg
PUMP in adults, and parietal cell H+ / abdominal pain, IV OD
INHIBITORS
gastroesophage K+ ATP pump, Diarrhea, nausea,
al reflux the final step of vomiting, gas
disease in acid production. (flatulence),
adults and In turn, dizziness, upper
pediatric omeprazole respiratory infection,
populations. suppresses acid reflux,
Studies have gastric basal and constipation, rash,
shown the stimulated acid cough
efficacy of secretion
omeprazole for
short term
treatment in
erosive
esophagiti
MANNITOL DIURETICS Mannitol has approval an osmotic diuretic 22.5 cc q6 with
for the reduction of that is metabolically BP
intracranial pressure inert in humans and precaution, hold
if <90/60
and brain mass. occurs naturally, as a
Mannitol is approved to sugar or sugar Change
reduce intraocular alcohol, in fruits and Mannitol 22.5
pressure if this is not vegetables. Mannitol to 45cc IV
achievable by other elevates blood q4 still with BP
means. plasma osmolality, Precaution
Mannitol can promote resulting in enhanced
diuresis for acute renal flow of water from
failure to prevent or tissues, including the
treat the oliguric phase brain and
before irreversible cerebrospinal fluid,
damage. into interstitial fluid
and plasm
Nursing Care Plan
 ent Diagnosis Planning Intervention Rationale Evalu
Ineffective After 2 hours of • Establish rapport • To gain the client and After 2
syon nursing SO’s trust nursing
Breathing • Assess and record • It is important to take
ko at intervention the interventi
p din
Pattern patient will
respiratory rate and action when there is an
patient
depth alteration in the pattern
minga,” related to maintain an of breathing to detect an
ed by seizure effective early signs of breathing
episode as breathing respiratory compromise. as evide
• Assess ABG • This monitors
evidenced by pattern. Patient’s (Arterial blood gas) oxygenation and
relaxed
harsh respiratory respiratory rate levels, according to ventilation status. at normal
und will return to facility policy. depth and
normal
rate of 27 normal • Observe for • Unusual breathing of
bpm parameters breathing patterns. patterns may imply an Patient’s
underlying disease
process or dysfunction.
respirator
ting • Auscultate breath • This is to detect returns to
nasal sounds at least decreased or parameter
every 4 hours. adventitious breath RR 20 b
sounds. patient m
• Assess for use of • Work of breathing
m accessory muscle. increases greatly as lung
through
of
en Diagnosis Planning Intervention Rationale E

• Monitor for • Paradoxical movement of

diaphragmatic muscle the abdomen (an inward
fatigue or weakness versus outward
(paradoxical motion). movement during
inspiration) is indicative
of respiratory muscle
fatigue and weakness.
• Observe for retractions • These signs signify an
or flaring of nostrils. increase in respiratory
effort.
• Assess the position • Orthopnea is associated
that the patient with breathing difficulty.
assumes for breathing.
• Utilize pulse oximetry • Pulse oximetry is a
to check oxygen helpful tool to detect
saturation and pulse alterations in oxygenation
rate.
ent Diagnosis Planning Intervention Rationale E

• Note for changes in level • Restlessness, confusion,

of consciousness. and/or irritability can be
early indicators of
insufficient oxygen to the
• Evaluate skin color, brain.
temperature, capillary • Lack of oxygen will cause
refill; observe central blue/cyanosis coloring to the
versus peripheral cyanosis. lips, tongue, and fingers.
Cyanosis to the inside of the
mouth is a medical
• Place patient with proper emergency!
body alignment for • A sitting position permits
maximum breathing maximum lung excursion
pattern. and chest expansion.
• Encourage sustained deep
breaths by: • These techniques promotes
 Using demonstration deep inspiration, which
highlighting slow increases oxygenation and
inhalation, holding end prevents atelectasis.
ent Diagnosis Planning Intervention Rationale E

• Provide respiratory • Beta-adrenergic

medications and agonist medications
oxygen, per doctor’s relax airway smooth
orders. muscles and cause
bronchodilation to
open air passages.
• Suction secretions, as • This is to clear
necessary. blockage in airway.
• Educate patient’s • This information
mother about promotes safe and
medications: effective medication
indications, dosage, administration.
frequency, and
possible side effects.
Incorporate review of
 ment Diagnosis Planning Intervention Rationale Ev
: Risk for After 4 hours • Establish rapport • To gain the client and Aft
syon ang Injury related of nursing SO’s trust of
nawalan to altered intervention • Assess and record • Documentation of inte
g malay,” level of the Child will seizure activity and information is essential the
ed by the consciousnes minimize the location. Note the for the prevention of min
other. s resulting risk for injury duration of seizures, injury or complications risk
data: from seizure when a parts of the body as a result of a seizure. dur
mace episode seizure involved, site of   afte
behavior occurs. onset and occ
ss progression of
y seizure. • Once seizures are
in • Assess skin for prolonged and
pallor, flushed, or respiration is
taken as cyanosis; Monitor compromised, this will
respiratory rate, provide information on
m depth, and signs of possible signs of
m respiratory distress.  aspiration of secretions. 
C • Side-lying facilitates
• Maintain side-lying drainage of secretions
ent Diagnosis Planning Intervention Rationale E

• Avoid restraining the • Restraining a child

child or putting can result in trauma
anything in his/her due to the amount of
mouth; provide force exerted;
gentle support to inserting object in
head and arms if mouth increases
harm might result. stimuli; Padding the
area helps to protect
the head from injury.
• Stay with the child • Provides support and
during the phase of prevents any injury
seizures, reorient to child.
when awake, and
allow to rest or sleep
after an episode.
ent Diagnosis Planning Intervention Rationale E

• Teach about • Provides physician

information to with important
record about information needed
seizure activity to prescribe
should it occur medical regimen.
(specify).
• Educate the parents • Guarantees safe
regarding and effective
precautionary interventions to
measures during a avoid the incidence
seizure. of injury.
• Administer
medication as
ment Diagnosis Planning Intervention Rationale Eval
Decreased After 4 hours • Establish rapport • To gain the client and After 4
Intracranial of nursing SO’s trust nursing
daw adaptive interventions • Monitor the patient’s • Subtle changes such as interven
o ng capacity the patient neurological status, irritability, increased patient
ko, related to will be able meaning the LOC, confusion, and improve
yon increased to improved pupils, and Glasgow restlessness can tissue p
siya intracranial cerebral coma scale scores indicate a deterioration evidenc
as pressure as tissue continuously. in status. A change in stable
by evidenced by perfusion and LOC may be a sign of LOC
atient seizure decreased an increased ICP
episode ICP. (intracranial pressure).
• Monitor vital signs • Changes in vital signs
continuously or at may be a sign of
least every hour increased pressure in
mace the brain. An increased
ICP causes
bradycardia, a
ss widening pulse
pressure, and irregular
ent Diagnosis Planning Intervention Rationale E

• Assess for fluid leakage • Leakage from the nose

from the ears and nose. (rhinorrhea) and ears
(otorrhea) might be
m cerebrospinal fluid (CSF)
m after head trauma caused
C by fractures. Because
there is no accumulation
of fluid in the brain, there
might be no signs of ICP.
• Keep Po2 between 80 and •  The goal is to prevent
100 mmHg and Pco2 prolonged states of
between 35 and 38 hypoxemia (decreased
mmHg blood level of oxygen)
and hypercarbia
(increased amount of
carbon dioxide in arterial
blood). Hypercarbia can
ent Diagnosis Planning Intervention Rationale E

• Avoid any • Position changes (keep head

activities and straight), Endotracheal
symptoms that suctioning, Coughing,
increase ICP. vomiting, Bending at the waist,
Valsalva maneuvers, Pain,
Fever, Shivering (These factors
can increase cerebrospinal fluid
and, therefore, intracranial
pressure. Elevation of the head
of the bed and maintaining a
neutral alignment help reduce
venous pressure and thus
decrease ICP. Limiting
suctioning and hyper
oxygenation before suctioning
helps keep ICP at bay. Treating
pain, fever and shivering helps
ent Diagnosis Planning Intervention Rationale E

Administer • Medications such as Mannitol are

medication as used to draw fluid from interstitial
ordered to decrease spaces into the intravascular space
ICP. reducing cerebral edema. Steroids
help reduce brain swelling.
Phenytoin are used to control
certain type of seizure, to treat and
prevent seizure. Antipyretics lower
body temperature, which lowers
metabolism, which lowers cerebral
blood flow – decreasing ICP.
Muscle relaxants prevent
shivering. Seizures might increase
metabolic demands and cerebral
blood flow, increasing ICP.
Anticonvulsants are administered
to avoid seizure activity.
Discharge Planning
PATIENT NAME: MJM
AGE: 5-year-old
GENDER: Female
DATE OF BIRTH: March 12, 2016
RELIGION: Roman Catholic
DIAGNOSIS: BFC TBI, covid 19 suspect
ATTENDING PHYSICIAN: Dr. Elsa Cruz Dufourt
 
TREATMENT
 Comply with medication
 Be able to tolerate 2-3 hours of therapy daily of 2-3 therapies such
as physical therapy and speech therapy
 Instruct SO to assist and supervised their child 24 hours a day
REHABILATATION PROGRAM
 To increase independence as much as possible
 Return to meaningful life
 Short term goals (daily or weekly)
 Long term goals (discharge home)
 Relearn skills
 Learn new ways to do things
 Increase mental and physical endurance/stamina
 Reduced therapies on weekends for rest and family time
HEALTH TEACHING
(/) Clinic appointment
(/) rehab therapy appointment
(/) understanding and knowing what to do with side effects of
medications
Seizure
Fluid buildup in the brain
Infections
Headaches
Vertigo
PRACTICE HOME HEALTHY HABITS
 Keep the atmosphere quiet and calm
 Adequate rets and get as much sleep as possible
 Activities to avoid such as (jumping, running, and bending down quickly)
 Eat foods that can help for brain injury recovery such as: dark chocolate,
fatty fish, dark, green leafy vegetables, walnuts or pumpkin seeds, berries,
eggs, avocado and meat
 Avoid strenuous mental activities like reading, playing video games,
watching television.
 Personal hygiene with the help of SO
DIET
a. Prescribed Diet
- Diet as Tolerated
- fruits, vegetable, whole grains, beans, nuts, fish and lean meat
- drinks a lot of water
- limit intake of salt and sugar
 
b. Restrictions
- no restrictions
 
Discharge Details
a. Transfer : Transfer to PGH
b. Accompanied : Mother
c. Surgical Intervention : For Neurosurgical
d. General Condition upon Discharge/Transfer : With episode of seizure
THESE DISCHARGE INSTRUCTIONS WERE EXPLAINED TO THE
PATIENT AND/OR RELATIVE
Read and Understood: (translated according to patient’s level of
understanding)
_____________________________________
PATIENT / RELATIVE
(Signature over printed name)
Validated:
_____________________________________
STUDENT NURSE
(Signature over printed name)
_____________________________________
CLINICAL INSTRUCTOR
(Signature over printed name)
Thank You

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