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

 Pick a condition from this chapter. and create a

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

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