PREDISPOSING FACTORS PRECIPITATING FACTORS

• Gender: Male Forceful blow in the head (i.e.

falls, nonpenetrating blast • Being involved in an accident
• Age:
injury)

Skull acceleration/deceleration

Brain contacts bone

Cellular damage Vacuum on brain rebound Anatomical damage

Mechanical stretching Mechanical shearing of

and disruption of axonal endothelial vessels in small
plasma membranes vessels Disruption of
Skull
reticular Edema
fracture
activating
system
Cellular Cerebral blood Calpain activation Increased
dysregulation flow dysregulation by increased Cell death Vascular Intracranial
intracellular calcium shear Altered level of pressure
consciousness
Deregulated ion Increased
flux with efflux of membrane pump Proteolytic breakdown of Chronic
potassium and activity to restore neurofilament proteins atrophy
influx of calcium ionic balance
 Release of Glucose Axonal shear DIAGNOSTIC TEST
Persistent Intracranial
excitatory amino consumption, • CT Scan
impaired hemorrhage • MRI
acids glycolysis with
lactate cognition
Structural
Binding of accumulation • Nausea
(Cytoskeletal)
glutamate to • Vomiting
disturbance ↑Intracranial
NMDA receptors • Papilledema
Pressure
↓Blood flow,
↑ Glucose
requirement LAB TEST
Neuronal Axonal • Papilledema • CBC MEDICATIONS
depolarization degeneration • Cerebral herniation • Serum & Ondansetron
Electrolyte Metoclopramide
• Urinalysis
Acute widespread • BUN &
Cellular energy
suppression of Impaired neural Creatinine
crisis
neurons communication

MEDICATIONS
• Confusion Furosemide
• Disorientation
• Unsteadiness
• Headache
• Visual Disturbances
• Anxiety
• Depression

MEDICATIONS
Acetaminophen
Ibuprofen
Naproxen Sodium
 If treated: If not treated:

Post – concussion
SURGERY syndrome
• Craniotomy with Open Surgery Seizure
• Endoscopic Ventriculostomy Infection
• Ventriculoperitoneal Shunt Surgery (VPS) Chronic Head Injuries
• Decompressive Craniectomy
• Cranioplasty

DEATH
TREATMENT
• Rehabilitation for vision
• Rehabilitation for balance problems
• Cognitive rehabilitation for problems with
thinking and memory

GOOD PROGNOSIS
 Pathophysiology: Traumatic Brain Injury secondary to motor vehicular accident
Risk factorst Mechanism Signs and Symptoms *_Presented by the patient Complications Treatment Death
LEGEND:
Medication Diagnostic test Lab Results Nursing Diagnosis Nursing Management Good Prognosis Shortcut (- - - -)

PREDISPOSING FACTORS Forceful blow in the head

PRECIPITATING FACTORS
• Gender: Male • Being involved in an accident
• Age: 22 years old
Skull acceleration/deceleration

Brain contacts bone

 Cranial CT
Vacuum on brain rebound – Scan
Plain
Cellular damage Anatomical damage

 CBC w/ BT
 Prothrombin
Axonal stretch due Nonselective, rapid time Brain Activation of
Broken tissue Skull fracture
to biomechanical neurotransmitter  HBs - Ag inhibitory
bone swelling
forces release cholinergic system
fragments
Mannitol of dorsal pontine
Microtubule Increase 150 cc IV Broken bone tegmentum
Cerebral
disruption extracellular q8 fragments ruptures
edema
Potassium and blood vessels Disruption of
Structural Glutamate, reticular activating
(cytoskeletal accumulation of Rupture Increase system
Compress Intracranial
disturbance) intracellular calcium blood intracranial
blood vessels hemorrhage
vessels pressure
Ionic disequilibrium *Altered level of
Axonal degeneration
across neuronal consciousness
membrane Decrease cerebral Cerebral (GCS:10)
*Papilledema
Impaired neural blood flow herniation
communication Energy consumed by
Sodium or
Potassium ATPase Decrease Decrease Dexamethasone
*Nausea  CBC w/ BT
pumps to re- cerebral oxygenated 50 mg IV q8
and  Prothrombin
establish ionic glucose blood to time
Vomiting  Creatinine
homeostasis level brain  Urinalysis
 Increase cerebral Decrease Brain cell Disruption of
glucose metabolism energy death messages Ineffective Cerebral
supply from eye to Tissue Perfusion
brain related to traumatic
Chronic brain brain injury as
Increase energy atrophy evidenced by
demand
*Vision decreased LOC
problems 1. Assess and monitor
Persistent neurological status frequently.
impaired 2. Assess and monitor vital
Cellular energy crisis signs.
cognition
3. Evaluate and monitor pupillary
responses.
Decrease 4. Monitor the patient’s bilateral
motor responses.
participation in 5. Avoid measures that may
 Confusion daily activities trigger increased ICP such as
• Tramadol 50 mg IV q8  Disorientation and work coughing, vomiting, straining at
stool, neck in flexion, head flat,
• Acetaminophen 300  *Unsteadiness or bearing down.
mg IV q4  *Headache  Anxiety 6. Control environmental
 Depression temperature as necessary.
Perform a tepid sponge bath
when fever occurs
7. Reorient to the environment
as needed.
Acute pain related to traumatic brain
injury as evidenced by restlessness

1. Observe for anxiety, irritability, crying,

restlessness, and sleep disturbances.
2. Evaluate vital signs on ongoing basis. Self-care deficit (bathing) related to
3. Instruct in regular use of a 0 to 10 (or similar) traumatic brain injury as evidenced
pain- rating scale. by weakness and poor mobility
4. Provide comfort measures, such as back rubs
and position changes; assist with self- care
activities; and encourage diversional activities, as 1. Determine any factors that hinder the client’s capabilities and
indicated. any limitations for movement.
5. Demonstrate and encourage use of relaxation 2.Assess for the adequacy of social support.
skills, such as deep breathing, visualization.  Cranial CT – TRAUMATIC BRAIN 3. Apply regular routines, and allow adequate time for the client to
6. Collaborate with patient in pain management. INJURY sec to motor complete tasks.
Instruct in early reporting of pain and ongoing Scan Plain
evaluation of effectiveness of current  Chest X – ray vehicular accident 4.Focus on the client’s strengths and optimal level of function.
interventions. 5.Providing a bed bath
6.Provide a mouth care routine including toothbrushing at regular
intervals with a soft-bristle toothbrush and fluoride toothpaste.
 If treated: If not treated:

SURGERY Post – concussion syndrome

• Craniotomy with Open Surgery Seizure
• Endoscopic Ventriculostomy Infection
• Ventriculoperitoneal Shunt Surgery (VPS) Chronic Head Injuries
• Decompressive Craniectomy
• Cranioplasty

DEATH
TREATMENT
• Rehabilitation for vision
• Rehabilitation for balance problems
• Cognitive rehabilitation for problems with
thinking and memory

GOOD PROGNOSIS